Inspection on 10/09/07 for Hambleton Court Residential Home

This inspection was carried out on 10th September 2007.

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

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

Other inspections for this house

Hambleton Court Residential Home 09/12/09

Hambleton Court Residential Home 12/09/06

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

CARE HOMES FOR OLDER PEOPLE Hambleton Court Residential Home Station Road Hambleton Selby North Yorkshire YO8 9HS Lead Inspector Anne Prankitt Unannounced Inspection 10th September 2007 09:30 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 Hambleton Court Residential Home DS0000066900.V346453.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. Hambleton Court Residential Home DS0000066900.V346453.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hambleton Court Residential Home Address Station Road Hambleton Selby North Yorkshire YO8 9HS 01757 228117 F/P 01757 228117 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) Mr Stuart Churm Mrs Sandra Churm Post Vacant Care Home 12 Category(ies) of Old age, not falling within any other category registration, with number (12) of places Hambleton Court Residential Home DS0000066900.V346453.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12/09/06 Brief Description of the Service: Hambleton Court provides personal care and accommodation for up to twelve older people. The home, which is a large detached building, is situated off the main road in the village of Hambleton, next to the village hall and local church. There are parking facilities at the front of the building. The village offers a range of facilities, including shops, pubs and restaurant, and is on the main bus route to the market town of Selby, which is about four miles away. The accommodation is provided on two floors. All bedrooms excepting one provide single accommodation. The first floor is accessed by a chair lift. Before being admitted, prospective service users are given information about the home within the Statement of Purpose. They are also informed about the range of activities available and are given samples of the written menu. The inspection report is available for those who wish to see it. The registered provider confirmed on 10 September 2007 that the current weekly fees range from £360 to £410. Items not included within the fees include hairdressing, toiletries, magazines, papers, transport, chiropody, dentist and optician. Hambleton Court Residential Home DS0000066900.V346453.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the site visit, the registered providers and manager returned a self assessment called an ‘Annual Quality Assurance Assessment’, which provided information about Hambleton Court. Surveys were sent to some people who live at the home (four returned), some relatives (two returned) and some visiting professionals (none returned). A record has also been kept about what has been happening at the home since the last key inspection took place in September 2006. During the visit, time was spent with people who live at the home, and observations made to see how staff interact with them. Time was also spent talking with some staff and relatives. Some documents were also looked at. A general tour of the communal areas was made. Some people’s bedrooms were visited after checking that this would be acceptable. The site visit took approximately eight hours to complete. All of the information gathered was used to form a judgement about the service that Hambleton Court offers to the people who live there. Feedback was provided at the end of the site visit to the registered providers, Mr and Mrs Churm, and to the manager. What the service does well: Staff make sure that people’s needs are assessed properly before they are offered a place at the home. This helps to check that people’s needs can be met with the resources available so that they get the care that they need. People are satisfied that staff know what care they need, and that this is given in a dignified and respectful way. Comments included ‘Staff are kind. They look after me well’, ‘I am happy – I’m given good care’, ‘I don’t want to be anywhere else’. Relatives commented: ‘Excellent levels of personal care’, ‘Very attentive and caring staff. Difficult to put into words the good/excellent support received all the time. Residents are treated with respect, love, care and dignity’. People’s social and spiritual needs are considered, and their visitors are welcomed into the home. This helps to make sure that people are treated as individuals. Hambleton Court Residential Home DS0000066900.V346453.R01.S.doc Version 5.2 Page 6 Staff understand the importance of passing on concerns which may affect the welfare of people who live at the home. This helps to keep them safe and protected from harm. The environment is kept clean, comfortable and pleasant for the people who live there. What has improved since the last inspection? What they could do better: People could be referred to the General Practitioner when possible nutritional risks are identified during the assessment completed by the home, to make sure that no further advice is needed to maintain their dietary needs. Hambleton Court Residential Home DS0000066900.V346453.R01.S.doc Version 5.2 Page 7 People could have a formal assessment completed to determine whether they are at risk of developing pressure sores, so that advice can be sought to stop any problems from happening. Plans to consult with people about their personal wishes upon dying and death should be carried out as soon as practicable so that people know that their last wishes will be recognised and carried out. The audit of the medication could include a check to make sure that the time at which medication needs to be given is recorded. This will help to make sure that people always get their medication at the time prescribed by their General Practitioner in order to help maintain their health. To make sure that people are fully protected, staff who have not received ‘safeguarding adults’ training could be provided with this. This will make sure that they all understand what constitutes abuse, so that they act quickly and consistently if a situation should arise that they need to pass on. The registered providers could consult with the fire authority to make sure that the access arrangements to the rear of the premises whilst building works are underway do not place any restrictions in access to or exit from the building in the case of fire so that people are protected from unnecessary risk. To confirm that the current systems are safe, the registered providers could consult with the environmental health officer to check that the food storage arrangements in the laundry are acceptable to them. They could also check whether they need to provide training for care staff who handle food that is consumed by the people who live there so that they can be assured that they are properly trained to do so in a safe way. To properly protect people from unsuitable workers, the recruitment procedure could be improved, by making sure that the proper checks are carried out before staff are allowed to provide care for people. The remaining gaps in mandatory training could be addressed, so that people can be assured that staff are fully up to date about how to work in a safe way. To keep people safe from the spread of fire, fire doors must not be wedged open. 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. Hambleton Court Residential Home DS0000066900.V346453.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 Hambleton Court Residential Home DS0000066900.V346453.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): 3 and 6 People who use the service experience good quality outcomes in this area. They can be confident that their needs will be assessed before they are admitted, to check that they can be met. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: All of the people living at the home at the time of this site visit were resident at the last site visit, when it was judged that people are assessed before admission so that they can be assured that their needs can be met. The manager confirmed that the policy of the home has not changed. People who are thinking about moving into the home have their needs assessed by staff before any admission takes place. The home also collects other information from care managers or hospitals to check that the home will be able to meet the person’s needs. People are also encouraged to visit the home so that they can see for themselves what it is like. All of this information is considered before deciding whether the home will be able to offer the person a place at the home. Hambleton Court Residential Home DS0000066900.V346453.R01.S.doc Version 5.2 Page 10 The manager explained that when it is decided that the home will be suitable for the person concerned, she writes a summary of current needs before they are admitted, so that staff get information straight away about what the person’s needs are, and how they are to be provided. This helps to make sure that they get the right care straight away. The home does not provided intermediate care. Hambleton Court Residential Home DS0000066900.V346453.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 the service experience good quality outcomes in this area. People’s care is generally well planned, recorded and delivered. But risk associated with their care could be better monitored to make certain that avoidable shortfalls in care delivery do not happen. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The staff have worked hard to make improvements to the care plans since the last inspection. They complete a full assessment of need and a number of risk assessments. From the information gathered, care plans are developed and then reviewed on a monthly basis by the manager. This helps to keep the information up to date. The plans give staff good information about the care that people need. They also support people who want to remain independent. From discussion with staff it was evident that they look at the plans, and get a daily update about people’s care. This helps to keep care consistent. The manager and owners have also introduced annual reviews for everyone when their care is discussed with them and their family. They also intend to discuss with people how they want to be cared for upon dying and death, so that they know they are giving care in a way that that meets with people’s Hambleton Court Residential Home DS0000066900.V346453.R01.S.doc Version 5.2 Page 12 personal wishes. This information will help to keep people informed about, and involved in, their care, but it is currently missing from the care plan. The plans demonstrate that staff ask for help from the General Practitioner and the district nursing team when they need advice about health care, although the following points were discussed with the management: People did not have a completed risk assessment to measure the risk from pressure sores, because the manager believed that she was not allowed to complete such an assessment. But it was evident that where such problems had been identified, the district nursing team had provided equipment such as special mattresses and cushions to reduce the risk of the problem getting worse. These people though should have a risk assessment completed and reviewed by the home along with the care plan, so that any further risks to them can be monitored, and reported back to the district nursing team. It would also be good practice for everyone to have this assessment carried out on admission and reviewed regularly, so that any increase in risk can be easily identified, and acted upon before a problem arises. Each person has a nutritional risk assessment, and a suitable means of weighing people has now been obtained. In two cases, the assessments had identified possible areas of nutritional risk for the person concerned. It is important that these are discussed with the General Practitioner to see whether any further advice about nutrition is needed. People spoke highly about the care that they get. Those spoken to agreed that their privacy is upheld, and that they receive care in a respectful and dignified way. They said that staff understand what care they need, and what they can manage themselves. This helps to keep people independent. Relatives commented: ‘Excellent levels of personal care’, ‘Very attentive and caring staff. Difficult to put into words the good/excellent support received all the time. Residents are treated with respect, love, care and dignity’. One person who lives at the home said ‘I don’t want to be anywhere else’. Staff who handle medication on behalf of people are trained to do so. Medication is not given out at mealtimes. This means that people can sit and enjoy their meal without interruption. The medication was appropriately stored. The manager audits the medication system. This will help to reduce the risk from error. The records were generally well kept. But there was occasion where staff had completed the medication record sheet, but had forgotten to include the time that the medication should be given. However, a random check concluded that the medication had been given correctly at the time directed. The manager should make sure that she checks this as part of her audit. She also intends to check with the pharmacist the best way to record supplements which have been prescribed, and which can be given several times a day. Hambleton Court Residential Home DS0000066900.V346453.R01.S.doc Version 5.2 Page 13 People who choose to self medicate receive their medication direct from the pharmacist via the home. A risk assessment is carried out and reviewed monthly to make sure that anyone who self medicates still wishes, and remains able, to do so. People are provided with lockable storage so that their medication can be kept safe. A record is also kept of current medication which is prescribed for them, so that correct information can be shared in the case of emergencies. Hambleton Court Residential Home DS0000066900.V346453.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): 12,13,14 and 15 People who use the service experience good quality outcomes in this area. People’s social needs are considered, and they can maintain important links with their families and friends. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: A recent satisfaction survey sent out by the home to people and their relatives has resulted in some minor changes being made to the activities programme. Group activities are organised on a daily basis, and are sometimes changed at short notice at the request of people who live at the home. A record is kept in people’s care plans when they have been involved in such activities. However, from discussion, it was evident that there are also a number of one to one activities that take place with individuals, and this is good practice. For instance, one person enjoys having extracts from the Bible read to them. Staff should record these activities as well, because they demonstrate how people’s individual needs and interests are understood and acted upon by the home. Some people are able to maintain links outside the home independently, and individual wishes are upheld. One person said ‘There are plenty of things going on but I don’t always want to be involved’. Links have been developed with the local church community. Representatives visit the home to help meet people’s spiritual needs. Arrangements have been Hambleton Court Residential Home DS0000066900.V346453.R01.S.doc Version 5.2 Page 15 made so that a person can access the local church activities. This is very important to them. The registered providers are planning to extend the home. Preparation for building work means that the garden area cannot be accessed safely. The registered providers have given assurance that on completion, the garden area will be redeveloped for people to enjoy. People said that they are able to live life as they choose. One said ‘I get up and go to bed when I want’. Another said ‘I don’t really need help, but when I do the staff are there for me’. Their visitors are free to come and go as they wish. A relative commented: ‘We are always made welcome. They (the staff) have time to speak to us whenever’. There is information readily available about advocacy services which people can access for help and support if needed. Comments about the food at the home were positive. People agreed that they have a choice of meal. The chef confirmed that they are provided with a good supply of fresh products, including meat, fruit and vegetables. Three meals and supper are offered each day, and the kitchen is left open so that snacks can be prepared at night if requested. The chef was aware of special dietary requirements. One relative commented ‘Food is always freshly cooked. Well balanced, served regularly’. Hambleton Court Residential Home DS0000066900.V346453.R01.S.doc Version 5.2 Page 16 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 the service experience good quality outcomes in this area. People are protected by a staff team who will not hesitate to pass on concerns to the right people so that action can be taken. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People spoken with said that should they need to make a complaint, there would be someone at the home who they would be happy to complain to. One person said ‘I would be happy to complain, but I have none to make’. There were no formal complaints recorded at the home, and there have been no complaints made to the Commission for Social Care Inspection about the home since that last inspection. The procedure is displayed in the entrance hall of the home, and the manager confirmed that everyone admitted has a copy of the home’s Statement of Purpose, which also includes a copy of the complaints procedure. Staff spoken with were clear that any complaints made to them would be passed on to the manager for attention. This will help to make sure that any concerns are dealt with quickly. The manager has amended the abuse policy at the home. It now explains the correct action that must be taken if an allegation is made, stating that the matter would be referred to the local authority for investigation. Some of the staff spoken to had not received training in abuse awareness. However, those spoken to knew their responsibilities in reporting such matters to the management without delay in all instances. This will help to keep people safe. Hambleton Court Residential Home DS0000066900.V346453.R01.S.doc Version 5.2 Page 17 All staff however should be provided with training in ‘safeguarding adults’ so that the people can be assured that they understand what constitutes abuse, and that they are absolutely clear about their responsibilities in passing on information. Hambleton Court Residential Home DS0000066900.V346453.R01.S.doc Version 5.2 Page 18 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 and 26 People who use the service experience good quality outcomes in this area. People live in a generally well maintained and pleasant environment. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The accommodation is provided on two floors. A stair lift is available to help people who need to access bedrooms on the first floor. These bedrooms are not fitted with window restrictors, but the risk to people has been assessed in their care plan. The home smelt fresh and clean throughout. There is a communal sitting area. The dining area was beautifully set out, and provided pleasant dining arrangements for people. There is no call bell in this area, but the manager confirmed that there are always staff on hand at meal times. All bedrooms except one, which is shared, provide single accommodation. There was a screen provided in the shared room to help maintain people’s privacy. A second call bell had been provided so that each person had their Hambleton Court Residential Home DS0000066900.V346453.R01.S.doc Version 5.2 Page 19 own means of alerting staff when in bed. Bedrooms contained personal belongings, and were individualised. People spoken with were pleased with their rooms. The grounds at the rear of the building are being prepared for an extension. The area poses some risks for people who may access it, because the ground is very uneven in places, and could be a potential trip hazard. The registered provider has warned people not to enter this area, because he has already assessed that the area is not safe. Work was due to commence the day following this site visit, when the registered providers explained that the area will be cordoned off by the builders. This will make it safer. However, the registered provider has agreed to consult with the fire authority forthwith to make sure that cordoning off the area does not present any problems with regards to access or exit in the event of fire. Whilst the works take place, people are not permitted to access the garden area. The registered provider said that the gardens will be redeveloped once the work is completed. This will be beneficial for people who enjoy gardening. In the interim, the registered providers have provided seating at the front of the building so that people are still able to sit out if they wish. Although there was no written confirmation, the registered provider and manager explained that the fire officer has visited since the last inspection. He has looked at the fire arrangements and the fire safety risk assessment completed by the home. The registered provider said that there were no recommendations made following a tour of the building, and there have been no concerns raised by the fire authority with the Commission for Social Care Inspection. The laundry is situated in an outhouse at the back of the building. Staff are able to access it without having to transport laundry through the kitchen area. There is a washing machine with a sluice facility, and a tumble drier. One member of staff said that there was always a good supply of gloves and aprons available for use, and that they are provided with their own supply of hand wash solution. This will help reduce the risk from cross infection. People’s clothes looked well laundered and pressed. A stock of unopened food items are stored in the laundry area, which is also used for the storage of some cleaning products. The laundry will soon be demolished to make way for the planned extension. However, the registered providers have agreed to contact the environmental health officer to check that the current arrangement for the storage of food in this area is satisfactory to them. Hambleton Court Residential Home DS0000066900.V346453.R01.S.doc Version 5.2 Page 20 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 the service experience adequate quality outcomes in this area. People’s needs are met, but the recruitment procedure needs to be more robust to make certain that the staff are fit to provide care to people. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Two care staff work throughout the day, and two at night, one of which is asleep but ‘on call’. There is also a chef on duty each day until 2.30pm. Both registered providers and the manager work supernumerary Monday to Friday. One of the registered providers also works Saturday and Sunday. Care staff undertake cleaning duties. They are responsible for the delivery of the tea time meal. People who live at the home, and who were spoken to on the day of the site visit, were satisfied with the number of staff available to them. Staff did not appear rushed. They had time to sit and talk with people, and to assist with social activities. One person said ‘Staff are kind and there are enough of them. They look after me well’. Another said ‘Staff are nice. There are plenty of them’. They agreed that if they ask for help, it is provided. Two people who returned their surveys thought that staff were always available, whilst two stated that they were sometimes available. The registered provider, available at the weekend when there are less supernumerary staff available, said that they ask care staff not to intrude when people have their visitors in the communal areas, so that people have some privacy. It was agreed that this Hambleton Court Residential Home DS0000066900.V346453.R01.S.doc Version 5.2 Page 21 may have resulted in staff not entering the sitting area for longer periods of time. He intends to review this practice so that the area is better observed. Two staff recruitment files were looked at. In each case, the care staff had begun to work at the home before their Criminal Records Bureau (CRB) check and both written references had been returned, and without a POVAFirst check. In addition, the manager believed that it was acceptable to employ a member of staff who supplied their own copy of a CRB check, which was applied for by a previous employer. These practices do not properly protect people from unsuitable workers. Once employed, care staff work alongside the manager, when they commence a full induction. One staff member said that this had been very useful, and that they had not been expected to carry out any tasks that they were unsure of. This helps to keep care safe for people. Staff are encouraged to undertake National Vocational Qualifications in care. Some staff have already achieved this award. Others are in the process of working towards the award. This will help to provide a well qualified work force. The manager keeps a training file for each staff member. She is aware that some mandatory training needs updating. She intends to check to make sure that all staff are brought up to date where necessary. It would be good practice to include a check of staff training as part of her quality assurance audits, so that she can keep a clear track of what training they have undertaken, and when it will need to be updated. She does not currently provide formal supervision. This is provided on an informal day to day basis. She also works alongside staff to assess their practice. Hambleton Court Residential Home DS0000066900.V346453.R01.S.doc Version 5.2 Page 22 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 People who use the service experience good quality outcomes in this area. The manager and registered providers endeavour to run the home in a professional way, taking into account the views and concerns of the people who live there. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The registered providers have owned Hambleton Court for over a year. They have previous experience as registered providers of another establishment. The registered manager in post at the last inspection has retired. Her replacement has been in post for approximately twelve months. She is studying towards a management qualification, and is looking towards making an application to become registered with the Commission for Social Care Inspection. Both staff and residents spoke highly of the input that the manager has made since taking up post. She makes sure that she has regular contact with people who live at the home. Staff find her approachable. People living at Hambleton Court Residential Home DS0000066900.V346453.R01.S.doc Version 5.2 Page 23 the home said that they see the management regularly. They referred to them by their first name. Since the last inspection, satisfaction surveys have been sent to people who live at the home, their relatives and also to professionals who visit the service to help support the people who live there. The management have identified areas which people think that they do well, such as care and food provision, and areas where they could do better, such as the activities. Although they confirmed that they have acted upon this information, they have chosen to pass on the results individually. It would be good practice to publish them, so that people can see how the information they have provided collectively has been considered and acted upon. There are no staff meetings, but staff said that they could go to the management to discuss any issues that they may have. The registered providers are looking at ways in which they can improve the way that information is given to people with an interest in the home. As part of people’s reviews, they are now trying to keep people informed about the changes that are about to begin with the forthcoming extension, and what this will mean for the people who live at the home. This will help to maintain communication and ease any anxieties that people may have. The registered providers look after money on behalf of people who live at the home if this is their wish. But they do not act as appointee for anyone, nor do they collect pensions on their behalf. They keep a record of all incomings and outgoings, including receipts. Although cash is pooled, people have access to it at any time, and can look at their records if they wish to see how much they have. People can and do manage their own affairs if this is their wish. All rooms have lockable facilities so that their money can be kept safe. Since the last inspection the registered providers have made sure that equipment that had not recently been serviced has been attended to. In house weekly checks are also now in place to make sure that the fire alarm system is in working order, that bed rails are safe for use, and that hot water temperatures accessible to people are maintained within safe limits. As an extra safety measure, staff always check the temperature of bath water each time they run a bath for people to make sure that the temperature is safe. The registered provider agreed to adjust the temperature of one hot water outlet on the day of the site visit so that it was nearer to acceptable limits. The hot water system will be renewed shortly as part of the planned extension of the home. However, the Legionella certificate had elapsed at this visit. So that he can be certain that stored water is being kept at an appropriate temperature, the registered provider has agreed to keep check of the temperature of an unregulated hot water outlet. Although he was confident that it would be stored well within acceptable limits. Hambleton Court Residential Home DS0000066900.V346453.R01.S.doc Version 5.2 Page 24 The staff are provided with wedges so that they are able to hold open doors for ease whilst cleaning. The manager said that the wedges are removed immediately once the area has been cleaned. However, one had not been removed from the top of the stairs. Another had been used by one person to hold open their bedroom door. This is dangerous, and increases the risk from fire spreading in the event of a fire. The registered provider made sure that these wedges were removed immediately, and reminded the people concerned that fire doors must not be held open in this way. They have agreed to remove the wedges forthwith so that there are no further incidents, and to provide safe alternatives acceptable to the fire authority should a person wish to have their door held open. This will reduce the risk to people should a fire break out. The registered provider and chef have attended training entitled ‘Safer Food Better Business’. The records kept by the kitchen staff have been updated accordingly. Records were generally well kept in accordance with this guidance. But staff must always remember to record the temperature at which hot food is served, as evidence that it has been heated to an acceptable temperature to ensure people receive food which has been safely prepared. The manager intends to look at the mandatory training and the following has been discussed: • Care staff prepare the tea time meal, but not all have received food hygiene training. The registered provider has agreed to contact the environmental health officer to check what level of training is expected for staff members who handle food, and to act according to their recommendations. There are a few shifts where there is no first aider on duty. But two staff were due to attend first aid training. The registered provider was advised to complete a risk assessment to check whether there was now sufficient first aid cover at all times at the home so that people receive suitable first aid attention in an emergency arrangement, and to provide additional training where it was deemed that this was not the case. Some staff have received training in infection control measures by the manager, who has obtained information from the infection control team following a previous outbreak of infection. The manager should check that all relevant staff have received this training, and provide an update where they have not. • • Hambleton Court Residential Home DS0000066900.V346453.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 X X 3 X X 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 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Hambleton Court Residential Home DS0000066900.V346453.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 OP8 Regulation 13 Requirement Timescale for action 10/09/07 2 OP19 23 Where potential risk is identified in a person’s nutritional assessment, the information must be referred to the General Practitioner so that they can consider whether any further advice and guidance is needed in order to help meet the person’s nutritional needs. 10/09/07 To make sure that people are protected from avoidable hazards, the fire authority must be consulted, to check that the arrangements in place to the rear of the premises whilst building preparation and works are underway, do not place any restrictions in accessing or exiting the building in the case of fire. To make sure that people are protected from avoidable hazards, the environmental health officer must be consulted to check whether the food storage arrangements in the laundry are acceptable to them. 17/09/07 3 OP26 16 Hambleton Court Residential Home DS0000066900.V346453.R01.S.doc Version 5.2 Page 27 4 OP29 19 In all future recruitment, the registered person must ensure that, prior to deployment, they have obtained: Two satisfactory written references A Criminal Records Bureau disclosure applied for by the home In extreme circumstances, where the staff member is deployed prior to the return of the CRB, a POVAFirst must be obtained. The staff member must be supervised at all times until such time that the CRB is returned, but not before two satisfactory references have been received. Timescale of 12/09/06 not met In order that the proper checks are made to protect people, a Criminal Records Bureau check must be obtained for the staff member discussed at the site visit, and for whom an applicant’s copy has been accepted. As agreed, in the absence of a POVAFirst check they must not be deployed until such time that this information has been obtained. 10/09/07 5 OP38 13 To reduce the risk from the spread of fire, fire doors must not be held open by unauthorised means. 10/09/07 Hambleton Court Residential Home DS0000066900.V346453.R01.S.doc Version 5.2 Page 28 6 OP38 16 To make sure that people are protected from avoidable hazards, the environmental health officer must be consulted to check whether food hygiene training must be provided for care staff who handle food that is consumed by the people who live there. Updated training about infection control must be provided to those staff who have not received it, so that they have clear information about the ways in which they can limit the spread of infection. A risk assessment must be completed to check what level of first aid training is required by staff at the home so that people can be assured that they will be given the proper first aid attention in emergencies. The risk assessment should consider • • • the needs of service users how likely it is that first aid will be needed what kind of first aid is likely to be needed. 17/09/07 7 OP38 13 30/09/07 8 OP38 13 30/09/07 Where a risk assessment is not completed, there must be a qualified first aider on the premises at all times. Hambleton Court Residential Home DS0000066900.V346453.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Plans to discuss people’s needs upon dying and death should be acted upon as soon as practicable, so that people know that they will be cared for according to their wishes. All people admitted to the home should have a formal assessment completed to determine whether they are at risk from pressure sores. This should be reviewed regularly so that help can be sought at the earliest point where advice or preventative equipment may be needed to stop any problems from happening. To help maintain people’s health, risk assessments should include a trigger so that staff are clear about when advice from other professionals is needed. 2 OP9 As part of the audit, and to reduce the risk from error, handwritten medication administration records should be checked to make sure that they include the time that medication is to be given All staff should be provided with safeguarding adults training so that people can be assured that they understand what constitutes abuse, and what to do if it is reported to them or suspected by them. 3 OP18 Hambleton Court Residential Home DS0000066900.V346453.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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. 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