Inspection on 20/05/05 for Hanbury Court Nursing Home

This inspection was carried out on 20th May 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hanbury Court Nursing Home 12/01/07

Hanbury Court Nursing Home 05/10/05

Hanbury Court Nursing Home 23/11/04

Hanbury Court Nursing Home 07/10/04

Hanbury Court Nursing Home 24/03/04

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

CARE HOMES FOR OLDER PEOPLE Hanbury Court Dagmar Road Dagenham Essex RM10 8XP Lead Inspector Rhona Crosse Unannounced Inspection 20 May 2005 11:30 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 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. Hanbury Court G55_S0000015592_Hanbury Court_V228422_200505_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hanbury Court Address Dagmar Road, Dagenham, Essex RM10 8XP Telephone number Fax number Email 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 8593 8000 020 8984 8914 MNS Care PLC Mrs Mandy Leggate CRC Care Home 42 Category(ies) of OP Old age (41) registration, with number TI Terminally ill (1) of places Hanbury Court G55_S0000015592_Hanbury Court_V228422_200505_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 23 November 2004 Brief Description of the Service: Hanbury Court is a purpose built care home providing 24 hour nursing care for 42 older people. The home is in a residential area of Dagenham. The majority of the bedrooms are single occupancy (26 of these have en-suite facilities). There are 8 shared bedrooms. The home is wheelchair accessible and there is a passenger lift to the first floor. Hanbury Court G55_S0000015592_Hanbury Court_V228422_200505_Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection so the home did not know the inspector was coming. The manager was not at the home and was on annual leave, therefore not all the requirements made at the last inspection could be checked. These 5 remaining requirements made in November 2004 will be checked at the next inspection There was a nurse in charge of each floor of the home. The nurses both knew the needs of the service users accommodated on their floors and were able to give good information about the care being provided. There was a good atmosphere in the home. Care plans and risk assessments, turn charts and fluid charts were inspected. Medication records and medication held in the home was also inspected for all service users. Records of meal choices were inspected. The tea time meal was being prepared. 7 different choices were being prepared over and above the set menu for tea time showing that service users are able to make an alternative choice of meal to the menu for the day. The kitchen was clean and well organised. There was sufficient staff to meet the needs of the service users and staff were observed to be providing care and dealing with service user’s needs well. 5 relatives were visiting at the time of the inspection and the inspector spoke with them to see what their views of the service the home was providing were. All were complimentary about the care being provided and stated that they were made to feel welcome when they visited and felt they could raise any concerns they had and these would be dealt with. Service users spoken with stated that ‘we’re well looked after here and the staff are kind’. Another service user commented that ‘I couldn’t want for anything here, they all are good girls’. A random selection of bedrooms and bathrooms were inspected. The home was clean and tidy throughout and free from odours. The home provides an intermediate care service for people who are not yet able to return home after a stay in hospital and require input from health professionals and time to rebuild their daily living skills. A consultant and Physiotherapists support the home and provide the input needed for service user to make a recovery and return home. These staff are supernumerary to the staffing levels of the home. Hanbury Court G55_S0000015592_Hanbury Court_V228422_200505_Stage 4.doc Version 1.30 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Although there had been a great improvement in the recording of medicine given there were two errors found at this inspection. One risk assessment had not been updated after a fall. However the home had taken the appropriate action and made a referral to the Physiotherapist who had started to work with the service user to improve their use of their walking frame. Although all areas of the kitchen were well managed it was observed by the inspector that raw lamb in a bag was thawing in the same container as sausages and bacon. All meat should be thawed in separate containers to ensure good food safety. Hanbury Court G55_S0000015592_Hanbury Court_V228422_200505_Stage 4.doc Version 1.30 Page 7 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. Hanbury Court G55_S0000015592_Hanbury Court_V228422_200505_Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Hanbury Court G55_S0000015592_Hanbury Court_V228422_200505_Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6 were inspected. The two standards inspected were well managed. EVIDENCE: A random selection of service users records were inspected. The admission process is well managed with information being provided from placing authorities and the home carrying out it’s own pre-admission assessments prior to coming into the home. Hanbury Court G55_S0000015592_Hanbury Court_V228422_200505_Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 and 11. There has been an improvement in the updating of care plans, risk assessments, turn charts and fluid balance charts. A monitoring system has been out into place by the manager and this is working well. Medication recording had greatly improved, although there were 2 errors found at this inspection this was after an audit of all service user medication held in the home. Over all, the standards in this section are being well managed. EVIDENCE: A random selection of service user records were inspected from both upstairs and downstairs units. All care plans were either updated or still within the date for review. However one risk assessment had not been updated after a fall, but the home had taken action to review the way the service user was walking and had made a referral to the physiotherapist. The physiotherapist had started to work with the service user to improve the use of the walking frame. Another service user requires a daily check of the condition of their skin -this was being undertaken. Health care needs were well documented with referrals to health care professionals as necessary, such as GP’s, Dietician, Speech and Language Therapist, Tissue Viability Nurse, Chiropodist, Dentist and Optician. Hanbury Court G55_S0000015592_Hanbury Court_V228422_200505_Stage 4.doc Version 1.30 Page 11 One service user was in the last stages of dying and the needs of this service user were seen to be being well met. All information required was recorded. Staff were keeping a close watch on the service user and attending to her needs, whilst ensuring that the service user was kept clean and comfortable but was not overly disturbed at this time. From discussions with service user’s and their relatives they stated that they felt that their health need were well attended to and that they were kept informed of any changes. A service user said ‘if I’m not well they get the Doctor to look at me and tell my family’. Another service user said ‘I’m alright I am never ill, but I know they would call the Doctor if I wasn’t, the girls are good here’. When privacy and dignity was discussed relatives said that they had not seen anything to give them concern. Service users said ‘they look after me well and knock on my door before they come in’ ‘they treat me well I have no complaints’. Hanbury Court G55_S0000015592_Hanbury Court_V228422_200505_Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 and 15 Standards 12 and 14 will be inspected at the next inspection. It was seen that choices are given and choices are made by service users in relation to food provided. This standard was well met. Links with family, friends are encouraged and supported. EVIDENCE: The tea time meal was in the process of being prepared during the inspection and served. The cook was seen preparing 7 different choices over and above the main tea time menu. Meals taken by service user’s are recorded, these records were inspected and were found to evidence the choices service users were making. In discussion with service user’s at tea time they said they ‘like to be able to stay in my arm chair at tea time and not go to the dining room’. When a service user was asked if they got a choice of meal the service user said ‘I can’t remember now what I chose but they come round and ask you every day so I know I will always get what I asked for’ ‘I don’t have a cooked breakfast but some do, I could not manage that now.’ Another said ‘they are a bit late tonight with our tea must be because you’re here’. The tea meal was nicely presented and the cook was aware of who liked bigger portions and meals were seen to be individually tailored to choice. Special meals can be provided for diabetics or anyone who requires a low fat diet or low salt diet. Hanbury Court G55_S0000015592_Hanbury Court_V228422_200505_Stage 4.doc Version 1.30 Page 13 Cultural needs can also be met, this would be discussed at the pre admission assessment. Relatives spoken with stated that they can come and go as they please and no restrictions are place on visiting time. They are able to have refreshments at any time. Hanbury Court G55_S0000015592_Hanbury Court_V228422_200505_Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of the standards in this section were inspected at this inspection but will be inspected at further inspections. EVIDENCE: See comment above. Hanbury Court G55_S0000015592_Hanbury Court_V228422_200505_Stage 4.doc Version 1.30 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21 24 and 26 were inspected at this inspection. The home was clean and tidy throughout, and service users have their own personal possessions in their bedrooms giving them a homely feeling. The standards inspected were well met. EVIDENCE: A random selection of service users bedrooms were inspected along with bathrooms and W.C’s all were found to be clean and free from odours. All were well maintained. Service users are able to bring small pieces of furniture with them, rooms were very individual with lots of personal possessions seen in them. Clinical waste, both within the home and outside storage awaiting collection was appropriately stored. Hanbury Court G55_S0000015592_Hanbury Court_V228422_200505_Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 the remaining standards will be inspected at the next inspection. There was sufficient staff on duty at the time of the unannounced inspection to meet the needs of the service users. EVIDENCE: There was a range of skills within the staff group. As this is a care home with nursing there were 2 nurses on duty. Both male and female carers were working on the afternoon of the inspection. Staff training is provided by the home, however this was not looked at during this inspection. Hanbury Court G55_S0000015592_Hanbury Court_V228422_200505_Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31. Standards 33, 35 and 38 will be fully inspected at the next inspection. The manager is suitably qualified to carryout the role of manager. As there are very few requirements made from this inspection this shows that the home is being appropriately managed. EVIDENCE: The manager has dealt with the requirements made at the last inspection and provided an action plan to show how she is dealing with these. The inspector was able to check all but 5 of these requirements. These will be checked at the next inspection. Closer monitoring of staff practice has been put into place by the manager and this appears to be working well. It was of concern in the homes kitchen that different meats were thawing out in the same container. Although these meats were wrapped (frozen lamb, bacon and sausages) all meat should be thawed separately to ensure that no blood leaks from one meat into another. This was immediately dealt with by Hanbury Court G55_S0000015592_Hanbury Court_V228422_200505_Stage 4.doc Version 1.30 Page 18 the cook. This standard (standard 38) was not fully inspected at this inspection but will be inspected at the next inspection. Hanbury Court G55_S0000015592_Hanbury Court_V228422_200505_Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 x 3 x x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 x x x x x x 2 Hanbury Court G55_S0000015592_Hanbury Court_V228422_200505_Stage 4.doc Version 1.30 Page 20 Are there any outstanding requirements from the last inspection? The inspector was not able to verify 5 previous requirements due to the manager being on annual leave. However an action plan was sent to state that all requirements had been met. 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. 2. 3. Standard OP7 OP9 OP38 Regulation 13(4)(c) 13(2) 16(2)(j) Requirement Ensure that at the point of any change in need the risk assessment is updated. Medication must be signed at the point of administration. All meats should be thawed in seperate containers to ensure food safety. Timescale for action 30/7/05 20/5/05 and ongoing. 20/5/05 and ongoing. 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 Good Practice Recommendations There are none arising from this inspection. Hanbury Court G55_S0000015592_Hanbury Court_V228422_200505_Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford Essex IG1 4PU National Enquiry Line: 0845 015 0120 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 Hanbury Court G55_S0000015592_Hanbury Court_V228422_200505_Stage 4.doc Version 1.30 Page 22 - 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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