Inspection on 13/07/07 for Hardwick Dene

This inspection was carried out on 13th July 2007.

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

Hardwick Dene 25/01/10

Hardwick Dene 09/07/08

Hardwick Dene 31/01/07

Hardwick Dene 06/04/06

Hardwick Dene 25/11/05

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

CARE HOMES FOR OLDER PEOPLE Hardwick Dene Hardwick Lane Buckden Cambridgeshire PE19 5UN Lead Inspector Don Traylen Key Unannounced Inspection 13th July 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hardwick Dene DS0000064193.V344988.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. Hardwick Dene DS0000064193.V344988.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hardwick Dene Address Hardwick Lane Buckden Cambridgeshire PE19 5UN 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) 01480 811322 01480 819120 sallyarcher1@aol.com Mr Krishan Parkash Sally Archer Care Home 38 Category(ies) of Dementia - over 65 years of age (33), Old age, registration, with number not falling within any other category (38) of places Hardwick Dene DS0000064193.V344988.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st January 2007 Brief Description of the Service: Hardwick Dene is a registered care home for 38 older people that includes 33 places for people with dementia related care needs. The home is set in large, attractive, well-kept gardens overlooking farmland, on the opposite side of the A1 to the village of Buckden. The market towns of Huntingdon and St Neots are within a 10-minute drive. The cities of Cambridge and Peterborough can each be reached within half an hour, and London is fifty miles to the south. Originally a family home, Hardwick Dene has been extended three times. A ground floor self-contained unit of 12 single bedrooms, all with en-suite facilities, 2 lounge/dining rooms, a shower room and a bathroom has been added to offer care to people who need safe, constantly supervised, accommodation due to problems with their mental health. Accommodation in the older part of the home is on two floors and consists of 22 single bedrooms, 2 double bedrooms, and 2 large lounge/dining rooms. The home has adequate bathroom and toilet facilities, a well-equipped kitchen, an office, a treatment room and laundry. The home has a large open and plain garden at the front of the property. The homes separate extra care unit leads onto an enclosed part of the garden. The home has well-maintained lawns and is a home to two peacocks. The fees to reside at Hardwick Dene cost from £351 to £560 per person per week and were provided verbally by the registered manager on the 31/01/07. Hardwick Dene DS0000064193.V344988.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out the unannounced visit to the service on Friday 13th July 2007. An Annual Quality Assurance (AQAA) dataset was completed by the service and returned to the Commission prior to the visit. Observations were made of interactions between staff and people living in the home and of a mealtime. Five visiting relatives were spoken. Brief chats to six people living at the home and to three care staff were conducted. A visiting District Nurse was asked for her views about the care provided by the home. The site visit inspection lasted 6 hours. What the service does well: What has improved since the last inspection? • • A questionnaire on admission to the home is offered to all people moving into the home. A ‘service user feedback’ survey questionnaire has also been implemented. The staffing situation was stable. Staff reported they were working together well as a team. Hardwick Dene DS0000064193.V344988.R01.S.doc Version 5.2 Page 6 • • • • • • • • • Attention to people and the general level of care was observed and was considered to be good. It was demonstrated through attentive, pleasant and re-assuring care. Five Team leaders have been nominated and each had been given specific responsibilities. The manager reported these arrangements were working well and that she felt supported and better able to manage the service. Care plans have improved. The administration of medication continues to improve; a register of controlled drugs has been started and maintained in a clearly dated and lined format, in a hardback bound book. The home has promoted the protection of vulnerable people by displaying signs in strategic point in the home that informed visitors and staff of the home’s zero tolerance of abuse and where the Lead Practitioners Social Workers and the Police can be contacted by telephone, should anyone consider it necessary to report a suspicion, or allegation, of abuse. Training for care staff in dementia care has taken place. Training in protecting vulnerable adults from abuse has been provided by Cambridgeshire County Council for all staff. Training records were clear and arrangements were better organised. The home is in the process of recruiting a person to work as an activities organiser although they have not yet found a suitable person. Some policies have been re-written. A copy of all policies is kept in the staff room for staff to refer to. The manager has completed her Registered Managers Award course. What they could do better: • One outstanding requirement made in the last inspection report for the 31/01/2007, has not been met. It is disappointing that this requirement has not been met as it is concerned with competencies of daily care tasks that should be monitored by the manager as a part of the daily management and running of the home. One outstanding requirement, regarding competencies for administering medication, made in the pharmacist report for the 16/05/2007, will be assessed at the next pharmacist inspection. An attitude shown by one person employed in the kitchen must immediately alter after she was seen and heard to be impolite towards a vulnerable person living at the home. To ensure the protection of vulnerable people, the manager was advised during the inspection visit, to act on this observation. • Hardwick Dene DS0000064193.V344988.R01.S.doc Version 5.2 Page 7 • • • • • Meal times in the larger of the two dining areas should be supervised at all times so that people receive attention if they require it. Stimulation could be provided through structured activities although a daily visitor to the home takes people for a gentle exercise session. People should be respected and asked if they want the television turned on so early in the morning, or at any time. There was one room where there was an offensive odour and this must be eradicated. When oversees staff are recruited, the registered manager must always ensure that two satisfactory references are obtained by the home and do not rely on a reference addressed, “to whom it may concern”. The home must obtain current references that are addressed to them. Recorded monitoring of specific care practices, such as moving and handling has still not been achieved despite being made a requirement at the previous inspection. The manager stated she was monitoring staff although there was no evidence to support this. Similarly, recorded monitoring of the management and administration of medication and monitored observation of staff attitudes (at meal times) should be used as a specific quality assurance and supervisory process. Other competencies should be periodically and regularly assessed. • 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. Hardwick Dene DS0000064193.V344988.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 Hardwick Dene DS0000064193.V344988.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): 3,6, Quality in this outcome area is good. Appropriate assessment information is gathered prior to admission, so that people are assured their needs are will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two people’s assessments were read. The assessments had been completed by PCT Care Managers and were comprehensive documents from which care plans had been written. The home had also carried out their assessment prior to the two people moving into the home. The home has a satisfactory history of obtaining assessments and this has been evident in their previous inspection reports. Hardwick Dene DS0000064193.V344988.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10, Quality in this outcome area is adequate. Not all service users are assured of being treated respectfully at all times by all of the staff, although they are assured that full attention and support is available for their health needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Attention to people and the general level of care giving were observed and considered to be good and was demonstrated through attentive, pleasant and re-assuring care. This was demonstrated through attentive, pleasant and reassuring care. However, this good care was offset by the shocking and disappointing remarks made by the cook during the lunchtime meal, when she said to a person who was eating his meal, “I am fed up with you,” and remarked to the person that he was “never satisfied”. This incident was immediately brought to the attention of the manager and was also relayed in a telephone conversation to the senior care worker on the afternoon of Monday 16th July. Observations made of another person who did not eat her lunch but Hardwick Dene DS0000064193.V344988.R01.S.doc Version 5.2 Page 11 sat with her head slumped forward and eyes closed. She was left alone until a senior carer noticed her and spoke to her at a time when most people had almost finished their main meal and desert. Care plans were good and included new risk assessments and weight and nutritional information. Care plans were improved in their amended format and the fact that each of the five senior care assistants (or Team Leaders) have individual responsibilities for ensuring records for Nurse and GP visits; weight and risk assessments; nutrition; daily living arrangements that include falls and food intakes and ordinary activity. One team leader said she felt this arrangement worked well, as she was the main link for visiting nurses and had clear responsibilities for recording issues around these visits. A visiting District Nurse stated the system works well and that all staff are good at communicating peoples’ needs and work in co-operation with her. She added that she valued their attitude and support. Similarly, her support and direction enables care staff to administer simple dressings and other tasks, where this is appropriate. Peoples’ health care needs are supported by regular and co-operative working arrangements with the community nurses and GPs. Staff are alert to summoning health professionals on behalf of people. A visiting District Nurse who has very regular contact with people living in the home confirmed the good working arrangements she has with the home. The home has implemented a register of controlled drugs that has been maintained in a clear dated and lined format in a hardback bound book. Hardwick Dene DS0000064193.V344988.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, Quality in this outcome area is good. People who use the service enjoy a quiet uninterrupted lifestyle. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection it was observed that the home was quiet and most people were inactive and were seated in armchairs. There was more activity, physical movement and stimulation from care staff in the extra care unit, where eleven people are accommodated. The AQAA stated that a qualified activities co-ordinator and records are kept of all activities and the participation of residents. Information regarding activities is displayed on the information board and residents are individually informed by the staff and the co-ordinator of the forthcoming events etc. Families are invited to join in, where possible.” It was found the home has musical events arranged approximately every two months. One regular visiting relative has undertaken to help people through a Hardwick Dene DS0000064193.V344988.R01.S.doc Version 5.2 Page 13 gentle exercise session once a week. The manager stated the home has advertised to recruit an activities worker although they have not yet found a suitable person. The television was on at 9am in the small lounge outside the manager’s office. One person was seated in the room alone and said the TV had been on since 8 am and that she did not want it on. She said that she was never asked if she would like the TV on or off. An appetising and seemingly nutritious meal of fish and fresh vegetables with an alternative choice of an omelette was served for lunch during the inspection. Most people who managed to eat their meal were observed to clear their plates. Ten people were asked and stated their meal was satisfactory and they had had enough to eat. The observations made and referred to in the previous outcome group when one person sat unattended and not eating indicated a need for earlier intervention. This was a more vulnerable person who was left alone until a senior carer noticed her and spoke to her at a time when most people had almost finished their meal. She was then provided with food that she said she would like. These comments are relevant to the last inspection report of the 13/03/2007 when it was reported that people with needs associated with their nutritional intake should be risk assessed and should have care plans that contain records of these needs. These steps have been implemented but it is also essential that these plans must be acted out in care tasks. Hardwick Dene DS0000064193.V344988.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. People are assured of protection through adequately trained staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has promoted and improved their protection of vulnerable people by displaying signs in strategic point in the home that informed visitors and staff of the home’s zero tolerance of abuse and where the Lead Practitioners Social Workers and the Police can be contacted by telephone, should anyone consider it necessary to report a suspicion, or allegation, of abuse. Training in protecting vulnerable adults from abuse has been provided by Cambridgeshire County Council for all staff. A complaints book has recently been maintained that showed on e recent complaint recorded and detailed. Hardwick Dene DS0000064193.V344988.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,23,24,25,26, Quality in this outcome area is good. People live and benefit from a safe and well-maintained environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was clean well maintained and comfortably furnished. People had rooms personalised that contained furniture of their choice. There was one room where there was an offensive odour of stale urine noticed. This was pointed out to the manager and discussed. The manager stated there are plans to re-carpet or cover the floor. Hardwick Dene DS0000064193.V344988.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30, Quality in this outcome area is good. Despite the requirement made in this outcome group people are provided care by adequately trained care staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Training for care staff in dementia care has taken place. Training in protecting vulnerable adults from abuse has been provided by Cambridgeshire County Council for all staff. Training records were clear and arrangements were better organised. The staffing situation appeared consolidated and stable. Staff reported they were working together well as a team. Five Team leaders have been nominated and each had been given specific responsibilities. The manager reported these arrangements were working well and that she felt supported and better able to manage the service. One team leader confirmed this on the day of inspection. She described her responsibilities for ensuring records of Health Service professionals’ visits and some of the reasons for treatments were recorded in the care plans. She liaised with the District Nurse and ensured peoples’ needs were made known to the Nurse. Hardwick Dene DS0000064193.V344988.R01.S.doc Version 5.2 Page 17 The AQAA returned by the home stated that 2 satisfactory references are taken when staff are recruited. Two staff files were assessed. These both revealed that two references had not been acquired. One reference for each person was available that was addressed, “to whom it may concern”. The two staff had been recruited through an employment agency for oversees workers. Home Office work permits had been acquired and CVs and qualification details and satisfactory CRB disclosures and POVA first checks. The application forms were not completed with two named referees and references had not been requested directly by the home, but had been supplied in advance “ to whom it may concern”. The home must obtain two references that have been requested by the home so that people are assured of safety and are satisfactorily protected. Hardwick Dene DS0000064193.V344988.R01.S.doc Version 5.2 Page 18 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): 31,33,35,38, Quality in this outcome area is good. The management has improved and has benefited people living at the home because they have become a greater focus of management quality assurance. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has completed a Registered Managers Award course and was awaiting her results at the time of the inspection. A questionnaire on admission to the home is offered to all people moving into the home. A ‘service user feedback’ survey questionnaire has also been Hardwick Dene DS0000064193.V344988.R01.S.doc Version 5.2 Page 19 implemented. Residents and relatives meeting have been held and are planned as regular meetings. There were three areas of the home where there were notices posted stating zero tolerance towards abuse and the telephone contacts of the PCT Lead Practitioners and the Police, to where any allegations should be reported. Some policies have been re-written. A copy of all policies is kept in the staff room for staff to refer to should they wish to. The Fire Service Safety Officer had visited recently to follow up a previous assessment visit. Fire alarm testing is carried out weekly and fire drills had also recently been planned and recorded. The fire alarm and emergency lighting were tested during the inspection. The overall management of the home has improved. It is recommended that further monitoring of care tasks, such as moving and handling, the administration of medication and any other tasks the manager should evidence a to guarantee good care are undertaken as soon as possible and planned to become regular and recorded features of the homes improved approach to quality assurance. Hardwick Dene DS0000064193.V344988.R01.S.doc Version 5.2 Page 20 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 3 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Hardwick Dene DS0000064193.V344988.R01.S.doc Version 5.2 Page 21 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 OP7 Regulation 12(1)(b) & (3) Requirement The needs of people who are known to require assistance, encouragement or motivation to eat must be met so they are assured of adequate supervision and nutritional intake. Staff must respect people who use the service and must maintain good professional relationships with them so that people who use the service are spoken to respectfully at all times. Offensive odours must be eradicated so that all people living in the home are treated with equal respect and live in clean and comfortable home. When staff are recruited, the registered manager and the registered provider must always ensure that two satisfactory references are obtained by the home and not rely on a reference written, “to whom it may concern”. The home must obtain current references that are addressed to them so that people who use the service are DS0000064193.V344988.R01.S.doc Timescale for action 01/09/07 2 OP10 12(4)(a), 5(b) 01/09/07 3 OP26 16(2)(k) 01/09/07 4 OP29 19(5)(d) & Schedule 2 01/09/07 Hardwick Dene Version 5.2 Page 22 5 OP38 24((1) fully protected and not placed at unnecessary risk. The home must ensure the safety of service users by monitoring staff for carrying out safe moving and handling practices so that people’s safety is assured during these manoeuvres. The timescale of 31/03/07 made in the last inspection report has not been met and has been extended. 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 Refer to Standard OP10 Good Practice Recommendations People who use the service should be respected by being asked whether they would prefer the communal television turned on so early in the morning, or at any time. It is recommended that regular monitoring of care tasks, such as moving and handling, the administration of medication and communication skills should be undertaken as soon as possible and should be recorded as evidence of a quality assurance method. 2 OP33 Hardwick Dene DS0000064193.V344988.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Cambridgeshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Hardwick Dene DS0000064193.V344988.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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