Inspection on 25/11/05 for Hardwick Dene

This inspection was carried out on 25th November 2005.

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 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

Hardwick Dene 25/01/10

Hardwick Dene 09/07/08

Hardwick Dene 13/07/07

Hardwick Dene 31/01/07

Hardwick Dene 06/04/06

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 Unannounced Inspection 25th November 2005 12:10 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.V260844.R01.S.doc Version 5.0 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.V260844.R01.S.doc Version 5.0 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 811322 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.V260844.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17/08/2005 Brief Description of the Service: Hardwick Dene is a registered care home for 38 older people that includes 33 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 and now offers care to 38 people. 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, office, treatment room and large 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 grounds that are laid to lawn and are home to two peacocks. Hardwick Dene DS0000064193.V260844.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the second inspection for the year 2005-2006. This report should be read in conjunction with the previous report made on the 17/08/2005. In order to track the progress expected from the requirements and recommendations made in the last report, this inspection visit was planned so that observations of the lunchtime meal could be carried out. The inspection started at 12.10 and concluded at 16.15 pm. Observations were made during the lunchtime in the three dining areas. One visiting relative and two members of staff spoke to the inspector. The assistant manager Diane Marsh was the senior member of staff working at the time of the inspection. The majority of service users living in the home are privately funding their care. What the service does well: What has improved since the last inspection? The observations made during the lunchtime meal indicated that staffing arrangements had improved and that service users were assisted in a polite and respectful manner. Sufficient staff were present to assist service users and this arrangement appeared to be satisfactorily managed and conducted. New curtains have been fitted in the lounge. A shift planner has been introduced and is used to indicate routine duties for each member of staff. The kitchen are cleaned on a regular basis that has been drawn up and is has been posted in the kitchen by the recently employed cook. Hardwick Dene DS0000064193.V260844.R01.S.doc Version 5.0 Page 6 What they could do better: • A Statement of Purpose and Service User Guide must be written according to the Care Homes Regulations 2001 and the National Minimum Standards. It is expected and assumed these two most basic and vital documents will be made available in the correct format by the 1st January 2006 The use of restraining service users with the seating belt in wheelchairs must be agreed between health professionals, relatives or advocates of the service user and the home. For service users who lack the mental capacity to understand this action, there must be the involvement of a Community Psychiatric Nurse or psychiatric consultant. GPs are expected to assist in any referrals the home feels necessary to make for psychiatric assessment or support in this matter. A response from the registered provider written on the 16 September 2005 and made after the last inspection claimed, “We consult with GP, District Nurse and occupational therapist on a very regular basis as and when required”. It is required this consultation is more vigorously and extensively sought when any restriction to a service user’s physical activity is anticipated. The presentation, the order and content of Care Plans showed there are improvements that can be made. These improvements must make these documents practical working files that clearly describe the methods of care in a person-centred approach. The use of the notice board should be established as the place to display the home’s complaints procedure and the Certificate of Registration. Literature such the Statement of Purpose and Service User Guide, should be available and on display for any visitor to read without having to ask. A complaints procedure must be promoted by the home. The procedure must be available so that it is easily accessed and understood by all interested persons. There is a gap between the outside paving and the step from lounge patio doors in the extra care unit that must be made safe. Additional training in understanding and responding to falls and for moving and handling skills must be made available for all staff. As good practice, staff should be consulted for their training needs • • • • • • • Whilst the physical environment of the interior of the home is being improved, there should be more immediate emphasis on how to improve care and provide person centred care, especially as the home is registered to provide for up to 33 elderly people with dementia related care needs. Please contact the provider for advice of actions taken in response to this inspection. Hardwick Dene DS0000064193.V260844.R01.S.doc Version 5.0 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hardwick Dene DS0000064193.V260844.R01.S.doc Version 5.0 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.V260844.R01.S.doc Version 5.0 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 the following standard(s): 1,3,4,5, The home has not conclusively demonstrated they can assure prospective service users that their needs will be met by the home. EVIDENCE: The Statement of Purpose and Service User Guide are documents that should be used to better inform prospective service users. The Assistant Manager showed the inspector the newly written Statement of Purpose and Service User Guide. The Statement of Purpose and Service User Guide that have been rewritten since the last inspection were presented in four different documents. The four documents were entitled: “Statement of Purpose and Service Users Guide”; “Statement of Purpose”; “Service Users Guide”; “Terms and conditions of Residence”. These documents appeared as a very similar format and presentation as the previous owners. The documents were undated and contained duplicated information. The inspectors brought this matter to the attention of the assistant manager during the inspection and discussed what each document must include. The Statement of Purpose and Service User Hardwick Dene DS0000064193.V260844.R01.S.doc Version 5.0 Page 10 Guide must be must be reviewed and presented according to the Care Homes Regulations 2001 and the National Minimum Standards and be successfully completed by 1st January 2006. Service users are assessed either by a Care Management assessment, or by an assessment conducted by the home prior to any planned admission. Service users’ files containing there assessment information. An initial trial period of one month is offered. In consideration of the comments made about care planning records in the following section, the judgement is that the home have not conclusively demonstrated they can assure prospective service users that their needs can be met by the home. Intermediate care is not provided by the home. Hardwick Dene DS0000064193.V260844.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,10, Care Plans do not address all aspects of care and consequently the approach to maximising a person’s social and health needs has been missed. EVIDENCE: In the last inspection report it was stated that, “Service users’ Care Plans were stated by the Manager not to record the expressions of desires, expectations and wishes for daily routines or any consultation with them or their representatives about their health. This aspect of care planning was discussed with the manager and provider as being essential and that Care Plan records must record the consultative methods used to agreeing how to provide all aspects of care.” During this inspection the inspector and the Assistant manager discussed how person-centred care could be promoted and how this should be written into Care Plans. The Assistant manager informed the inspector that Care Plans are going to be revised in the near future. Three Care Plans were read. One Care Plan contained a reference to strapping the service user in a wheelchair to prevent her falling from the chair. The service user’s spouse had been consulted and agreed to this practice but no consultation with a Psychiatric Health professional had been made in relation to Hardwick Dene DS0000064193.V260844.R01.S.doc Version 5.0 Page 12 the use of this restraining method. It was observed that two other service users were also restrained by a seating belt for certain periods of the day and no consultation involving mental health services had been sought in their circumstances. Care staff were aware of the reasons for using these restrictive seat belts and were being considerate in their care and were not intentionally causing distress or abuse. However, the assistant manager was informed of the potential for abuse as a result of this action. It was agreed that for any service user for whom it was a consideration to use a restraining belt, consultation and agreement must be reached when people lack the capacity for understanding their care arrangements. The assistant manager agreed that she would immediately refer this aspect of their care to psychiatric services for their involvement. Care Plans did not include this record of care for the two service users who wore restraining belts, nor was there any record of falls in the “Falls and Treatment” pages of two service users’ Care Plans. There was no available record assessing risks and no explanation about the reason and use of restraining belts. The three Care Plans did not have a contents page, were missing identifying photographs, contained duplicated information, falls and treatment records had not been maintained, a page called “health and safety” sheet had no apparent use that the Assistant Manger could indicate. In addition, the Care Plans were jumbled in their contents; they were difficult to read and to find any particular aspect of a persons care. Considering the need for service users to be assisted at mealtimes, none of the Care Plans contained information regarding this aspect of care. It is recommended the Care Plans should be developed in a person focused manner, as indicated in the Statement of Purpose offered by the home. It is required that Care Plans must include all aspects of care and record how care is provided. Where risks have been suspected, such as the potential for falls, all consultation and possible courses of preventative measures must be pursued and the description of how to apply any preventative measure, must be recorded. The home did not have any record of consulting the falls specialist nurse falls specialist nurse. As a consequence of the above it is appropriate for staff to have training in falls management and for refresher training in moving and handling so that service users receive the considered care and are protected from potentially abusive practice. The manager is expected to be active in ensuring the supervision of appropriate care practices within the home. Hardwick Dene DS0000064193.V260844.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 13,15, Family contacts are maintained and meals are nutritious and well presented. EVIDENCE: One visiting relative spoke of his daily visits to the home. He considered the care and attention shown to his wife was very good and he was totally satisfied with and confident in her care. He added that he had been consulted and kept informed by the home of her care arrangements and was made welcome at all times. A very well presented meal was observed being served. During the inspection the gas cooker became faulty. A quickly re-arranged meal of fresh ham and vegetables was served instead of the fish meal that had been planned. The food looked very appetising and of good quality. Service users confirmed they had enjoyed their meal. Observations of the mealtime assistance and staffing arrangements were made. The assistance given was attentive and kindly and was suited to service users individual needs. It was a very different and much improved situation than that observed during the last inspection. Hardwick Dene DS0000064193.V260844.R01.S.doc Version 5.0 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 the following standard(s): 16,18 The home’s complaints process is not adequately promoted. EVIDENCE: The home did not have a complaints logbook when asked by the inspector. The inspector and the assistant manager agreed the home should immediately start a book entitled “Compliments and Complaints”. One visiting relative stated he had not seen the homes complaints procedure and did not know about the role or existence of the CSCI. The home is reminded of the comments written in “Health and Personal Care” section of this report about the practice of restraining service users in their seats and that this must not become an abusive practice. Hardwick Dene DS0000064193.V260844.R01.S.doc Version 5.0 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 the following standard(s): 19,20,21,22,23,24,25,26, Service users live in very comfortable and well-presented environment that can be made safer by minor alterations. EVIDENCE: Generally the home is very well maintained. Attention must be given to the outside area where the step from the door to the paved area has a wide gap for service user to navigate. The step that had been referred to in the previous inspection report is a difficult physical and visual barrier to negotiate for service users affected by dementia: “The doors to the outside from the extra care dementia unit had gaps between the wall and the paving level.” It is expected that service users have the freedom to use the garden /patio area when the weather permits and this access must be safe. The gap must be made safe. In relation to the comments made in the previous sections, “Health and Personal Care” and “ Complaints and Protection” of this report, an occupational therapist and or a falls co-ordinator nurse should be requested to assess the Hardwick Dene DS0000064193.V260844.R01.S.doc Version 5.0 Page 16 home facilities and for advice regarding any moving and handling needs that service users may have. Hardwick Dene DS0000064193.V260844.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30, Further staff training is required. EVIDENCE: The two staff working in the dementia care unit were observed to be good communicators and attentive and kind towards service users. However, observations made after the lunchtime meal indicated the staff were struggling to assist two service users to move from one seat to another. Staff must be confident when to use equipment designed to assist with moving and must understand the correct non lifting procedures. Additional training in understanding and responding to falls and for moving and handling skills must be made available for all staff. As good practice, staff should be consulted for their training needs. The last report suggested, “A review of the physical and mental health care needs of all service users who do not live in the Dementia extra care part of the home should be considered. Consultation with Community Psychiatric Services and other Community Nurses and Occupational Therapists for both mental and physical health should be sought in these re-assessments.” The home is expected to have responded to this recommendation by the time of the next inspection and to show their willingness to improve care planning, staff training and the wider consultation process to ensure care is suited to individual needs. Hardwick Dene DS0000064193.V260844.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,37, Management of the daily care practices needs to be focused on the benefits that can be achieved for service users. EVIDENCE: The home is yet to implement quality assurance methods. Care Plan records should be improved as already identified. Hardwick Dene DS0000064193.V260844.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 3 2 3 3 3 3 STAFFING Standard No Score 27 X 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X 2 X Hardwick Dene DS0000064193.V260844.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 6 Requirement Timescale for action 01/01/06 2 OP7 OP33 14(2)(a)( b),15(1)( 2) 3 OP8 13(1)(b) The Statement of Purpose and Sevice User Guide must be kept under review and must be dated. This requirement has not been met since the last inspection report for the 17/08/2005 Care Plans must be kept in a 01/02/06 clear and concise manner and must relate to all aspects of a persons care and must record all consultation and advice from health professionals. The practice of restraining 01/01/06 service users with the seating belt in wheelchairs must be agreed between health professionals, relatives or advocates of the service user and the home. For service users who lack the mental capacity to understand this action, there must be the involvement of a Community Psychiatric Nurse or Psychiatric Consultant and for service users who have needs arising from risks associated with falling, they must be referred to specialist falls-nurse coordinators. DS0000064193.V260844.R01.S.doc Version 5.0 Hardwick Dene Page 21 4 OP18 13(6) 5 OP19 23(2)(n)( o) 18(1)(c,(i )) 24(1)(a)( b) 6 OP30 7 OP33 The home must inform the CSCI in writing of what action they are taking to prevent potential abusive care practices related to the use of restraining equipment. The gap between the doorstep and the outside paving from the doors in the dementia unit lounge must be made safe. Refresher training for staff in Safe Moving and Handling and in falls prevention must be arranged. The home must implement a quality assurance method. 01/01/06 01/01/06 01/01/06 01/02/05 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 OP16 Good Practice Recommendations The complaints procedure should be more obviously advertised within the home so that all visitors are able to read the arrangements and methods of making a complaint or compliment. Service users should have safe and easy access from the lounge into the garden whenever the weather permits. In relation to the comments made in sections, “Health and Personal Care” and “ Complaints and Protection” of this report, an occupational therapist and or a falls coordinator nurse should be requested to assess the home’s facilities and for advice regarding any moving and handling needs that service users may have. 2 3 OP19 OP22OP30 Hardwick Dene DS0000064193.V260844.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE 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 Hardwick Dene DS0000064193.V260844.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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