CARE HOMES FOR OLDER PEOPLE
Hardwick Dene Hardwick Lane Buckden Cambridgeshire PE19 5UN Lead Inspector
Don Traylen Unannounced Inspection 31st January 2007 10:00 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.V329182.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.V329182.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 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.V329182.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19 October 2006 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.V329182.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A Regulation Inspector and a Regulation Manager carried out this key unannounced inspection on 31st January 2007. A number of service users were spoken to during the visit and several staff spoke to the inspectors. The registered manager and the area manager were both available throughout the inspection and feedback was given to both persons during and at the end of the inspection. The requirements from the last report were discussed and evidence in care Plans maintenance records and training records were assessed. Two visiting relatives and a District Nurse and Physiotherapist spoke to the inspectors. Of the four requirements made in the last inspection one had been considered met and three had not been met. Standard nine was not assessed on this occasion as this standard has been the subject of a specialist pharmacist inspection. There are six outstanding requirements concerning this standard that will be assessed by the pharmacist inspector in the future. These six outstanding pharmacist’s requirements have not been included in this report. What the service does well: What has improved since the last inspection?
The manager has completed her Registered Managers Award coursework and was awaiting confirmation of the award. The main entrance area was bright and inviting and appeared more spacious. The deputy manager has left and this has provided an opportunity for the manager and the area manager to rethink their management of the home. Staff were observed to have a more focused and confident approach to their work. The manager and the area manager were in the process of updating the home’s policies and some had been rewritten, whilst others were still in the
Hardwick Dene DS0000064193.V329182.R01.S.doc Version 5.2 Page 6 process of being reviewed. Care Plans are continuing to be rewritten in the new format and a ‘key worker’ system is being introduced. New responsibilities and roles are being introduced that are designed to monitor the performance of care responsibilities. A senior care assistant will conduct some of this monitoring, whilst other tasks, such as monitoring the practice of moving and handling, will be monitored by the manager. There are some initiatives that the management have started that are potentially good indicators of quality and quality assurance. One initiative is the relatives and service users meetings that have been promoted and several have relatives have attended. The home has a number of visiting relatives and they are being informed of these meetings and are encouraged to keep contact with each other, as part of a relatives’ network. Staff meetings and staff supervision sessions are now being held regularly and have been recorded. A quality assurance questionnaire has been devised for service users and relatives. What they could do better:
The registered manager needs to generally improve her record keeping and to develop systems to ensure that on a daily basis there is recorded evidence of service user focused care within the home. Some of these approaches are indicated in the requirements that have been brought forward from the last report. It is essential that all staff undertake training in the protection of vulnerable adults from abuse, provided by Cambridgeshire County Council trainers and are individually capable and know how and to where to report a suspicion or n allegation of abuse should this ever be necessary. All contact details for the Police Action for Justice Officers and Adult Protection Lead Key Practitioners, employed by Cambridgeshire PCT should be clearly visible and easily available for all staff to access. All contact details for the Police Action for Justice Officers and Adult Protection Lead Key Practitioners, employed by Cambridgeshire PCT should be clearly visible and easily available for all staff to access. All staff need to undertake ‘in- depth’ Dementia related care training, despite it being identified as an arrangement to have been made in the requirement in the last inspection report. This has now become an urgent matter considering the home is registered to provide for up to 33 service users with dementia. Given that there are various ways to access dementia related care information and training, the manager has not made adequate progress in arranging this training for care staff. Dementia related care and a range of available information on this subject should also be promoted and encouraged by the
Hardwick Dene DS0000064193.V329182.R01.S.doc Version 5.2 Page 7 manager to ensure that all care staff and ultimately service users, will benefit from staff having greater awareness and knowledge through this information. To ensure service users’ safety and to ensure that appropriate care is identified, risks assessments must be undertaken and recorded for all service users and maintained within their care plans. Subsequent to identifying risks in a risk assessment, care plans should contain sufficient detailed information about dietary needs and habits that have been assessed or noticed by care staff. Any action taken to monitor and address known weight loss or reduced consumption of food should be recorded. The daily records for each service user should contain specific detailed information about a service user’s routine and habits, so it is clearly recorded whether anyone has eaten all or part of a meal and it is therefore possible to quantify the daily amount of food a service user has eaten. Records of training that all staff have undertaken, must be accurately recorded. Records of the temperature of any freezer used to store food must be maintained and a working thermometer must always be available in the freezer(s) to read the temperature. The registered manager should promote the home’s complaints policy and procedure so that it is more noticeable within the home to ensure that any person is encouraged to make their views or complaints known to the manager. 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.V329182.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.V329182.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, Quality in this outcome area is good. Assessments are carried out for all service users prior to them moving into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Assessment details of three service users were read. These assessments were comprehensive Care Programme Approach assessments conducted by Mental Health services. There was sufficient information from which to make adequate care plans. There were also assessments carried out by the home. These assessments contained details of family and personal history and a medication profile. Intermediate care is not provided by the home and therefore Standard 6 was not assessed.
Hardwick Dene DS0000064193.V329182.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): 7,8,10, Quality in this outcome area is adequate. Not all service users’ known risks are recorded or assured of being met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three service users care plans were read and were more than adequately informed by a CPA assessment. One area of risk was not included in the care plan of one person likely “to abscond”. Nutritional screening had not been carried out adequately for another service user, who was known by the cook and the manager to have a reduced appetite and known to have lost weight. Another service user who had been assessed as, ‘not eating properly’, did not have a dietary action plan within her care plan although the manager did point out that she was eating well and had actually gained weight. The two inspectors discussed with the manager that the home must have measures to assess these known risks for any service user and what actions, if any, are being taken.
Hardwick Dene DS0000064193.V329182.R01.S.doc Version 5.2 Page 11 Service users were observed to be treated respectfully and their privacy upheld. Standard nine is the subject of a separate specialist pharmacist inspection. There are six outstanding requiremnts made from the last pharmacist inspection that will be assessed at a future pharmacist inspection. These requirements have not been shown in this report. Hardwick Dene DS0000064193.V329182.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. Service users experience a quite and peaceful lifestyle that is suited to their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Most service users are quiet and frail and experience passive lifestyles. The home has frequent family visitors. Whether service users can always be satisfied of their choice is not evidenced. One service user who informed the inspector that she wanted something else for dinner eventually ate what she was served although this had been her choice that was made the night previously. She stated that the choices of meals are limited to two. The meal that was seen being served was a choice of two and service users had made different choices. The meals looked appetising. For service users whose nutritional intake is reduced or whose weight loss is known the kitchen staff did not have a specific record of what they ate or of any special dietary requirement.
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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 adequate. Immediate improvements are necessary to ensure service users’ safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Not all staff have received training to protect vulnerable adults from abuse. Nine staff had not received this training according to the training records and the manager verified this during the inspection. There were no available written directions or instructions for staff to contact should they need to report abuse. The manager could not show the inspectors any contact details for the Police or for the Key Practitioner Social Worker to report abuse an allegation of abuse to. The manager was advised to immediately contact the Adult Abuse Co-ordinator for Cambridgeshire County Council. The manager stated that no complaints had been made to the home and none were recorded. The complaints procedure posted in the home was unknown to visiting relatives who stated they were confident of speaking to the manager should they choose to. The complaints procedure advertised in the home was seen near the main entrance and should be made more visible in other places in the home.
Hardwick Dene DS0000064193.V329182.R01.S.doc Version 5.2 Page 14 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): 19,24,26, Quality in this outcome area is good. Service users live a comfortable wellmaintained homely environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has achieved a high standard of comfort and furnishings. It is very clean and brightly decorated, very well maintained and warm. The home is equipped with a large kitchen and plenty of garden and outdoor storage and parking facilities. There is a decidedly ‘homely’ feel to the building. Service users rooms were individually furnished and contained many personal items. Hardwick Dene DS0000064193.V329182.R01.S.doc Version 5.2 Page 15 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, Quality in this outcome area is adequate. Service users’ needs could be better assured by additional staff training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were six care staff plus the manager working on the day of the inspection and there were 37 service users living at the home. The staff on duty were meeting service users’ needs at the time of inspection and they appeared competent and confident at carrying out their tasks. Two relatives stated that they were satisfied with the staffing arrangements they encountered when visiting their relative in the dementia care unit. Five care staff that were consulted stated they would like more training in Dementia care. It was not clearly evidenced in the training records exactly what training each care worker had undertaken. Not all care staff had received training in Protecting Vulnerable Adults or in Dementia care. The home is registered to provide for 33 people with dementia care and a thorough overhaul of the staff who are competent should be arranged to assure service users their needs can be more adequately met. Some training in Dementia care had been provided, although some staff records did not reflect this. The
Hardwick Dene DS0000064193.V329182.R01.S.doc Version 5.2 Page 16 manager informed the inspectors she was in the process of sourcing providers so she could arrange this training. Staff recruitment records were accurate and contained the essential and necessary information. Staff meetings are held regularly and have been recorded. Supervision arrangements are progressing and are now being recorded. Hardwick Dene DS0000064193.V329182.R01.S.doc Version 5.2 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 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 adequate. Management of the home is much improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has completed her Registered Managers Award and on the day of inspection was awaiting confirmation of her award. The management of the home is supported through the appointment of an Area Manager, that has been mentioned in previous reports and the beneficial effects are tangible in the clarity of work and improvements being focused on and the support given to the manager of the home. Evidence of an improved
Hardwick Dene DS0000064193.V329182.R01.S.doc Version 5.2 Page 18 management approach was seen in the staff meetings and staff supervision sessions that were held and have been recorded and in the quality assurance questionnaire that has been devised for service users and their relatives. There are some initiatives that the management have started that are potentially good indicators of quality and quality assurance. One initiative is the relatives and service users meetings that have been promoted and several have relatives have attended. The home has a number of regular visiting relatives and they are being informed of these meetings and are encouraged to keep contact with each other, as part of a relatives’ network. Records were read for fire safety maintenance and the Chief Fire Officer’s report was read. 23 staff undertook fire safety training on 11/01/2007. The last fire alarm was recorded as tested on 26/01/2007. Thermostatic valves control the temperature of hot water and this was considered within acceptable limits of temperature. Record of care plans and staff recruitment and staff training showed that additional recording of detailed risks must be kept in care plans and that staff training records need to be accurately maintained. The temperatures of one freezer had not been recorded and there was no thermostat to use to measure the temperature. Quality assurance monitoring of safe Moving and Handling practice had not progressed since the last inspection. As a consequence the requirement made in the last report has been brought forward and the registered manager must provide evidence of correct safety procedures being used when staff carry out moving and handling of service users. Service users finances held by the home were assessed and found to be accurate records of their monies. Hardwick Dene DS0000064193.V329182.R01.S.doc Version 5.2 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 N/A 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 2 17 X 18 2 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 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.V329182.R01.S.doc Version 5.2 Page 20 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 15(2)(a) & Schedule 3 (m) 13(4)(c ) & 14(2)(a)( b) 22(2)(5) Requirement The registered manager must ensure that care plans records contain details of any care relating to nutrition. The registered manager must ensure that a risk assessment is conducted for each service user to include weight, diet and nutritional intake. The registered manager must ensure that the home’s complaints procedure is accessible to all service users and their representatives. To ensure that service users are safeguarded against harm, the registered manager must arrange for all staff to undertake training in the protection of vulnerable adults from abuse, provided by Cambridgeshire County Council trainers. Arrangements must be made for all care staff to receive appropriate training in dementia care. The registered manager must arrange to provide appropriate accredited dementia care training for care workers.
DS0000064193.V329182.R01.S.doc Timescale for action 31/03/07 2 OP8 31/03/07 3 OP16 31/03/07 4 OP18 13(6) 31/03/07 5 OP30 18(1)(c) 31/03/07 Hardwick Dene Version 5.2 Page 21 6 OP38 13(4)(c) 7 OP38 24((1) The timescale of 19/12/06 made in the last inspection report has not been met and has been extended. Accurate records of fridges and freezers temperatures must be kept to ensure unnecessary risks to service users are eliminated. The timescale of 30/10/06 made in the last inspection report has not been met and has been extended. The registered manager must ensure the safety of service users by monitoring staff for carrying out safe moving and handling practices. The timescale of 30/10/06 made in the last inspection report has not been met and has been extended. 31/03/07 31/03/07 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 OP7 Good Practice Recommendations Care plans should contain sufficient detailed information about dietary needs that have been assessed as a risk. The daily records for each service user should contain specific detailed information so it is clearly recorded whether anyone has eaten all or part of a meal and to quantify the daily amount of food a service user has eaten. A more comprehensive promotion of dementia care and dementia related matters should be sought and promoted within the home by the registered manager. All contact details for the Police Action for Justice Officers and Adult Protection Lead Key Practitioners, employed by Cambridgeshire PCT should be clearly visible and easily available for all staff to access. 2 3 OP30 OP18 Hardwick Dene DS0000064193.V329182.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office 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
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