Inspection on 06/04/06 for Hardwick Dene

This inspection was carried out on 6th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 13/07/07

Hardwick Dene 31/01/07

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 10:00 6 ,21 , 28 April & 3rd May 2006 th st th 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.V288684.R01.S.doc Version 5.1 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.V288684.R01.S.doc Version 5.1 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.V288684.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th November 2005 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 £414 to £560 per person per week and were provided verbally by the registered manager on the 03/05/2006. A copy of the latest CSCI Inspection reports is usually made available to all visitors to the home to read and is located inside the main entrance on a tabletop. Hardwick Dene DS0000064193.V288684.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The pre-inspection planning was guided by the expectation to cover all key National Minimum Standards. Initial planning consideration was given to: 1. The last inspection on the 25 November 2005 indicated the home was assessed as a home that should improve. 2. The 8 Requirements and 4 Recommendations made in the previous inspection report of the 25 November 2005 with timescales of January and February 2006. 3. The detail and quality of information provided in the regulation 26 reports sent to the CSCI as a method of self -monitoring by the provider. 4. A pre-inspection questionnaire and 38 service user survey forms sent to the home on 07/04/06. The questionnaire was not received by the CSCI within the timescale requested. Only five service users’ comment cards were returned to the CSCI. The inspection consisted of four visits to the home: at 11 pm on 06/04/2006; at 9.30 am on 21/04/2006; at 10 am on 28/04/2006 and at 10 am on 03/05/2006. On the first two visits, two inspectors assessed the home and one inspector assessed the home on the last two visits. The first inspection visit took place over 1.5 hours, the second visit lasted 2 hours, the third inspection visit took 5.5 hours and the fourth inspection visit took 2 hours. The first inspection visit was unannounced and was intended to determine the circumstances prevailing in the home during the night and to seek the views of the care assistants, their responsibilities and duties as well as enquire about the night time needs of service users. During the second unannounced visit which was decided after the first inspection visit, the inspectors spoke to the deputy manager, four care assistants, the cook, the cleaner, two visiting relatives and assessed the administration of medication, staff supervision, the functioning of the kitchen and the methods and manner of communication between the registered manager, the owner and care staff. This second visit revealed concerns about the quality of management. As a consequence of these concerns, a third visit was planned when the registered manager would be present and this was arranged through the deputy manager. During the third visit the proprietor and the registered manager and four care assistants and a District Nurse who was visiting service users spoke to the inspector. Three Care Plans and a range of records and policies were assessed during this visit in the presence of the registered manager. Further records for care planning issues about moving and handling, staff recruitment and staff training and supervision were assessed during the inspector’s fourth visit. Hardwick Dene DS0000064193.V288684.R01.S.doc Version 5.1 Page 6 Feedback was given to the registered manager during the third visit and to the registered manager at the end of the fourth visit. On the 28 April both the registered provider and the registered manager were informed of the poor standard of management of medications prevailing in the home and that a full pharmacy inspection would be undertaken by a dedicated inspector from the CSCI. The manager informed the inspector that an alternative pharmacy (Boots) had been contracted to supply service users’ medication and would commence on the 1st May 2006. An Immediate Requirement was left during the inspection on the 03/05/2006 for the home to respond within 24 hours because they had failed to apply for CRB disclosure for two oversees persons they had employed as care assistants. What the service does well: What has improved since the last inspection? Of the 8 Requirements and 4 Recommendations set in the last inspection report of the 25/11/2005, 3 Requirements and all the Recommendations had been met. 2 further Requirements to do with Care Plans had been partially met. An improvement to the approach of providing information to the CSCI in the Regulation 26 reports has been evident. However, the actual content of these reports and any meaningful consultation should be more evident in the reports received by the CSCI. This issue and opportunity to assure quality, was discussed with the provider during the inspection on the 28/04/2006. The standard of interior decoration has been maintained and new curtaining and carpets have been supplied in some bedrooms and lounges. A total of 6 care staff have achieved NVQ level 2 awards in care and 6 more staff are due to complete this award in the near future. Hardwick Dene DS0000064193.V288684.R01.S.doc Version 5.1 Page 7 What they could do better: A number of subjects for improvement have been addressed in the 14 Requirements and 6 Recommendations made in this report and include those remaining unmet from the last report. There are areas of concern where there has been a significant failure to meet regulations that present risks to service users. A satisfactory level of improvement depends upon the home instigating a rigorous and transparent quality assurance process designed to monitor all aspects of their service. The aspects of the service that need to improve are: • • The home’s Statement of Purpose must always be made available for inspection for any person who requests this. All service users’ Care Plans must be maintained and should include specific care details about dietary needs and regular records of weight. Needs that indicate risks associated with mobility, must be risk assessed and must contain a detailed instruction or plan for methods of manoeuvring, moving and handling the person. Records of meals and the choices of meals offered must be maintained. Records and the management of medicines must be accurate and meet The Care Homes Regulations 2001 and follow the guidelines for managing medication in care homes that have been issued by the Department of Health. Equipment for manoeuvring service users must be appropriate to their needs and should be regularly checked for safe use. Staff training arrangements need to be reviewed and records of staff training must be maintained in a readable and usable format. Staff supervision must be regularly conducted. Staff recruitment procedures need to be reviewed so that satisfactory CRB checks and two references are received for every worker before they commence employment. Most of the home’s policies and managements systems need to be reviewed to ensure the Requirements and Recommendations made in this report can be achieved. • • • • • • • During the second inspection on the 21/04/06, the evidence gathered showed that the management, recording and administering of medication was poor. It is considered that the registered manager has not exercised good management skills because she had not ensured adequate management of medicines or of recruitment procedures and has not reviewed the home’s less than adequate written policies. Hardwick Dene DS0000064193.V288684.R01.S.doc Version 5.1 Page 8 Supervision arrangements have not been consistent and records of any supervision for most staff were unavailable apart from some supervision having taken place in December 2005 for a few members of staff. Some staff reported they were not receiving supervision and that staff meetings had not been held. The management of the kitchen must be improved so that records of meals and choices and dietary needs are kept and attention to maintaining a cleaner environment should be made. The appropriate and recommended moving and handling techniques and the use of appropriate equipment must be followed. Poor moving and handling techniques were observed on 28th April in the extra care unit for service users with dementia related care needs. It is recommended the home employ additional cleaning staff or make arrangements for cleaning to be conducted by dedicate domestic staff other than people employed as care workers. The conclusion of this report is that the home is not managed in the best interests of service users although staff demonstrated they were committed to providing good care. Considering the range of concerns raised throughout this report, there has been a failure of management and a lack of co-operative, open and effective communication. 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. Hardwick Dene DS0000064193.V288684.R01.S.doc Version 5.1 Page 9 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.V288684.R01.S.doc Version 5.1 Page 10 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): 1,2,3,4,5, The quality outcome for this group of Standards is poor. There was less than adequate information provided about the home’s admission procedures to confirm that prospective service users are well informed. EVIDENCE: During the visit on the 28/04/2006 the home did not have a Statement of Purpose (SOP). The manager printed one from the home’s computer but it was for a different care home. During the inspection on the 28/04/2006 the manager was asked to produce a satisfactory SOP document by the 03/05/2006. No available copy of the Statement of Purpose was available on this date although the manager did state she was in the process of completing the document. The Service User Guide did not provide written information about the range, or amounts of fees. These details were requested from the manager who verbally gave this information. Fees to reside at the home cost from £414 to £560 per week. Two self-funding service users’ contracts showed respective payments of £500 and £550 per week. The two contracts did not contain details about Hardwick Dene DS0000064193.V288684.R01.S.doc Version 5.1 Page 11 assurance of meeting service users’ needs, or of arrangement to be made if assessed need could not be met, or if a person’s needs were to change, or their room number. The contracts did not fully address or include any the responsibility laid out in National Minimum Standards 2. On the 03/05/06 there were 22 private or self-funding service user and 16 service users supported by a Local Authority contribution, 10 of whom were paying an additional “top-up” amount to meet the difference between the LA contribution and the charges requested by the home. The manager stated that that pre-admission assessments are required either from a Care Manager who is commissioning care on behalf of a local authority or PCT, or may be carried out by the home prior to agreeing to accommodate any service user. In the absence of an available Statement of Purpose or an admission policy document, the manager verbally confirmed the information in the Service User Guide as being accurate and that the home operates a trial period for any admission. Two self-funding service users’ contracts stated their respective payments of £500 and £550 per week. The two contracts did not contain details about assurance of meeting service users’ needs, or of arrangement to be made if assessed need could not be met, or if a person’s needs were to change. The lack of a Statement of Purpose, the brief details contained in the service users’ contracts and the lack of substantiation in the Service User Guide about contractual agreement plus an overall lack by the home to demonstrate good practice arrangements and a quality assurance process referred to in The requirements and recommendations made in this report did not adequately address the responsibility laid out in National Minimum Standards 2 and 4. Intermediate Care is not provided. Hardwick Dene DS0000064193.V288684.R01.S.doc Version 5.1 Page 12 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): 7,8,9,10, The quality outcome for this group of Standards is poor. Generally the Care Plans are adequate but are missing specific detail whilst the homes practices and policies to manage medication are poor and place service users at risk. EVIDENCE: During the second inspection on the 21/04/06 the medication system was inspected as were the storage facilities, and records of medications brought into the home, administered and disposed of. A number of serious concerns were noted and the inspector advised the manager that a Pharmacist inspection has been requested because of the evidence found during this inspection. During this inspection it was noted that there was overstocking of medication, that medication records were not accurate, that there was not a records of medications received into the home or returned to the pharmacy, that not all medication was being administered from its original container and that some medication was out of date. The manager informed the inspector that an alternative pharmacy (Boots) had been contracted to supply service users’ medication and would commence on the 01/05/06. Hardwick Dene DS0000064193.V288684.R01.S.doc Version 5.1 Page 13 Three Care Plans for service users living in the extra care dementia related care part of the home and one Care Plans for a service user with very dependent physical and dementia related needs not living in the dementia care part of the home were read. Only one of these four service users was independently mobile. The three Care Plans for service users living in the dementia related care part of the home were concise and neat and easy to read and use. They focused on preventative actions and were risk based. It was considered that all Care plans had underscored service users mobility dependency levels. This underscoring was pointed out to the manager. One Care Plan for a service user with extremely limited means of manoeuvring independently, did not include a ‘risk assessment’, ‘a manual handling risk assessment’, ‘pressure sore plan’, ‘daily routine’, ‘medication profile’ or ‘weight profile’, that were all subjects clearly written in the printed index of the Care Plan. Each of the four Care Plans had clearly indicated each service user had needs associated with mobility. Staff working in the dementia unit appeared not to be kept informed of the information provided by Community Psychiatric Nurse who regularly visit some service users and these visits were not recorded on Care Plans. Not all aspects of care had been adequately recorded in any of the Care Plans: there was no system to record amounts of food intake when it was known that service users appetite or ability to eat was reduced. There were no records of weight in any of the four Care Plans. A district nurse discussed the care of a number of service users and reported that at times the home has not had sufficient incontinence sheets and that the home should be requesting assistance and reporting information more often and regularly to GPs and District nurses. Poor moving and handling techniques were observed on 28/04/06 in the extra care unit for service users with dementia related care needs when staff not working in the unit assisted a service user to move from one chair to another after she had been attended by the district nurse. The inspector observed this example of poor moving and handling skill by two staff and one example of excellent moving and handling skills both on the 28/04/06. One service user was assisted and encouraged to move with the care assistant from one chair to another by one member of staff. Two other care assistants then attempted the same move by manually holding and lifting. The manager, who is trained to provide training for moving and handling skills, was informed of this observation and confirmed that she had not taken any steps to implement any system to monitor or ensure care staff use appropriate skills matched to the needs of service users. One service user seated on a wheelchair in the lounge/dining room was awaiting her breakfast at 10.15 am on 28/04/06 and told the inspector she must have a pad/cushion to sit on. She stated she had already asked a member of staff and was waiting. The inspector asked a care assistant to provide a cushion /pad and he replied there were not any spare cushions. The manager was informed of this event and asked to intervene. Hardwick Dene DS0000064193.V288684.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, Quality in this outcome area is adequate. Service users’ lifestyle appears to be adequate although service users were very quiet and placid with little observed stimulation. Attention to service users individual dietary needs and choices of food is poor and appears controlled. EVIDENCE: This section should be read in conjunction with environmental group of Standards and with Standard 7 and be considered in relation to any consultation with service users. During the second inspection visit on the 21/04/06 choices for service users about meals and information about their dietary needs and habits were not recorded or maintained in the kitchen. On the 21/04/06 the meal provided was not the fish pie that had been recorded on a wall chart but was battered cod. Two service users who do not eat fish were going to be offered lasagne but there was no record of this. Food intake and lack of recording of this by kitchen staff and in Care Plans, already referred to in this report, indicates there is a lack of information and insufficient attention to service users choices and to their nutritional needs. However, the meals that were observed over two visits were appealing and were eaten by service users and three service users stated they were provided with enjoyable food and had sufficient to eat. One service user, whilst speaking to the inspector on the 28/04/06 at 10.15 am, requested her breakfast. Another service users shouted Hardwick Dene DS0000064193.V288684.R01.S.doc Version 5.1 Page 15 out, “not had anything to eat yet”. Both service users were subsequently assisted by staff. Four other service users were eating their breakfasts. The home operates a system where the cook enquires of each person seated in the dining area what he or she would like for breakfast. The cook personally serves each service users with their breakfast. A choice of breakfasts on the 28/04/06 was limited to cereals and /or toast. One of the five service user comment cards returned to the CSCI had written, “the food is bland and the meat is tuff....should be given a choice the day before”. On the 21/04/06 and on the 28/04/06 there were uncovered and undated, prepared deserts stored in a fridge. There was a sink full of cold dirty washingup water, with dishes and a full open rubbish bin in the kitchen. On the 21/04/06 both inspectors spoke to the cook who was unable to provide written records of service users meals and individual needs. There was a menu posted on the wall that listed menus and these somehow were cross-referenced to a calendar with handwritten entries about the actual food provided on the day. This method of recording was the only available record of the actual food provided. There were no choices of food available in the dementia care unit and on the 28/04/06 the menu written on the wall of the lounge showed the previous days menu. There were no available records of temperatures of cooked meats. The area immediately to the outside rear door of the kitchen was scattered with empty boxes and to the side there were discarded items of furniture. The inspector has made a request to the Environmental Health Officer to inspect the kitchen. Service users were observed to have frequent and regular family visitors. Three visiting relatives stated they were pleased with the care provided by the home and stated that the manager and care assistants are friendly, approachable and busy. One relative wrote, “ I feel satisfied that I am consulted adequately when it is appropriate”. There were no noticeable organised activities or stimulation provided to service during any of the inspection visits. However, staff took service users outside in wheelchairs into the sunshine for a brief period during two of these inspection visits. The level of interaction with service users and ability of skill and willingness of staff to interact varied. One relative, who regularly visits, often encourages a few service users to participate in an exercise session in the lounge. Hardwick Dene DS0000064193.V288684.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18, Quality in this outcome area is poor. Service users are not adequately protected from potential abuse. EVIDENCE: The home did not have a written adult abuse policy although they have the guidelines issued by Cambridgeshire County Council to protect vulnerable persons from abuse and the manager stated the home adhere to these guidelines. However, staff training in protecting vulnerable adults from abuse has not been received by all staff. One care assistant was not aware of any training about abuse. Two oversees care staff have been employed directly by the registered provider without any CRB applications being made. A new complaints book and a compliments book are available near to the home’s main entrance to allow anyone to write a complaint or compliment. There were no ongoing complaints being dealt with by the home. The home’s complaints policy was not read. Hardwick Dene DS0000064193.V288684.R01.S.doc Version 5.1 Page 17 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, Quality in this outcome area is adequate. Overall the environment is adequately clean and tidy and homely. There are some aspects of the environment that are poor and these are not in the service users’ best interests. EVIDENCE: Service users’ rooms had been comfortably personalised with their possessions. The lounge areas are light, bright and spacious and have enough seating for service users. The main lounges partially doubles up as dining rooms. The extra care unit has a separate dining area suitable for the needs of service users although there was an out of use television that has been sited in the corner of this room for a few months. A shared room, number 9, had a very worn carpet. Arrangements for maintaining the specialist equipment used for moving and manoeuvring service users have not been made and the registered manager admitted this on the 03/05/06. The manager confirmed there was not a Hardwick Dene DS0000064193.V288684.R01.S.doc Version 5.1 Page 18 system or responsible person named to checking the hoists, the slings or the wheelchairs or any equipment used to manoeuvre service users. No records were kept of the number of hoists or of any risks or checks carried out on this equipment. Staff reported that the home does not have sufficient slings for the different needs of service users. The manager, who is trained to provide training for moving and handling skills, has not taken any steps to implement any system to ensure that hoists, slings and other moving and handling equipment is in good order and is appropriate to the needs of service users. The home did not have a system to monitor or assess if staff skills are appropriately used when service users are being manoeuvred. This failure to manage was discussed with the manager on the 3/05/06. A mattress used to prevent a particular service user from being injured should he fall out of bed was stained, badly worn and ripped with the filling coming out. This was reported to the manager during the inspection on the 28/04/06. The only reclining chair in the extra care unit for dementia related care did not operate fully, despite it being regularly used by one service user. The inspector discussed the equipment and needs of the service users with a visiting District Nurse who was asked if she could refer to an Occupational Therapist to assess if the home’s moving and handling equipment was suitable for the service users’ needs. On the 21/04/06 two chairs with broken legs were stored in the hallway waiting to be repaired or replaced and one chair was blocking a fire exit. At the next visit the chair had been removed. Service users’ rooms had been comfortably personalised with their possessions. The lounge areas are light, bright and spacious and have enough seating for service users. The main lounges partially doubles up as dining rooms. The extra care unit has a suitable separate dining area although there is a broken television sited in the corner of this room. A staff smoking room is located quite close to two bedrooms and at times there is a strong smell of smoke within the home and near to the doors of these two service users’ rooms. There were uncovered and undated, prepared deserts stored in the fridge in the kitchens on two occasions; the 21/04/06 and the 28/04/06. The area immediately to the outside rear door of the kitchen was scattered with empty boxes and old pieces of furniture and appeared untidy. The inspector has made a request to the Environmental Health Officer to inspect the kitchen. There were no records kept in the kitchens of meals provided or of choices or of service users dietary needs. A full rubbish bin did not have a lid and there was a sink full of cold dirty washing water and the area immediately outside of the rear kitchen clear was scattered with boxes packing and pieces of furniture. Uncovered and undated prepared deserts were stored in the fridges. Records of the temperatures of cooked meats were not available. Hardwick Dene DS0000064193.V288684.R01.S.doc Version 5.1 Page 19 The inspector contacted the local Environmental Health Office and requested them to inspect the kitchens. It was reported that two care workers who live in the flat above the home share the use of the home’s kitchen. Hardwick Dene DS0000064193.V288684.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30, The quality outcome for this group of Standards is poor. Service users are not protected by any recruitment policy and have been placed at risk by poor recruitment procedures and inadequate staff training arrangements. Because the judgements are poor for Standards 29 & 30, satisfactory outcomes for service users that relate to Standards 27 & 28, have not been achieved. EVIDENCE: One service user informed the inspector on the 28/04/06 that staff do not have enough time to help and “they are hard pushed”. The registered provider had employed two care assistants from another country without any applications for a CRB check having been made and no references obtained. An Immediate Requirement for 24 hour action was left with the manager during the inspection visit on the 03/05/06. The registered provider telephoned the inspector the following day and stated that he did not think it was necessary to make a CRB check if he believed that a prospective employee had not lived in this country before. One other care worker’s file showed that only one reference had been requested. Staff training records are kept for each employee and these showed that that there has been little attention to arranging training for most training topics expected of care staff during the last 12 months and that some staff have still not yet undertaken training in the protection of vulnerable adults. One care assistant was unaware of what this training subject entailed. There was an Hardwick Dene DS0000064193.V288684.R01.S.doc Version 5.1 Page 21 absence of a spreadsheet or a matrix analysis of induction, mandatory, essential or further training needs that staff may have or wish to gain. The manager was unable to satisfactorily explain what, if any, the training arrangements were. Considering the manager is trained to provide manual handling training and declared that she works two shift patterns each week (13 hours), she admitted she had not arranged to monitor skills in moving and handling or provide adequate monitoring of any equipment used for manoeuvring. A number of care staff including the deputy manager and manager verbalised their surprise and concerns at staff being requested to undertake additional cleaning tasks when service users need assistance. Care staff working in the extra care unit for service user with Dementia related needs have been given an extensive roster for cleaning duties that conflicts with their time to provide personal care. A copy of a list of “jobs” for, “AM”, “PM” “Night”, and “EMI unit”, issued by the provider for each working shift was read. It is clear that the emphasis ion domestic tasks is likely to take care staff away from service users and therefore affects the level of care and attention to people who have significant and deteriorating dementia care needs. It is recommended the home should consider making alternative arrangements for cleaning to be conducted by dedicated domestic staff and not by people employed as care workers. Furthermore, the instructions appear as institutional approaches to care that state, “after breakfast take residents to toilet and then back to their places in the lounge armchairs” and “after lunch take residents to toilet and then to their chairs” and “after tea toilet residents” and “6.25pm start taking residents to bed whoever wants to go” and “8.30pm give out supper and hot drinks to those residents who want some”. It is recommended the provider reflects upon his methods and approaches to giving instructions to staff employed in the home and the use of language when attempting to give instructions about care tasks that may be construed as potentially abusive towards service users. Staffing levels maintained during the day are usually 6 care staff and a manager or deputy manager. The ratio of 2 care staff to 11 or 12 service users with dementia related care needs as operated in the dementia unit is minimal staffing. There are two staff employed in the kitchen who overlap to cover from 6.30 am to 6pm; one laundry assistant working 7 am –3pm for 5 days a week; a domestic cleaner working 8am –1.30pm 9-1for 5 days a week. Therefore any additional cleaning expectations for staff to manage will detract from their roles as care workers. Care staff informed the inspector that they feel the registered provider and registered manager do not listen to their views and consider they are not consulted or encouraged sufficiently despite the staff meetings held on the 19/08/05, the 26/10/05, the 16/12/05, and the 04/01/06 and a General Meeting on 21/03/06. Hardwick Dene DS0000064193.V288684.R01.S.doc Version 5.1 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36,37,38, The quality outcome for this group of Standards is poor; the management, records and policies of the home do not adequately protect service users or serve their best interests. EVIDENCE: The registered manger is completing a Registered Managers award and is a qualified Moving and Handling trainer qualified through Colchester Institute on 24 &25/11/2006. It is considered that the registered manager has not exercised good management skills and there are not clear lines of accountability. She had not ensured adequate management of medication or of recruitment procedures and had not reviewed the home’s policies. No monitoring arrangements regarding safe moving and handling had been arranged and no checks of slings hoists or other aids used to assist moving a service user were available for inspection. The registered manager has not challenged the provider when conflicting routines concerning workloads had Hardwick Dene DS0000064193.V288684.R01.S.doc Version 5.1 Page 23 been issued that prevent staff from providing attention to service users’ needs. Either the manager did not notice, or failed to challenge the registered provider when he decided to employ two oversees recruited members of staff without applying for CRB checks. The manager had not arranged regular supervision arrangements for care staff or kept any records of the few supervision arrangements that had taken place. Care assistants, the deputy manager and the registered manager, reported to the inspector(s) there were not any firm supervision arrangements but supervision had taken place for a few care staff. Records of supervision dates that were seen were irregular with last supervision dates set in August and December 2005 and there were no records of any supervision contents able to be shown by the deputy manager or the registered manager on the 21/04/06 and the 28/04/06. One member of staff who has had disciplinary record was last supervised on the 25/08/2005. Two inspectors on the 06/04/06 read a communications record kept in the small staff area. The record indicated poor methods of communicating and issues remained unresolved. On that day of inspection there was not a staff rota where it was usually pinned to the wall of the staff area and the staff were unable to inform the inspectors where the rota was. A Pre-Inspection Questionnaire (PIQ) form sent to the home had not been returned to the CSCI by the 28/04/06 and an additional form was left on that day for the manager to complete by the 03/05/06. The document was eventually given to the CSCI but was missing sufficient detailed information. Information requested about staffing rosters was delayed and was not provided in full until the inspector had made further requests for it. Regulation 26 reports have been sent regularly to the CSCI. The reports for March 2006 February 2006, January 2006 and November and December 2005 all stated the same words, “Checked medication and fire records-all satisfactory”. They do not reflect the findings about medication that have been written in this report. The home’s policies and procedures were read on the 28/04/06 and on the 03/05/06 and had not been maintained or reviewed and some were inadequate to instruct staff, apart from the medications policy and yet, the home failed to manage medications satisfactorily. It is of some significance that on the 21/04/06 when the deputy manager was asked for the home’s policies, she replied that she did not know where they were and was unable to locate the Regulation 26 and 37 records when requested. Policies read and copies taken by an inspector included, ‘Training and Development’; ‘Selection and Recruitment’; ‘Staff Supervision’; ‘Drugs and Medication’; ‘Medications Procedure’ and documents taken were the “Minutes of General Meeting on 21 March 20062; List of “jobs”; Staff rota; list of service users funding arrangements; Care Plan Index sheet. Hardwick Dene DS0000064193.V288684.R01.S.doc Version 5.1 Page 24 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 1 2 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 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 1 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 X X 1 1 1 Hardwick Dene DS0000064193.V288684.R01.S.doc Version 5.1 Page 25 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 OP1 Regulation 6 Requirement The Statement of Purpose and Service User Guide must be kept under review and must be dated. This requirement has been carried forward from the last inspection reports of the 17/08/2005 and the 25/11/05. The timescales were not met. Care Plans must be kept in a clear and concise manner and must relate to all aspects of a persons care and must record all consultation and advice from health professionals. This requirement has been carried forward from the last inspection made on the 25/11/05. The timescale has not been met. Accurate records for the management, control and administration of all medication handled by the home must be maintained according to the National Minimum Standards and the Care Homes Regulations 2001. DS0000064193.V288684.R01.S.doc Timescale for action 20/06/06 2 OP7 14(2)(a) (b) & 15(1)(2) 20/06/06 3 OP9 13(2) 17(1)(a) Schedule 3 25/05/06 Hardwick Dene Version 5.1 Page 26 4 OP15 17(2) 5 OP18 13(6) 6 OP29 19(10) (11) & Schedule 2 7 8 OP30 OP30 18(1)(c) 18(1)(c) The registered manager must ensure that correct handling and labelling and recording of temperatures of cooked food and that records of meals planned and provided are accurately maintained. Arrangements must be made for all staff to be trained in the Protection of Vulnerable Adults and must receive this training from Cambridgeshire County Council. Recruitment procedures must not deviate from the Care Homes Regulations 2001 that ensures the home carries out a satisfactory CRB check or a POVA first check and two written references for all new staff prior to commencing employment. Immediate Requirement for 24 hour action. Arrangements must be made for all care staff to receive dementia care training as soon as possible. Refresher training for staff in Safe Moving and Handling and in falls prevention must be arranged. This requirement has been carried forward from the last inspection made on the 25/11/05. The timescale has not been met. The registered manager must adequately demonstrate her fitness to manage the home in an open and transparent manner to communicate effectively and enable care staff. The registered manager must adequately demonstrate her fitness to manage the home in an open and transparent manner to communicate effectively and enable care staff. DS0000064193.V288684.R01.S.doc 20/06/06 20/06/06 04/05/06 20/06/06 20/06/06 9 OP31 9(2)(b[I]) 20/07/06 10 OP32 9(2)(b[I]) 20/07/06 Hardwick Dene Version 5.1 Page 27 11 OP33 9(2)(b[I]) 12 OP33 18(1)(c) 13 OP33 24(10) (a)(b) 14 OP33 14(2)(a) (b) & 15(1)(2) The registered manager must adequately demonstrate her fitness to manage the home in an open and transparent manner to communicate effectively and enable care staff. A training matrix record must be produced that clearly indicates all training achieved by all staff and includes future training topics arranged and the document must be sent to the Cambridge offices of the CSCI. The home must implement a quality assurance method. This requirement has been carried forward from the last inspection made on the 25/11/05. The timescale has not been met. Care Plans must be kept in a clear and concise manner and must relate to all aspects of a persons care and must record all consultation and advice from health professionals. This requirement has been carried forward from the last inspection made on the 25/11/05. The timescale has not been met. The registered manager must ensure there are regular supervision arrangements made for all care staff and write and inform the Cambridgeshire & Peterborough office of the CSCI of these arrangements by the timescale for action date. All of the home’s policies must be reviewed. The registered manager must ensure there are reliable and regular arrangements to monitor and organise safe practices for the moving and handling of service users and that this DS0000064193.V288684.R01.S.doc 20/07/06 20/06/06 12/07/06 20/06/06 15 OP36 18(2) 20/06/06 16 17 OP37 OP38 24(1) 13(5) 20/07/06 20/07/06 Hardwick Dene Version 5.1 Page 28 18 OP38 17(2) system includes an audit of recorded checks of any equipment used to assist with moving and handling or prevent injuries related to reduced mobility and agility. The registered manager must ensure that correct handling and labelling and recording of temperatures of cooked food and that records of meals planned and provided are accurately maintained. 20/06/06 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 OP2 Good Practice Recommendations The home’s contracts should include details that relate to the details addressed in National Minimum Standards 2, 3, 4 & 5. The home’s contracts should include details that relate to the details addressed in National Minimum Standards 2, 3, 4 & 5. The home’s contracts should include details that relate to the details addressed in National Minimum Standards 2, 3, 4 & 5. The home’s contracts should include details that relate to the details addressed in National Minimum Standards 2, 3, 4 & 5. An Occupational Therapist should be consulted and requested to assess service users’ moving and handling needs and the equipment provided by the home and the skills used by care staff. Service users autonomy should be encouraged through being offered choices of meals and the choices of the meals offered should be recorded. DS0000064193.V288684.R01.S.doc Version 5.1 Page 29 2 OP3 3 OP4 4 OP5 5 OP8 6 OP14 Hardwick Dene 7 8 OP15 OP22 9 10 OP27 OP28 11 12 OP32 OP32 Service users autonomy should be encouraged through being offered choices of meals and the choices of the meals offered should be recorded An Occupational Therapist should be consulted and requested to assess service users’ moving and handling needs and the equipment provided by the home and the skills used by care staff. The home should make arrangements to relieve care staff of the tasks of domestic cleaning so they are not distracted or prevented from carrying out care tasks. The number of staff who have achieved NVQ awards in care or who are undertaking these courses should be included in the training matrix record that the home has been required to record. The registered provider should consult staff in an open approach when intending to instruct care staff. The home should make arrangements to relieve care staff of the tasks of domestic cleaning so they are not distracted or prevented from carrying out care tasks. Hardwick Dene DS0000064193.V288684.R01.S.doc Version 5.1 Page 30 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. 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