CARE HOMES FOR OLDER PEOPLE
Hardwick Dene Hardwick Lane Buckden Cambridgeshire PE19 5UN Lead Inspector
Don Traylen Unannounced Inspection 9th July 2008 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.V368938.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.V368938.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Hardwick Dene Address Hardwick Lane Buckden Cambridgeshire PE19 5UN Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01480 811322 01480 819120 sallyarcher1@aol.com Mr Krishan Parkash Sally Archer Care Home 38 Category(ies) of Dementia - over 65 years of age (33), Old age, registration, with number not falling within any other category (38) of places Hardwick Dene DS0000064193.V368938.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th July 2007 Brief Description of the Service: Hardwick Dene is a registered care home for 38 older people that includes 33 places for people with dementia related care needs. The home is set in large, attractive, well-kept gardens overlooking farmland, on the opposite side of the A1 to the village of Buckden. The market towns of Huntingdon and St Neots are within a 10-minute drive. The cities of Cambridge and Peterborough can each be reached within half an hour, and London is fifty miles to the south. Originally a family home, Hardwick Dene has been extended three times. A ground floor self-contained unit of 12 single bedrooms, all with en-suite facilities, 2 lounge/dining rooms, a shower room and a bathroom has been added to offer care to people who need safe, constantly supervised, accommodation due to problems with their mental health. Accommodation in the older part of the home is on two floors and consists of 22 single bedrooms, 2 double bedrooms, and 2 large lounge/dining rooms. The home has adequate bathroom and toilet facilities, a well-equipped kitchen, an office, a treatment room and laundry. The home has a large open and plain garden at the front of the property. The homes separate extra care unit leads onto an enclosed part of the garden. The home has well-maintained lawns that are home to two peacocks. The fees to reside at Hardwick Dene cost from £351 to £560 per person per week. Commission for Social Care Inspection (CSCI) reports are available at the home and can be accessed on the CSCI website. Hardwick Dene DS0000064193.V368938.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is “2 star”. This means the people who use this service experience good quality outcomes.
An Annual Quality Assurance Assessment (AQAA) was completed by the home prior to the inspection. Of the twenty survey forms sent to people living at the home, ten were completed and returned to the Commission and each indicated satisfaction with the home. The inspection was carried out by one inspector and lasted 5 hours. The registered manager was present throughout the inspection. People living at the home were spoken to randomly during the inspection. People were asked about the care they were given and if they considered care staff were respectful. Two relatives visiting the home were spoken to as were two care assistants. The care plans for three people were assessed. The recruitment details of two recently employed care staff were read and a tour of the premises was carried out. What the service does well: What has improved since the last inspection?
Hardwick Dene DS0000064193.V368938.R01.S.doc Version 5.2 Page 6 The home has met the seven requirements included in the last inspection report for the 13/07/2007. They have achieved this because they have improved assistance at meal times and have arranged for this to be carried out in a more respectful manner. The home was fresh and clean and free of any offensive odours. Staff recruitment was fully documented and appropriately carried out so that people are safeguarded. They have started to monitor and record care staff for their competencies in tasks such as moving and handling skills and medication administration. The storage arrangements and the accurate recording of medication were in appropriate and accurate. Care plans were clearly written showing needs and included some risks assessment. New carpets have been laid in all areas of the home. They have continued to redecorate the home in a planned and systematic manner so that all parts of the building are included. The management of the home has improved. Senior care worker have been delegated specific tasks. The manager and senior care workers demonstrated during the inspection they were mutually supportive and senior care workers showed they were competent to undertake a number of management tasks. The manager has introduced a useable reference log about the guidance for specific topics relating to care homes issued by the Commission for Social Care Inspection. Staff meetings and residents meetings are now arranged on a regular basis and are recorded. What they could do better:
Care plans must include how a person’s known needs are being met when the person has been referred to and is being treated by a District Nurse or other Community Health worker. These plans must include a record to show when the home has requested, or arranged with Health Service professionals to attend to a person’s needs. Care plans should include risk assessments that address the known and assessed needs already recorded. The home must keep a record of the plan and reason to offer, or administer any medication prescribed as “PRN” or, “as required”. Medication taken from the home on behalf of people when they are absent from the home should be
Hardwick Dene DS0000064193.V368938.R01.S.doc Version 5.2 Page 7 recorded on the MAR charts so it is clear whether the medication is in the home. The hot water supplied to the sinks of the bathrooms on the upper floor of the home must be supplied at a safe temperature. The home completed an Annual Quality Assurance Assessment. The AQAA could be completed so that more information about their future intentions to make improvements to the service are written in this Assessment. 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.V368938.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.V368938.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): 1,3,6, Quality in this outcome area is good. People are provided with adequate information about the home and they are appropriately assessed prior to any decision to move into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a suitable Statement of Purpose and a Service User Guide and brochures. Two people’s records were read and showed one had been assessed under a PCT Care Management process. The other person had been assessed by the home. Intermediate care is not provided and therefore Standard 6 was not assessed. Hardwick Dene DS0000064193.V368938.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11, Quality in this outcome area is good. People receive good outcomes through the care that is planned and provided despite the identified areas where improvements can be made. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans had been re-written in a clear format and were directly referenced to assessed needs and were uncomplicated to read. The care plans for two people affected by Dementia were assessed. One person discussed the aspects of her care plan and was aware these details about her had been recorded. Her care plan did not include the referral, or request, or the plan and arrangements that were in place for the District/ Community Nurse to treat her. In this instance, there were no negative outcomes for the person. Her care and treatment by the Community Nurses was fully understood and known to the manager and three care staff who were asked about her care and her needs had been appropriately responded to and her healthcare needs were being
Hardwick Dene DS0000064193.V368938.R01.S.doc Version 5.2 Page 11 met. The visits by District Nurses and by her GP had been recorded in her care plan. Medication records and the accuracy of stored medicines and the storage arrangements for prescribed medication, including controlled drugs, were assessed. Medication Administration Record (MAR) charts were looked at for five different people’s medication and these included controlled drugs. The records were accurately maintained and the amounts of medication were counted and found to be accurate. Controlled drugs were satisfactorily stored and recorded. Records showed that the MAR charts included indications when people had gone out from the home, but did not clearly indicate whether their medication had been taken out of the home with them. However, a list did show what medication had been taken from the home in one instance when somebody records showed the entry “D” (for social leave). It was discussed with the manager and two senior carers that the MAR charts should indicate clearly when medication has been taken away from the home. The MAR charts showed one person taking medication prescribed as “as when required for anxiety”. Entries for refusal were recorded. The MAR charts showed regular times to offer this medication but there was no guidance about how to evaluate her anxiety, or about managing her anxieties and what amounts of medication should be administered. This was discussed with the manager who agreed to ask for her medication to be reviewed by the prescribing GP and to record the circumstances for administering this medication. Staff were observed to speak respectfully to people and to address them by name. Four people stated that staff were polite and respectful to them. Two regular visitors said they had observed staff were always supportive and polite and respectful. The manager has arranged to undertake a course in palliative care so the home is able to meet the needs of people when they are near to the end of their life. Hardwick Dene DS0000064193.V368938.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, Quality in this outcome area is good. People are assured of a quiet and comfortable lifestyle that suits their expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A music session was provided in the afternoon and this is a regular weekly arrangement at the home. Twenty-two people were observed in the large lounge to be listening and dancing to the sound. One person commented that, “parties are well organised” she also added that she is, “very happy”. During the day five visitors were seen at the home. A visitor’s book showed a variety of people visit the home each day. The meal menus for lunchtime were read and showed a variety of meats and vegetables served and choices of alternative meals offered. One person remarked, “lunch today was lovely”. Another person said the food was “gorgeous” and other people reported they were provided with enough food and drink. An evening snack or light meal of sandwiches and cake and drinks was observed. During the afternoon people were provided with drinks. There
Hardwick Dene DS0000064193.V368938.R01.S.doc Version 5.2 Page 13 was no noticeable provision for people to help themselves to a drink at any time should they wish to and this is something the home could consider making available. A television was turned up quite loudly in one lounge, which was partly for the benefit of one person. In each of the two lounges a TV was turned on for the duration of the inspection apart from the time when the music session was taking place. Hardwick Dene DS0000064193.V368938.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18, Quality in this outcome area is good. People and relatives are assured that any person residing at the home is safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an abuse policy and guidance issued by the Cambridgeshire County Council. All staff have received training in preventing abuse. It was discussed with the manager and two senior care workers how the home could further promote safeguarding and were urged to become more familiar with the initiatives of Cambridgeshire County Council to provide information and training to care providers in this matter. Two people stated they would raise any problems with the manager and two visitors said they would not hesitate to report and issue of abuse should they suspect it had occurred. The home has a complaints record book that showed how complaints have been responded to in a generally satisfactory manner and timeframe. Hardwick Dene DS0000064193.V368938.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,23,24, 25,26, Quality in this outcome area is adequate. People are not totally assured their environment is safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The hot water supplied to the sinks of the bathrooms and to rooms 6,7,8,9, and the sink in the toilet near to these rooms presented a risk of scalding from very hot water. The temperature of the water was tested at 61 degrees C. A thermostatic control had not been fitted to this supply of hot water. The manager stated that thermostatic controls were planned to be fitted to the hot water supply to these sinks. The bedrooms were fresh, clean and comfortably furnished and had been personalised. In general, the home is very well decorated and maintained.
Hardwick Dene DS0000064193.V368938.R01.S.doc Version 5.2 Page 16 New carpets have been fitted to all floors. Communal areas were spacious and appropriately furnished. The home has been generally well maintained over a period of years. Hardwick Dene DS0000064193.V368938.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30, Quality in this outcome area is good. People are assured they will be supported by competent staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were five care staff working during the afternoon and were seen to attend to people’s care and attention. All staff wear uniforms and this makes it easy for some of the people to recognise care staff. Recruitment records for two care staff that had been employed since the previous inspection on 13th July 2007 were assessed. Criminal Records Bureau disclosures for both persons were received prior to them commencing employment. Two references and application forms showing employment history and interview records for both persons were checked and found satisfactory. Adequate training had been arranged for care staff. The training record showed all staff had received training in moving and handling, first aid, food hygiene health and safety, infection control, fire safety and adult protection. Palliative care training was being arranged for the future for a few care staff. Most staff had received training in Dementia care.
Hardwick Dene DS0000064193.V368938.R01.S.doc Version 5.2 Page 18 Five staff have NVQ level 3 awards in care. The manager has an NVQ level 4 award in care and the deputy manager has started and NVQ level 4 award. Hardwick Dene DS0000064193.V368938.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38, Quality in this outcome area is good. People are assured the home is run in their best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new role entitled “Head of Care” has been created. Some management responsibilities have been shared or delegated amongst senior care staff. Since the last inspection on 13th July 2008, the manager has started to monitor care staff for their competencies in moving and handling and administering medication. Supervision is arranged regularly for all staff. Topics for supervision include the skill tasks where staff have been monitored.
Hardwick Dene DS0000064193.V368938.R01.S.doc Version 5.2 Page 20 Communication between care assistants and senior carers was open and senior carers demonstrated they were able to provide some management support to care assistants. People’s finances are not managed by the home. The home has a current annual fire certificate issued on 03/01/2008 and an emergency lighting certificate tested on the same date. Meals provided are recorded, as are the temperatures of the fridges and freezers. The home has provided the Commission with regular report concerning The Care Homes Regulations 26 and 37. The Annual Quality Assuranmce4 Assessment completed by the home contained adequate information about the home’s current activities. However, this assessment could have included more information and detail of how the home intends to make improvements in the future. Comments made in the AQAA when asked about plans for improvements over the next 12 months were, “ongoing improvement programme” (p8); “no plan” (p11);”keep the home tidy. No other plan in place”. Hardwick Dene DS0000064193.V368938.R01.S.doc Version 5.2 Page 21 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 3 3 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 3 Hardwick Dene DS0000064193.V368938.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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) Requirement Care plans must include how a person’s known needs are being met when the person has been referred to and is being treated by a District Nurse or other Community Health worker. These plans must include a record to show when the home requested, or arranged with Health Service professionals to attend to a person’s needs, so that a person’s care is not neglected and they are not at risk. The home must record the reasons and under what circumstances the home will plan to offer, or to administer medication prescribed as “PRN”, or “when/as required”, so that people are safeguarded against overdosing and under doses of medication. Hot water temperatures from the sinks in the first floor and bathrooms must be supplied close to 43 degrees C, so that people are safe from being scalded.
DS0000064193.V368938.R01.S.doc Timescale for action 01/09/08 2 OP9 13(2) 01/09/08 3 OP25 13(4)(a) 01/09/08 Hardwick Dene Version 5.2 Page 23 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 OP9 Good Practice Recommendations Medication taken from the home, on behalf of people when they are absent from the home, should be recorded on the MAR charts, so it is clear whether the medication is in the home. Hardwick Dene DS0000064193.V368938.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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