Inspection on 13/03/06 for Hare Lodge

This inspection was carried out on 13th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hare Lodge 30/04/09

Hare Lodge 09/02/09

Hare Lodge 26/02/07

Hare Lodge 19/12/05

Hare Lodge 14/09/04

Hare Lodge 11/05/04

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

CARE HOMES FOR OLDER PEOPLE Hare Lodge 57 Harebeating Drive Hailsham East Sussex BN27 1JE Lead Inspector Rebecca Shewan Unannounced Inspection 13th March 2006 09:30 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 Hare Lodge DS0000021126.V283556.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. Hare Lodge DS0000021126.V283556.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hare Lodge Address 57 Harebeating Drive Hailsham East Sussex BN27 1JE 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) 01323 849913 01323 849913 The Harebeating Care Company Vacant Care Home 32 Category(ies) of Dementia (32) registration, with number of places Hare Lodge DS0000021126.V283556.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is thirtytwo (32) Service users must be older people aged sixty-five (65) years or over on admission Service users with a senile dementia type illness only to be accommodated 19th December 2005 Date of last inspection Brief Description of the Service: Hare Lodge is a large, detached, purpose built care home situated in a residential area of Hailsham, approximately one mile from the town centre. Accommodation is provided on two floors and a shaft lift is fitted to assist those service users who may have mobility problems. The home is registered to accommodate up to 32 older people with a dementia type illness. The registered owners are the Harebeating Care Company. Hare Lodge DS0000021126.V283556.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second unannounced inspection to take place in the CSCI inspection year of 2005/2006. To gain a complete overview of the standards assessed it will be necessary to read both inspection reports for this inspection year. This unannounced inspection took place during the morning & afternoon of the thirteenth of March 2006. Before the inspection papers held by the Commission for Social Care Inspection were read. The inspection of the home took six hours. The homes Acting Manager, four care staff, two service users and five service users relatives were spoken with. There were thirty one service users (known as Residents) living at the home at the time of the inspection. What the service does well: What has improved since the last inspection? To ensure confidentiality of residents care plans, the plans have now been stored securely. The homes medication store and records were viewed and it was evidenced that the previous inspection requirements that all medication is dispensed to service users at the prescribed time and that storage arrangements for medicines and dressings should be improved to ensure orderly storage had been met. It was evidenced that the broken window restrictors had been repaired. The previous inspection requirement (the target date for which remains the nineteenth May 2006) that staff are trained in infection control matters is being addressed by the home, with some care staff having attended training within the last few weeks. The required Regulation 26 visits by a representative of the owner have been reintroduced with reports being forwarded to the CSCI. Hare Lodge DS0000021126.V283556.R01.S.doc Version 5.1 Page 6 What they could do better: 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. Hare Lodge DS0000021126.V283556.R01.S.doc Version 5.1 Page 7 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 Hare Lodge DS0000021126.V283556.R01.S.doc Version 5.1 Page 8 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): 4, 5 & 6 The home has suitable procedures in place for allowing potential new residents with the opportunity to visit the home. EVIDENCE: Staff were observed to have the appropriate skills and experience to deliver the services and care, which the home offers. The Acting Manager said that potential new residents are invited to visit the home for a morning or afternoon and that their relatives would be invited to attend, in accordance with the potential new residents wishes. Intermediate care is provided by this home. Hare Lodge DS0000021126.V283556.R01.S.doc Version 5.1 Page 9 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, 9, 10 & 11 There is a need for the home to revise its current care planning system in accordance with the previous inspections requirement. The home has to make some improvements in recording handwritten entries onto Medication Administration Record (MAR) sheets and elaborating the use of medication non-administration codes. Residents are treated with respect and dignity. Resident’s dying/critical illness wishes are not recorded in their care plan and there is a need for the home to review this. EVIDENCE: From the care plans viewed at the time of the inspection it was evidenced that the previous inspection requirement that care plans are expanded to include full guidance regarding service users dementia, personal care needs and contain guidance for staff on how to manage challenging situations had not been met. The Manager said that care plans are currently being discussed with the homes Registered Provider and plans are in place to implement a revised Hare Lodge DS0000021126.V283556.R01.S.doc Version 5.1 Page 10 care planning system. Staff training in record keeping and care planning has been arranged for the near future and care staff spoken with said that they ‘are looking forward’ to the training. Records viewed where seen to be stored in a locked cupboard in the homes dining area. Therefore the previous inspection requirement that to ensure confidentiality the plans should be stored securely has now been met. The homes medication store and records were viewed and it was evidenced that the previous inspection requirements that all medication is dispensed to service users at the prescribed time and that storage arrangements for medicines and dressings should be improved to ensure orderly storage had been met. Of the medication administration records (MAR) sheets viewed it was evidenced that some improvement is required in ensuring that handwritten entries onto MAR sheets are dated, signed with an explanation of the reason for a handwritten entry being detailed. It was also evidenced that staff had utilised the non-administration of medication code ‘O’ (meaning ‘other’) yet no reason for this code entry had been described on the sheet. The implications of this were discussed with the Manager at the time of the inspection and immediate requirements were made. Personal support in the home is offered in such a way as to promote and protect resident’s privacy and dignity, whilst promoting independence in accordance with the resident’s capabilities. From the care plans sampled it was evidenced that the home does not currently record residents wishes in the event of dying or critical illness. The Acting Manager said that residents wishes would be respected until such time that the home is unable to meet the needs of the resident, if necessary the input and assistance of the District Nurse and/or palliative care team would be utilised, in order for a dying resident to remain at the home and that family members of a dying resident could remain with them for as long as is necessary. Hare Lodge DS0000021126.V283556.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 & 14 The home has well-established links to local community events and activities. Where able, residents are encouraged to have control over their lives and to exercise choice. EVIDENCE: The home provides a wide range of choice for the residents in order that they can maintain relationships and attend events within the local community. Resident’s family, friends and representatives are welcomed by the home. Residents are actively encouraged to maintain family contact and visitors are able to attend the home at any time, in accordance with the service users wishes. Residents can entertain their guests in any of the homes communal areas or privately in their own bedrooms. Resident’s relatives spoken to at the time of the inspection confirmed this. Where able, residents are encouraged to attend events held within the local community. Residents are assisted to attend the local church every Sunday and residents can also attend the inhouse service held by the home every fortnight. Two residents attend the local Age Concern day centre and residents are assisted to attend the local ‘Women’s Group’. During the times of year where the weather is brighter, residents are taken to places of local interest, theatre trips and go to local restaurants for meals out. Funds for such activities are generated for the Hare Lodge DS0000021126.V283556.R01.S.doc Version 5.1 Page 12 residents ‘Occupational Therapy Fund’ by sponsored events held within the home. All staff actively contribute to this fund by carrying out sponsored activities such as sponsored walks, raffle ticket events and tea parties, amongst other events. The home is run to ensure that the resident’s are encouraged to maintain their independence, where practicable, and in making choices and decisions relating to their daily living. Hare Lodge DS0000021126.V283556.R01.S.doc Version 5.1 Page 13 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): 17 & 18 Resident’s legal and political rights are protected and respected at all times. The homes procedures, processes and training of staff should protect service users in the event of any allegation of abuse. EVIDENCE: Residents vote by proxy and the Acting Manager said that if a resident wished to attend the polling station then they would be encouraged to do so. The Acting Manager said that most residents have family or a representative to ensure that their legal rights are protected. This was evident form the resident’s files sampled. From the staff training matrix viewed it was evident that care staff had attended Protection Of Vulnerable Adult training within the last year. Criminal Record Bureau (CRB) checks have been carried out on all existing staff. Both CRB and Protection of Vulnerable Adult (POVA) checks are carried out on all new staff. Hare Lodge DS0000021126.V283556.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 21, 25 & 26 The home must seek the advice of the Environmental Health Officer regarding the risks of infection and Legionella from the homes redundant sluice located in the medication store. There is a need for the home to replace the clinical waste bin located in the same room, in order to reduce the risk of cross infection. EVIDENCE: Residents, relatives and care staff spoken with during the inspection conveyed to the Inspector that the home would benefit from having a shower installed, as many residents have stated that they prefer to have a shower then a bath. Therefore a recommendation has been made. It was evidenced that the previous inspection requirement that the broken window restrictors are repaired had been met in full. It was noted that in the medication store there is a redundant sluice, which has been partially boxed in with the cistern and chain remaining openly accessible. The infection control implications and risk of Legionella were discussed with the Hare Lodge DS0000021126.V283556.R01.S.doc Version 5.1 Page 15 Acting Manager at the time of the inspection. It was also noted that the clinical waste bin in the medication store does not have a ‘no touch’ system for placing waste into it. The Acting Manager said that a replacement bin has been ordered but that it is yet to be received. Therefore immediate requirements were made. The previous inspection requirement (the target date for which remains the nineteenth May 2006) that staff are trained in infection control matters is being addressed by the home, with some care staff having attended training within the last few weeks. Hare Lodge DS0000021126.V283556.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 The home has a commitment to its staff achieving National Vocational Qualification (NVQ) level two, however 50 of care staff must obtain this qualification. EVIDENCE: Hare Lodge has a staff team of twenty nine care staff. From the staff training matrix it was evidenced that seven care staff are currently trained to NVQ level two or above, with a further seven staff undertaking NVQ level two training. Therefore the previous inspection requirement that 50 of staff are trained to NVQ level 2 remains unmet. Hare Lodge DS0000021126.V283556.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 36, 37 & 38 The homes Acting Manager and her Deputy are easily accessible to both residents and staff. The Service User’s Guide needs to be updated to include the results of the recent survey, in order to inform residents and stakeholders of the outcomes. There are plans in place to revise the homes Policies and Procedures to include a date of issue, a review date and the Managers signature. The home are required to investigate the concerns raised about the homes bath hoist and the potential risk to residents safety. EVIDENCE: Hare Lodge DS0000021126.V283556.R01.S.doc Version 5.1 Page 18 The Acting Manager has been in post now for approximately eight weeks. During the inspection it was evident that the Acting Manager operates an open door policy and is available to both residents and staff at any time whilst on duty. The homes Acting Manager and staff were observed to be working in a co-operative manner in order to achieve the aims and objectives of the home. There is a Quality Assurance policy in place. The home undertook a survey of residents and their representatives in November and December of last year. The results of which have been studied and used to inform practice but now need to be published and incorporated into the Service Users’ Guide. The Acting Manager said that during the transition phase of the home recruiting a new manager, formal supervision of care staff had not been conducted. Therefore the homes Acting Manager has implemented a plan to conduct formal supervision of all care staff within the next month. The Acting Manager said that documented records would be kept of all supervisions held. Care staff spoken with at the time of the inspection said that they have felt supported and have had open access to discuss issues with the homes Deputy Manager or the Registered Provider, during the recent period of the vacant Registered Manager’s post. The previous inspection requirement that the required Regulation 26 visits by a representative of the owner are reintroduced with reports being forwarded to the CSCI has now been met in full. Of the Polices and Procedures viewed for the standards assessed it was evident that a number of Policies were undated and unsigned. This was discussed with the homes Acting Manager at the time of the inspection. Plans are in place to review all of the homes Policies and Procedures within the near future. Policies and procedures in place must include evidence of a date of issue, a review date and the Managers signature. Care staff spoken with at the time of the inspection informed the inspector that they had concerns about the homes bath hoist being unsuitable for the needs of those with advanced dementia. Care staff said that the bath hoist does not provide any means of support to the front of residents. In order to address their concerns the Inspector advised the Care staff to discuss their concerns with the homes Acting Manager or Registered Provider. In the interests of the health and safety of residents a requirement has been made. Hare Lodge DS0000021126.V283556.R01.S.doc Version 5.1 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 X 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 3 X X X X X X 3 2 STAFFING Standard No Score 27 X 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 2 X X 3 3 2 Hare Lodge DS0000021126.V283556.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement That care plans are expanded to include full guidance regarding service users dementia, personal care needs and contain guidance for staff on how to manage challenging situations. (Outstanding from previous inspection). That all handwritten entries onto MAR sheets are dated, signed and an explanation given for the entry. (This was an immediate requirement). That medication nonadministration codes are elaborated to detail why medication has not been administered. (This was an immediate requirement). That advice is sought from the Environmental Health Officer regarding the risks of infection and Legionella from the homes redundant sluice located in the medication store. (This was an immediate requirement). DS0000021126.V283556.R01.S.doc Timescale for action 13/04/06 2. OP9 13 (2) 13/03/06 3. OP9 13 (2) 13/03/06 4. OP26 13 (3) (4) & 23 (5) 13/03/06 Hare Lodge Version 5.1 Page 21 5. 6. OP26 OP26 18(1)(a) 13 (3) & (4) That staff are trained in infection control matters. That the clinical waste bin in the medication store is replaced with a bin that has a ‘no touch’ system, thereby reducing the risk of cross infection. (This was an immediate requirement). That 50 of staff are trained to NVQ level 2. (Outstanding from previous inspection). That the results of the quality assurance questionnaires sent out since in November and December 2005 should be published and included in the Service Users Guide. That the Registered Provider investigates the concerns raised regarding residents safety and potential risks associated with the homes bath hoist and take any action necessary as a result of the investigation findings. 19/05/06 13/03/06 7. OP28 18(1)(a) 30/04/06 8. OP33 24 (1) (a) (b) & (3) 13/05/06 9. OP38 13 (4) (a) (b) & (c) 13/04/06 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. 2. Refer to Standard OP11 OP21 Good Practice Recommendations That residents dying/critical illness wishes are recorded in their care plan. That consideration is giving to the home obtaining the views of residents with regards to having a shower for residents installed. Hare Lodge DS0000021126.V283556.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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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