CARE HOMES FOR OLDER PEOPLE
Hartcliffe Nursing Home Murford Avenue Hartcliffe Bristol BS13 9JS Lead Inspector
Kathy Marshalsea Unannounced 17 August 2005 09:45 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 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. Hartcliffe Nursing Home D05 D56 S31895 HartcliffeNursingHome 238725 170805 Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Hartcliffe Nursing Home Address Murford Avenue Hartcliffe Bristol BS13 9JS 0117 9641000 0117 9641100 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Methodist Home for the Aged Mrs Ruth Andrews Care home with nursing 66 Category(ies) of OP Old age (66) registration, with number PD Physical disability (10) of places Hartcliffe Nursing Home D05 D56 S31895 HartcliffeNursingHome 238725 170805 Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: May accommodate up to 66 persons aged 65 years and over requiring nursing care. May also accommodate up to 10 persons with physical disability under the age of 65 requiring nursing care. Date of last inspection 22-Feb-2005 Brief Description of the Service: Hartcliffe Nursing Home is owned by Methodist Homes for the Aged and provides nursing care for up to sixty-six older people and 10 persons with physical disability under the age of 65 reuiring nursing care. It is located in a suburban position and can be accessed by public transport. Transport is needed to reach local shops and amenities.The home itself is purpose built and has now been in operation for 5 years. 64 bedrooms are for single occupancy and there is one double room. They are set out over two floors accessible via the passenger lift. Communal space is offered in 4 lounges and there is a spacious dining room on each floor. There is a small garden and parking spaces for visitors. Hartcliffe Nursing Home D05 D56 S31895 HartcliffeNursingHome 238725 170805 Stage4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was un-announced and conducted as part of the annual inspection process. The inspection was conducted over 2 days. This was due to the fact that a complaint was discussed as part of the inspection. The inspector spent time looking at records, talking with residents and relatives, having lunch with the residents and discussing care issues with one of the trained nurses. What the service does well:
As well as caring for those elderly persons who require nursing care, it also provides continuing care which allows people to come to the home from hospital and be assessed while in the home. The home also provides excellent palliative care based upon good practice and relevant clinical guidelines. The pre-admission process enables all involved to make an informed decision about the suitability of the home. Relatives are made to feel welcome and are supported too. The core principles of care are upheld by staff, these being maintaining independence, promoting respect, dignity and choice. Health care needs are fully met and where necessary specialist advice is sought. Medication systems were safe and organised according to good practice. There are group activities as well as individual time spent with residents. Staff make every effort to discover social preferences for those residents who may not be able to communicate. There is community involvement and entertainers coming to the home. Account is also taken of residents’ religious needs. Nutritious meals are offered with choices and individual likes/dislikes taken into account. Menus are seasonal and residents are consulted about the menus. The kitchen is run professionally and all safety checks are completed regularly. Complaints received by the home are taken seriously and investigated according to the home’s policy. Resident’s legal rights are promoted and protected. Hartcliffe Nursing Home D05 D56 S31895 HartcliffeNursingHome 238725 170805 Stage4.doc Version 1.40 Page 6 The environment is clean, safe and well maintained. There is sufficient specialist equipment to cater for all nursing needs. The gardens are also pleasant and accessible. Staff are encouraged to attend training sessions pertinent to the resident group. Mandatory training is also provided ensuring a competent and confident staff team. The residents and staff benefit from a manager who is competent, approachable and professional. She has an inclusive management style and is open to change. She is also up to date herself ensuring that care is based upon good practice. Residents, staff and relatives are consulted regularly to ensure that the home is working to its Statement of Purpose. What has improved since the last inspection? 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.
Hartcliffe Nursing Home D05 D56 S31895 HartcliffeNursingHome 238725 170805 Stage4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Hartcliffe Nursing Home D05 D56 S31895 HartcliffeNursingHome 238725 170805 Stage4.doc Version 1.40 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 standard(s) 1, 3, 4, 5. Prospective residents are given sufficient information about the home before admission. The home assures itself that it can meet assessed needs even for emergency admissions. There is the opportunity to visit the home before admission. EVIDENCE: 1.The home has a welcome pack which incorporates the Statement of Purpose and Service User guide. Additional information needs to be added to meet the criteria in the requirements and to give the reader up to date and complete information. The information needed to be added was given to the manager. 3.Pre-admission assessments are completed to ensure that as much information as possible is collated about each person. This should enable the home to feel confident at meeting their needs. However, in two instances the resident’s Mental Health needs have become their primary need. In one case the resident was in an assessment bed and therefore was not due to be a permanent placement. Their behaviour has not adversely affected other residents and a bed is being sought in an EMI home.
Hartcliffe Nursing Home D05 D56 S31895 HartcliffeNursingHome 238725 170805 Stage4.doc Version 1.40 Page 9 In the second case the resident only began to display behavioural problems after admission. No history of mental heath problems had been available. The home has been pro-active in seeking specialist advice to deal with these problems. Some behaviour has affected other residents and steps have been taken to protect other residents. Any restriction imposed upon this resident must be clearly recorded. As this resident’s primary need is one of mental health a more suitable home should be sought, as the home is not within its categories of care by keeping them. 4.Pre-admission assessments are conducted wherever the prospective resident is residing. This gives a detailed account of their holistic needs and forms the basis of the care plan. 5.Relatives spoken with during the inspection stated that they visited the home before making any decision. They stated that they were made to feel welcome and liked the atmosphere in the home. Hartcliffe Nursing Home D05 D56 S31895 HartcliffeNursingHome 238725 170805 Stage4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10. The care plans are holistic but could give more detailed information about social needs. Medication systems are being handled according to the home’s policies and procedures. Residents and relatives spoken with said that they are treated with respect and their dignity upheld. EVIDENCE: 6. The care plans viewed as part of the case tracking process. One plan looked at in detail concerned a resident who had only been at the home for 6 weeks. The pre-admission assessment was detailed and included any risks and cognitive impairments. Most of the plan itself was written on the day of admission and had been reviewed again a month later. Some entries were not realistic and could be worded in a more useful way. Problems identified after admission had been recorded which had been passed on to the GP. Hartcliffe Nursing Home D05 D56 S31895 HartcliffeNursingHome 238725 170805 Stage4.doc Version 1.40 Page 11 8. A GP visits the home to do a weekly surgery. There are assessments for the following: Pressure sore risk Manual Handling risk Generic risks Social care needs Nutritional risk Resuscitation Other evidence of health care needs being met included regular weights being done, physiotherapy input, psychiatric referrals, intermediate care team involvement, observations of pulse-blood pressure and respirations. 9. The home uses a Monitored dosage system supplied by Boots. A representative from Boots audits the system twice a year. The home has a Homely Remedies Policy signed by the GP’s, which is reviewed 6 monthly. The room where the mediation is stored is now kept at the optimum temperature. Fridge and room temperatures are checked and recorded daily. Medicines received, administered and leaving the home are handled appropriately. The system recently introduced to nursing homes for the disposal of medication is now being used. The home is adapting it to ensure that there is no risk of mis-use. This will be checked at subsequent inspections. There were clear instructions for the care of diabetes on individual charts. Any persistent refusal of medication is dealt with by referral to the GP and possibly using an alternative form of administering medication. This is good practice. 10. The inspector spoke with several residents and three relatives. The residents said that they are treated with respect and that all efforts are made to maintain their dignity. Hartcliffe Nursing Home D05 D56 S31895 HartcliffeNursingHome 238725 170805 Stage4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15. Social needs are assessed and a range of activities provided in response. There was anecdotal evidence of individual social needs being met. Appealing balanced meals are offered taking into account individual needs. EVIDENCE: 12.The activities organiser was not available to discuss how she spends her time. The inspector was not able to evidence specific activities for individuals. Staff told the inspector that key worker time is spent with residents. There are regular sessions offered of bingo, music, church services, painting and arts & crafts, slide shows and entertainers. An example was given to the inspector of meeting the social needs of one resident who had no family and was visually impaired. The staff over a period of time realised that they enjoyed music and also being involved in church activities. The manager arranged to buy him/her a CD player and also CD’s of music staff had identified that they liked. They also arranged for a chaplain to visit. This is commended. Hartcliffe Nursing Home D05 D56 S31895 HartcliffeNursingHome 238725 170805 Stage4.doc Version 1.40 Page 13 13.The inspector noted that there were numerous entries in the visitors book on the first day of the inpection. The inspector spoke with three visitors. All spoke highly of the home and the staff. Some comments included: “ The staff are very good”,” nothing is too much trouble”,” I have never had to complain”,” they have given me lots of useful information”. 15. The inspector had lunch with the residents on the ground floor. There was a choice of main meal and pudding. Fresh cold drinks were served throughout the meal. Although the tables were laid nicely there were no condiments on the table. Staff assisted those residents who needed assistance discreetly. It was observed that one resident who has a very small appetite was given quite a large plate of food. The catering staff need to consider giving very tiny portions so that the amount being given is not too off-putting. Menus are seasonal and discussed at residents meetings. The menus are displayed in reception. The catering manager meets new residents and has a list of likes/dislikes in the kitchen. The residents are asked each day what they would like for their meals. The kitchen staff are also informed of individual problems such as weight loss, and take steps to increase their calorie intake. Cultural needs are also taken into account. Usually fresh fruit is on display. The catering manager stated that it wasn’t at the moment due to fruit flies. It is recommended that ways be sought to ensure that residents are encouraged to eat fresh fruit regularly and are aware of its availability. The kitchen was clean, cleaning schedules and fridge and freezer temperatures checked daily. Temperature checks are also done for hot food. This is good practice. New dining room tables are being ordered. Due to the fact that one resident is unable to be sat up high enough to be ale to eat her meal, an old table will be kept and the legs shortened to enable her to sit at the table comfortably. This is commended. Hartcliffe Nursing Home D05 D56 S31895 HartcliffeNursingHome 238725 170805 Stage4.doc Version 1.40 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 Complaints are investigated by the home and taken seriously. Residents’ legal rights are protected. EVIDENCE: 16.The inspector received one complaint about the home, which was investigated as part of the inspection. This involved a relative being concerned about staff recognising their relative’s deteriorating condition and their response to that. This complaint was investigated through the home’s own complaint’s procedure but the complainant was not satisfied with the outcome. The inspector’s findings were as follows: 1. The GP should have been called 2. Head injury observations were not done 3. Staff were not observant enough of the resident’s changing condition 4. The reduction of risk due to falls was not well documented A separate letter will be sent to the complainant and the home. 17. An annual electoral roll of all residents is conducted. 3 residents used their postal vote at the last inspection. There is a lockable facility in each bedroom. Currently no residents use a key to their bedroom. The manager stated that if wanted they would supply this. Hartcliffe Nursing Home D05 D56 S31895 HartcliffeNursingHome 238725 170805 Stage4.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 23, 24, 26 Residents live in a safe, clean and well maintained environment. Bedrooms are personalised. The home has sufficient specialist equipment to meet needs. EVIDENCE: 19.The home is purpose built. The furniture in bedrooms is functional and homely. Décor, fixtures and fittings are of a high standard. Each room has ensuite facilities. The garden is well maintained. A new patio area has been recently been improved. It contains new furniture and colourful plant pots, borders and a small pond with a fountain. 20.There are a range of small lounges around the home. One downstairs is designated as a smoking lounge. The carpet has numerous burns which are unsightly. This needs to be replaced as soon as possible. 21.The dining rooms are spacious. Toilet and bathing facilities and sufficient and suitable.
Hartcliffe Nursing Home D05 D56 S31895 HartcliffeNursingHome 238725 170805 Stage4.doc Version 1.40 Page 16 23.Bedrooms viewed were homely and contained may personal items. There are 64 single bedrooms and one double room. They meet the minimum required standard. There are colourful nameplates on each bedroom door. 24.Bedrooms are equipped to ensure that they are comfortable. Many of the beds are adjustable which makes Manual Handling safe. There is lockable storage. 26.The home was clean and had no unpleasant odours during the inspection. Hartcliffe Nursing Home D05 D56 S31895 HartcliffeNursingHome 238725 170805 Stage4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These standards were inspected and met at the last inspection. All but one standard was met. The requirement about recruitment was partially met. The requirements made as a result of that have been met. It was noted that there were numerous notices posted in the staff office about forthcoming training events. Hartcliffe Nursing Home D05 D56 S31895 HartcliffeNursingHome 238725 170805 Stage4.doc Version 1.40 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32, 33. Residents benefit from the ethos, leadership and management approach of the home. The home is run in the best interest of the residents. EVIDENCE: 3132.Mrs Andrews continues to be the registered manager of the home. Those residents and relatives who commented said that she was kind, approachable and helpful. She is able to demonstrate her knowledge of the client groups she is responsible for and keeps herself updated professionally. There are clear lines of accountability within the home which is clearly communicated to all staff.Mrs Andrews management style is an inclusive one so that there is a real sense of team work and of staff feeling valued.Mrs Andrews is to be commended for her excellent management skills. Hartcliffe Nursing Home D05 D56 S31895 HartcliffeNursingHome 238725 170805 Stage4.doc Version 1.40 Page 19 33.The Quality Assurance audit of social and emotional needs was conducted on 12/05/05. 18 residents and 6 staff were consulted. The actions needed were: Daily plan of activities to include one to one time Arrange a coffee morning/afternoon tea group Arrange a residents meeting Arrange for bibles to be available in each bedroom Purchase large print and listening books Organise conversational groups The actions will be checked at subsequent inspections. Hartcliffe Nursing Home D05 D56 S31895 HartcliffeNursingHome 238725 170805 Stage4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 2 3 x 3 3 x 3 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 3 x 3 x 3 x x x x x Hartcliffe Nursing Home D05 D56 S31895 HartcliffeNursingHome 238725 170805 Stage4.doc Version 1.40 Page 21 NO 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. 2. 3. 4. 5. 6. Standard 20 1 12 12 3 14 Regulation 16(2)(c 4&5 15 16(2)(m)( n) 14 12(2) Requirement Timescale for action By 17/10/05 By 17/11/05 The carpet in the smoking lounge must be replaced. The Statement of Purpose & Service user guide must be amended. Social care needs must be clearly By documented. 17/11/05 Activities must be recorded. From 26/08/05 The home must not keep any By resident whose primary need is 30/09/05 Mental Health. Any restrictions imposed by the From home must be clearly 1/09/05 documented and regularly reviewed. 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. 3. Refer to Standard 7 15 Good Practice Recommendations Use achievable and realisitic goals in the care plan and assessments. Offer food portions suitable for each individual. Hartcliffe Nursing Home D05 D56 S31895 HartcliffeNursingHome 238725 170805 Stage4.doc Version 1.40 Page 22 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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