Inspection on 14/08/08 for Hassingham House Care Centre

This inspection was carried out on 14th August 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Hassingham House Care Centre 23/08/07

Hassingham House Care Centre 06/06/06

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 13/11/2008.

CARE HOMES FOR OLDER PEOPLE Forest Healthcare Hingham Norfolk Hardingham Street Hingham Norfolk NR9 4JB Lead Inspector Mrs Marilyn Fellingham Unannounced Inspection 14th August 2008 07:30 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 Forest Healthcare Hingham Norfolk DS0000066011.V370235.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. Forest Healthcare Hingham Norfolk DS0000066011.V370235.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Forest Healthcare Hingham Norfolk Address Hardingham Street Hingham Norfolk NR9 4JB 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) 01953 851890 01953 852458 hassinghamhouse@btconnect.com Forest Healthcare. Jacquelyn Foran Care Home 46 Category(ies) of Old age, not falling within any other category registration, with number (46), Physical disability (46) of places Forest Healthcare Hingham Norfolk DS0000066011.V370235.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users should be aged 30 years and over. Date of last inspection 23rd August 2007 Brief Description of the Service: Hassingham House is a purpose built home circa 1997, situated in the small Norfolk town of Hingham. It is approximately 15 miles west of Norwich. The local amenities consist of a post office, a public house, a convenience store, hairdresser and facilities for bed and breakfast. Hassingham House is registered to provide nursing care to 46 elderly service users or those with a physical disability under the age of 65 years. All the accommodation is on the ground floor and it comprises of a large reception area, two spacious day rooms, two dining rooms and a quiet room. The grounds have laid out gardens that can be accessed by the Service Users. All rooms have a door to access the grounds and some Service Users have personalised these areas with bird tables and garden chairs. Each room has a hospital designed bed to ensure safe handling of the Service Users. Chiropody and hairdressing services visit the Home on a regular basis. The fees are currently between £660 and £3,500 per week. Forest Healthcare Hingham Norfolk DS0000066011.V370235.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 0 star. use this service experience poor outcomes. This means that the people who This was an unannounced inspection that took place over two days. The key inspection for this service has been carried out using information from previous inspections, information from the Annual Quality Assurance Assessment (AQAA), some residents, relatives, visitors to the home and people who work in the home. The AQAA is a report that the manager has to fill in and send to us to tell us how the service is operating. We use the information provided to help us to plan our inspection visit. The main method of inspection used was ‘case tracking’. This involved selecting individual care plans and information available about people who live at the home and tracking the experience of people and speaking to them about the outcomes they experience as a result of the support provided. During our visit a tour of the premises was undertaken and resident’s records and staff files were looked at. A number of requirements have been made as a result of this inspection visit, these can be found at the end of this report. What the service does well: The service has a core of trained nurses who showed that they are committed to caring for those people they look after. The service provides a range of activities during the week for residents to participate in. The premises outside is well kept and many seating areas are available for those residents who wish to sit outside. Forest Healthcare Hingham Norfolk DS0000066011.V370235.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Although the care plans have improved there are some areas that need more detail particularly in relation to specific needs pertaining to certain individuals; some require updating to show any changes that have taken place. People who are prescribed when required medicines by their doctor need to have care plans for this so that the staff can monitor their continued use. Recruitment must be more vigorous to provide more protection for the residents. The process for supervision of staff needs to be improved so that it becomes a more formal and a continual process. The manager must ensure that all staff have updates in safeguarding adults that she herself attends a course for this. The manager must implement a policy and procedure that is specific to the home for use when dealing with adult abuse. The staff-training programme covers all mandatory training but this needs to be extended to include training in relation to meeting specific needs of the individuals who use the service. The process for assessment of residents prior to admission to the home needs to be more detailed to prevent unsuitable residents being admitted to the homes whose needs cannot be met; this will also prevent other residents being placed at risk. Forest Healthcare Hingham Norfolk DS0000066011.V370235.R01.S.doc Version 5.2 Page 7 Some areas around the home need refurbishing and maintaining. The service needs to ensure that there are no offensive odours in parts of the home and all parts of the home are kept clean and tidy. More consideration needs to be given to extending activities into the weekends. The manager needs to have a better system for maintaining records. The service must ensure that the Commission is always advised of all incidents that occur in the home. The manager needs to ensure that the care staff are not taken away from their caring duties by dog walking. All matters highlighted in this report suggest that a more robust monitoring and oversight of the management of the home is required for its safe management. 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. Forest Healthcare Hingham Norfolk DS0000066011.V370235.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 Forest Healthcare Hingham Norfolk DS0000066011.V370235.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The personalised needs assessment means that people’s diverse needs are not identified and planned for before they move into the home; this can also mean that other residents are placed at risk. EVIDENCE: We looked at the assessment records of seven residents; the initial assessment prior to admission for two of these were informative and from these assessment records it would appear that these resident’s needs could be met by the home. However the remaining three records for assessment prior to admission did not contain sufficient information in relation to these people’s particular specific needs related to their condition: two records of assessment prior to admission were missing. Forest Healthcare Hingham Norfolk DS0000066011.V370235.R01.S.doc Version 5.2 Page 10 The manager and two sisters are responsible for carrying out the initial assessments of residents prior to admission to the home: the manager ultimately has the final decision of who is appropriate to be admitted to the home. No evidence is available as to the consideration given to each individual and how they would ‘fit into the home’ and the impact of the environment on certain individuals. Two residents who we spoke with who are under sixty five years old shared with us that they felt that they should not be at the home and that they were surrounded by very old people. We noted that a number of residents have been admitted to the home, that are not covered by the regulations in relation to the registration of the home. Forest Healthcare Hingham Norfolk DS0000066011.V370235.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although improvements have been made in the care planning process, the variable practice regarding the planning and delivery of this care means that residents cannot be sure that their health and personal care needs will be fully met and in a safe and acceptable manner. EVIDENCE: We observed the early morning handover between the night staff and the trained members of staff on duty. We used some of the information given at handover to inform us of some of the resident’s needs in relation to their conditions and incidents that had happened overnight. We looked at fifteen resident care plans, a number showed improvement and were generally complete; however a number had needs that were not addressed in their plans of care and some had no signatures of the prescribing person or date. One resident had care plans in place that had not been Forest Healthcare Hingham Norfolk DS0000066011.V370235.R01.S.doc Version 5.2 Page 12 evaluated since May 2008 and also the assessment for risk of developing pressure sores had not been evaluated since April 2008 although this resident had previously been assessed at being at risk. Another resident did not have an initial assessment of needs in place and it was difficult to see what their diagnosis was; it is known amongst staff and information recorded in incident records that this resident has an addiction problem. We noted that this person did not have a care plan in place to describe how their needs to this problem could be met and this persons challenging behaviour in and out of the home. One resident was seen aimlessly wandering around the home, this person is young in comparison to the rest of the residents; they smelt strongly of alcohol and told us that there was not much to do in the home. The daily notes refer to their consumption of alcohol but no plan of care in relation to this need. Another resident that has been admitted to the home who has an addictive problem has no plan of care to meet this need and deal with their problem; there was also no guidelines in place to ensure that this resident was cared for in a safe environment that did not put them at risk. This resident also had a fluid chart in place to monitor their fluid intake, there were three in their room, the record that had been commenced on the first day just had three additions on it the other two were blank. We looked at the care plans of one resident who required dressing to an infected toe, we noted that there was no record in place for the toe having been dressed for six days. During our tour of the home we noticed that many residents were in wheelchairs in the lounge; when we looked at these residents care records there were no care plans in place to relieve pressure and facilitate movement as a preventative measure to maintain skin integrity. We also noted that the wheelchairs were being used without footplates in position to prevent the resident’s feet dragging on the floor when being moved. Discussion with one relative revealed that they felt that the carers did not understand their relative’s condition and that they often found them wet and cold: but went on to say that “ I feel that on the whole my relative is well treated”. We spoke to another relative who said they had asked why their relative had a bruise on their eye but no one can tell them how they got it. This relative also expressed concern and said, “ I am not sure how often the continence pads are changed”. Nothing in this persons care plan denoted how often pads were changed. One resident we talked to said that the staff “don’t come to your aid when you want them”. This resident looked unkempt and their wheelchair was very dirty with caked on food and sputum. They remarked that the carers are “ more or less polite, sometimes not too pleasant”; another resident told us that there were two carers who were “not nice” and that “they have an attitude problem”. Another resident we spoke with told us that one carer had snapped at him and was not very nice to him. A number of allegations have been Forest Healthcare Hingham Norfolk DS0000066011.V370235.R01.S.doc Version 5.2 Page 13 made with regard to care staff’s attitude and the aggressive way they talk to the residents. During the morning handover we noted that one residents special boots had been sent to be altered, and the staff were advised not to use the stand aid without their boots. When we looked at this persons care plans we noted that their care plan for manual handling had not been updated. On examination of two residents care notes we noted that they had an MRSA infection, however there were no care plans in place for this or notes for the care staff, however when questioned those carers that we spoke with were aware of the precautions needed when dealing with MRSA infections. The carers were also aware of other infection control procedures that included catheter care and dealing with all bodily fluids. We noted from the daily notes that some residents had expressed suicidal thoughts, we saw no evidence in records that described the care that these residents needed in relation to these thoughts; however when questioned one of the residents said that the staff had sat with them and supported them well. The manager explained that one member of staff has a counselling qualification and they used their expertise when needed. Conversations with relatives and written communications to us reveal that many of them have a number of concerns about the care their relatives receive and the manner of some staff. One related to us about their relative being visited by a friend when the resident needed to go to the toilet to have their bowels open. This process needed two members of staff so they rang for assistance, when the carer arrived the resident was told that they could not take him to the toilet and they were told to “do it in their pad”. One resident discussed with us how their wishes have not been respected in relation to their care particularly when they were not feeling very well, they discussed it with the manager but do not feel confident that it has been dealt with appropriately. Of those case notes we looked at all had good risk assessments in place including assessments for skin integrity and nutrition. We also noted that most residents had weights recorded on a monthly basis. We did notice however that those residents that had bed rails in position did not have appropriate documentation in place for this purpose although this had previously been a concern of ours and had been discussed with the manager in relation to an incident that had taken place in the home and involved bed rails. A random audit was carried out of the medicines that were in use and these were found to correspond to the medicine record charts; these charts were well maintained and had clear records of why medicines had not been given of refused. We did note that those residents who are prescribed p.r.n. (as required) medicines did not have records in place to clinically justify continued use. Forest Healthcare Hingham Norfolk DS0000066011.V370235.R01.S.doc Version 5.2 Page 14 When we looked at the records for Temazepam we noted that one tablet had gone missing; we could not find any records for investigating what had happened to this tablet. On examination of the medicines that are held in stock and not currently in use we found that too many tablets of Co-dydramol, Trimethopin, Codeine syrup, and Prozac were kept. Forest Healthcare Hingham Norfolk DS0000066011.V370235.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A limited range of activities for the younger residents in this home and in the community mean that the residents do not have a wide range of opportunities to participate in stimulating and motivational activities. More consideration needs to be given to extending the activities into the weekend. EVIDENCE: The home now employs 3.5 staff to facilitate activities. The lifestyle manager told us that they aim to do at least 2 activities a day as well as one to one and taking the residents out. The activity programme appeared very varied although the younger residents at the home felt that there was nothing for them, as it seemed very much geared towards the older residents. One resident told us that they had requested to go to the cinema to see one of their favourite actors but was told it was not possible. Another younger resident told us “ I do not do karaoke or bingo” and did not feel that the activities included residents like them and another younger resident told us Forest Healthcare Hingham Norfolk DS0000066011.V370235.R01.S.doc Version 5.2 Page 16 “there is not much to do in the evenings”. We also noted that the programme did not ensure that peoples spiritual needs were met. A number of activities have taken place including a wine and cheese evening, entertainment that the residents have chosen themselves and flower arranging. We saw programmes for the daily activities that are also placed in the resident’s rooms on a weekly basis; we did note however that activities at the weekends rarely take place. There are ‘talking books’ available for those who wish to use them and a luncheon club. The lifestyle staff are in the process of recording life histories in order to help them plan activities for the future. Some relatives become involved in the social events but on the whole not many do although they are always invited. Good records are kept of the resident’s involvement in the activity programme and these are audited monthly. The menus are varied and appear to be nutritionally balanced and in discussion some residents felt that they were not offered sufficient fresh fruit, vegetables and fish. The younger residents that we spoke with said the food was geared very much towards the older person and one said “although I was asked about what I would like to eat, no one has yet given me what I like”. After discussion with a number of residents we felt that on the whole they thought the food was acceptable. We did overhear one resident being asked what they would like for supper, sandwiches or a teacake, they replied sandwiches and the kitchen assistant then went on to another resident having made an assumption what this resident would like in their sandwiches, no choice was given. We did however establish that choices are given for the main meals of the day. Forest Healthcare Hingham Norfolk DS0000066011.V370235.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents do not feel safe or listened to and relatives do not feel their concerns are taken seriously. There are poor practices of maintaining records and formal processes need to be developed to ensure that the home’s procedures and policies are constantly applied and adhered to, to maintain the safety of all who live at the home. EVIDENCE: A complaints procedure is available to all the residents and their relations. Relations have expressed a number of concerns to us; most have spoken about their concerns and how they are handled by the home. One relative has informed us that they are constantly being told that “the manager will not speak with you”, when the manager was told this she replied that it was a lie, but when asked if she had tried to contact the relative she said she had not. We could not find any documented evidence of this relative’s concerns although they had been relayed to her by the staff. One relative commented to us that if only they could work closely with the management they would all feel greatly reassured. Another relative says that they write messages in the message book in their relative’s room but no one ever responds. A resident said “ I know who to complaint to, but it wont do any good, no one pays any attention”. Forest Healthcare Hingham Norfolk DS0000066011.V370235.R01.S.doc Version 5.2 Page 18 We checked the records for complaints, not all had been recorded and those that had been, did not all have a record of the action taken and if the complaints had been resolved. One complaint was about another resident going into their room in the middle of the night and shaking them awake and looking for alcohol. Other complaints that have been documented were incidents of missing money but no records were in place to say how these were dealt with or if the police had been involved. One has been reported to the Adult Protection Unit and has been under investigation. A number of allegations have been made in relation to the way some carers speak to the residents or handle them; some have been reported to the appropriate authorities but some have not. One relative reported to the manager about a carer speaking unkindly to a resident however the relative did not feel her concerns were taken seriously. Another allegation of verbal abuse was discovered at the time of inspection where an allegation had been received in writing about a witnessed verbal abuse but the manager had failed to do anything about it although the letter was dated the 28th July 2008 and we discovered it on the 15th of August 2008. We looked at the training records for evidence of staff training in relation to safeguarding adults; we noted that some staff had received training but had not had an update since 2005, some had received training in 2007 and 2006 14 care staff had not received any training at all including the manager. (Staff training will be covered more fully in Standards 27-30). All the training that had been done was ‘in house’ with use of a video by someone who had not been updated in safeguarding issues since 2005. Forest Healthcare Hingham Norfolk DS0000066011.V370235.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The poor condition of the fixtures and fittings and some equipment means that residents live in an inadequate and unsafe environment. EVIDENCE: A tour of the premises was made internally and externally. We found that in some areas of the home there was a distinct smell of urine and other offensive odours, this was also detected on entry to the home. Overall the inside of the home was looking tired and drab and in need of re decorating; we did note that some of the corridors had been re carpeted. A number of fixtures and fitting need replacing, the cover on the radiator opposite the manager’s office was falling apart as was the cover on the radiator in room one. We found room one to be in need of decoration, the Forest Healthcare Hingham Norfolk DS0000066011.V370235.R01.S.doc Version 5.2 Page 20 carpet had a lot of burn holes in it and the door was hanging off the small bedside cabinet, the wall by the back door looked as if it had something unpleasant stuck on it. The manager’s office was dirty and untidy and had crumbs on the floor it also smelt strongly of a dog. The area behind the reception desk was littered with empty cardboard boxes and could be considered as a fire hazard, however when this was pointed out to the administrator she cleared the boxes away. We spoke to one cleaner who was aware of precautions they needed to take in relation to infection control and safe storage of all cleaning agents that could be hazardous. The area outside the home was looking acceptable with seating areas for the resident’s; some seats were in shaded areas with umbrellas to keep the sun off the residents whilst sitting there. Many of the wheelchairs were dirty and lacked footplates; the manager stated that the night staff were meant to ensure that the wheelchairs were kept clean. This does mean however that the care staff are then taken away from their caring duties to do this. One newly admitted resident has been allowed to have their dog with them, unfortunately they are unable to care for the dog themselves: the manager states that it is the remit of the lifestyle team to look after the dog and take it out however the lifestyle team are not in the home during the night or at the weekends and the responsibility then rests on the care staff. Members of staff told us that the dog bites and therefore poses a hazard not only to the staff but also the residents. The dog has been given a small confined area outside the back door of the room and staff were unable to tell us who is responsible for clearing up the excreta made by the dog. Forest Healthcare Hingham Norfolk DS0000066011.V370235.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some improvement has been made in relation to staffing, but no improvements have taken place in relation to training. This means that the people who use the service do not have good outcomes. EVIDENCE: Comments from the residents and relatives suggested that some residents were not getting the support they needed, one resident we spoke with said that they felt that some residents got more care than their relative. Many comments made to us by residents and relatives highlighted the fact that the quality of their care depended on which carers were on duty and one resident said “it take the staff ages to answer my bell”, they did comment that the agency The staff rosters showed that for the majority of shifts there were sufficient staff on duty although this did vary considerably at the weekends when staff tend to take ‘sick leave’. Mostly agency staff cover these shifts but staff confirmed along with the manager that this was more difficult during holiday periods and the weekends. The AQAA tells us that there are always two Registered Nurses on the night shift, this was found not to be so, but the manager said that this was going to commence soon. Forest Healthcare Hingham Norfolk DS0000066011.V370235.R01.S.doc Version 5.2 Page 22 The staff themselves felt that at times they were very busy and would like to spend more time with the residents. There is a training matrix and this evidences that on the whole only mandatory training has taken place, it also tells us that fifteen staff members have not received any training in relation to Safe Guarding Adults and of those that have had this training twelve have not been up dated since 2005. Those that have been in receipt of training most recently have received their training from a member of staff who have not received any specialist training in this area since 2005. This means that although the resident’s basic needs are being met, staff are unable to respond to the individual specific needs of the residents. A number of staff that we spoke with felt that they did not have the skills to deal with some of the resident’s care, especially those who have presented with challenging behaviour. The training matrix tells us that only 14 of staff hold a NVQ qualification. All training is done internally with lack of training from outside facilitators. Those staff we spoke with confirmed their lack of training particularly in relation to the resident’s specific needs. We looked at the records for newly appointed staff, two of these who were registered nurses only had one reference in place and no CRB check, but did have a POVA. One care staff member had not declared a criminal conviction on their application form and there was no record of how the manager has dealt with this. Forest Healthcare Hingham Norfolk DS0000066011.V370235.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are management shortcomings that potentially compromise the health, safety and welfare of the people who use the service. EVIDENCE: We have had numerous concerns expressed to us in writing and verbally from residents and relatives saying that they wished for more contact from the manager who they also felt did not listen to them or deal with their concerns. One relative said, “if only we could work together with the manager we would all feel greatly reassured”. Forest Healthcare Hingham Norfolk DS0000066011.V370235.R01.S.doc Version 5.2 Page 24 One relative has told us of numerous attempts to speak with the manager that have failed. Some have said they do not like going to the office because of the big dog that belongs to the manager and is always in the office. Some relatives and residents have expressed concern to us about disruptive residents that have been admitted to the home. The management of records is not entirely satisfactory and the manager at times has difficulty locating paperwork necessary for inspection purposes. A number of incidents have occurred in the home that the Commission had not received notification about. A number of incidents and complaints that have been recorded have not got the outcomes in relation to these incidents/complaints and records of how they were handled. The resident, relative and staff surveys that had been sent to the home from the Commission had not been distributed and the staff were unaware of their existence. Formal supervision has not been happening and this was confirmed by both the manager and those staff we spoke with. A sample of health and safety related information was checked, these were clear and in good order. A number of requirements made in the last inspection report have not been met. Forest Healthcare Hingham Norfolk DS0000066011.V370235.R01.S.doc Version 5.2 Page 25 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 1 1 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 1 1 2 x x x 2 1 1 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 1 2 x x 1 2 2 Forest Healthcare Hingham Norfolk DS0000066011.V370235.R01.S.doc Version 5.2 Page 26 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 OP30 Regulation 18 (1) (i) Requirement It is required that all staff receive training appropriate to the work they are to perform. This is a repeated requirement People who use the service must have medicines prescribed on a p.r.n. (as required) basis given to them by staff only when clinically justified and this can be demonstrated by record keeping practices. This is a repeated requirement All people using the service must be confident that all their health care needs will be met by staff using a consistent approach to care. This is a repeated requirement The manager must ensure that she makes herself available to listen and address all concerns made by the service users and their relatives. This is a repeated requirement DS0000066011.V370235.R01.S.doc Timescale for action 15/08/08 2. OP9 13 (2) 15/08/08 3. OP7 15.1 15/08/08 4. OP16 22 (2) 15/08/08 Forest Healthcare Hingham Norfolk Version 5.2 Page 27 5. OP19 23 (2) (d)(o) All parts of the home must be kept clean, reasonably decorated and well maintained to ensure the residents live in an acceptable and safe environment. This is a repeated requirement 15/08/08 6. OP30 18 (1) The manager and all staff must 15/08/08 be appropriately trained in the work that they perform. This will ensure people are safe and protected whilst helping to reduce risks related to their care. This is a repeated requirement All staff must be recruited to the standards required by the regulations; shortfalls in the system for recruitment can place residents at risk. The manager must ensure that all staff are appropriately supervised with policies and procedures in place, which ensure that residents have sufficient protection. All incidents of complaints must be recorded and action taken, this will ensure that residents and others feel that they are listened to. Prospective residents must be appropriately assessed so that the service does not admit residents that do not comply with the category for registration. 15/08/08 7. OP29 8. OP36 19 4 (b) (ii paras 1-7 0f schedule 2) 18 (2) 15/08/08 9. OP16 17 (2) & Schedule 4 14 (1) (a) 15/08/08 10. OP3 15/08/08 Forest Healthcare Hingham Norfolk DS0000066011.V370235.R01.S.doc Version 5.2 Page 28 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 OP12 Good Practice Recommendations Consideration needs to be given to given to extending activities into the weekends so that the residents are given the choice of participating in meaningful stimulation at the weekends and especially for those who do not receive visitors. Consideration also needs to be given to providing the younger residents with more meaningful activities. Consideration needs to be given to the amount of excess medicines held in stock; this will reduce the risk of errors being made. Consideration must be given to putting risk assessments in place for both dogs in the home to ensure the safety and well being of the residents and staff. 2. 3. OP9 OP19 Forest Healthcare Hingham Norfolk DS0000066011.V370235.R01.S.doc Version 5.2 Page 29 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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