Inspection on 23/08/07 for Hassingham House Care Centre

This inspection was carried out on 23rd August 2007.

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

Hassingham House Care Centre 14/08/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Hassingham House Nursing Home Hardingham Street Hingham Norfolk NR9 4JB Lead Inspector Mrs Marilyn Fellingham Unannounced Inspection 09:05 23 August 2007 rd 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 Hassingham House Nursing Home DS0000066011.V352260.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. Hassingham House Nursing Home DS0000066011.V352260.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hassingham House Nursing Home 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 Hassingham Limited 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 Hassingham House Nursing Home DS0000066011.V352260.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 6th June 2006 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 undergone extensive alteration this year and there are now beautiful laid out gardens that can be accessed by the Service Users. All rooms have a door to access the grounds and some Service Users had 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 £550 and £2,315 per week. Hassingham House Nursing Home DS0000066011.V352260.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over eleven and a half hours and two visits to the home. The manager was present for the inspection process. Opportunity was taken to examine care and staff records and recruitment documentation. We spent time observing staff working with service users, speaking with staff members, service users and visitors to the home. Six comment cards were received from relatives and three from service users. Telephone calls had been received by the Commission prior to the inspection from concerned relatives. The inspection report reflects regulatory activity since the last inspection and evidence from inspection of Key Standards. What the service does well: What has improved since the last inspection? There have been some improvements in the induction and training programmes. Hassingham House Nursing Home DS0000066011.V352260.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Hassingham House Nursing Home DS0000066011.V352260.R01.S.doc Version 5.2 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 Hassingham House Nursing Home DS0000066011.V352260.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process remains good, is informative and enables the service to ensure that the care needs can be met. EVIDENCE: The home has an admissions procedure that adequately guides the assessor as to actions to be taken to ensure service users needs that bare assessed prior to moving into the home: it also allows the home to ascertain if the individuals needs can be met. Case tracking confirmed good practice in part. Of the five admission assessments seen four were very informative but one was not very detailed and lacked a full assessment of needs; however the assessment of needs on admission was most detailed. Hassingham House Nursing Home DS0000066011.V352260.R01.S.doc Version 5.2 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. 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. Variable practice regarding care planning and delivery of care means that the service users cannot be sure that their health and personal care needs will be fully met. The administration and handling medication is satisfactory, however some improvements are necessary to ensure that appropriate records are kept for p.r.n. medication. Service users are not always treated with respect and dignity. Hassingham House Nursing Home DS0000066011.V352260.R01.S.doc Version 5.2 Page 10 EVIDENCE: Ten care plans were reviewed; these were clearly set out and addressed all health care needs. It was noted that the initial needs assessments were used to formulate plans of care. In general the plans reflected clear guidelines for care with appropriate referral to risk assessments for falls skin integrity, nutrition and mobility. All but two of the care plans had evidence of constant review of care; however it was disappointing to note that the care plan in relation to a wound had not been reviewed at all. Another care plan had not been updated after a GP’s visit who had revised the treatment for this individual. Those staff spoken to were familiar with the care plans and the care that was needed for the care plans under examination. There were very detailed daily notes that highlighted some areas of need that were then used to formulate care. Some comments made in the surveys stated that the standard of personal care was not always given as expected and one stated that “mother was incontinent but did not appear to have many baths”. Another comment in the surveys suggested that the needs are not continually met and care plans not adhered to. One visitor and service user commented that they felt that the standard of care varied as to how many staff were on duty at any given time. Comments on two surveys stated that the care was good. Another survey stated that a resident was not regularly toileted. Those relatives and service users spoken to by us felt that overall the care was acceptable but depended how on many staff were on duty. One service user was prescribed oxygen therapy but there was no plan of care in relation to this, or the oral hygiene that was required. Although we observed on the day of inspection service users being treated with respect and dignity the comments made by some service users and relatives would suggest that this is not always so and that some of the staff are unpleasant, one even commenting that a resident should “be put in a box”. There appears to be some inconsistent practice. This means that service users cannot always be confident that they get assistance and support from people who understand there care needs. A random check of medication records showed that the medication available tallied with that on the records and related to the care plans, daily notes and visits from GP’s. It was noted that prescribed eye drops did not have a date for opening, this can lead to out of date medication being used. During the audit trail for prescribed p.r.n. medication it was found that the records were accurate but there was no record in the resident’s care notes to clinically justify why medication was being given. Hassingham House Nursing Home DS0000066011.V352260.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good records are kept for all activities that the residents have participated in. A wide range of opportunities for activities are planned for the future to meet the needs of all individuals. Meals and mealtimes are handled well. The menus are imaginative and nutritious. Hassingham House Nursing Home DS0000066011.V352260.R01.S.doc Version 5.2 Page 12 EVIDENCE: Those service users that we spoke to were positive about their lifestyles and that it matched their expectations. A new facilities and hospitality manager has been appointed who has already started to plan many activities along with the carer responsible for activities. This member of staff is also responsible for overseeing the preparation of food and menus along with the newly appointed chef. This hospitality manager has visited many of the service users to discuss menus with them and to establish what they like doing. Although many comments on the surveys related to the dislike of the food we found that generally there had been much improvement since the new appointments. We observed a mealtime that was relaxed and many residents made favourable comments about the food; we also tasted the food on two days and found it to be both acceptable and imaginative whilst at the same time being nutritious. Hassingham House Nursing Home DS0000066011.V352260.R01.S.doc Version 5.2 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. 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. Service users and relatives do not feel listened to. A more formal process needs to be developed so that the home’s procedure for complaints is constantly applied and that the manager makes herself more accessible. More training needs to take place in relation to safeguarding adults so that all staff have a better understanding of all areas relating to this area. EVIDENCE: A complaints procedure was available and those we spoke to were aware of how to make a complaint. A detailed complaints record is kept with what action was taken in relation to each complaint. A number of comments made by relatives and service users cited in our surveys suggest that they do not always feel listened to and that the manager is difficult to access to share their concerns with. We have received a number of concerns from relatives, mainly about the food, cleanliness of the environment and lack of staff. Hassingham House Nursing Home DS0000066011.V352260.R01.S.doc Version 5.2 Page 14 The home was being investigated in relation to an allegation of neglect in care, however an outcome to this allegation was not known at the time of inspection. Records were in place for this particular incident, however the plans of care could have been more detailed. The training matrix was examined and it highlighted that more POVA training was needed, the manager is aware of this and arrangements being made to increase this. Hassingham House Nursing Home DS0000066011.V352260.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a potential risk in relation to infection control. The poor condition of some of the décor and carpets means that service users live in an inadequate environment. Hassingham House Nursing Home DS0000066011.V352260.R01.S.doc Version 5.2 Page 16 EVIDENCE: We made a tour of the internal and external environment. The poor condition of some of the décor and carpets means that service users live in an inadequate environment. A number of concerns had been voiced to the Commission about the garden and the cleanliness of the home. We noticed during the tour of the home that the garden in places was untidy and the flowerbeds needed weeding. An area in one corridor looked damp and had not been attended to. The pink carpet was very stained and needs to be replaced. An area outside room nine smelt strongly of urine and other unpleasant odours were detected. We noticed on the tour of the home charts and instructions on doors outside service users rooms, this could be seen as a breach of confidentiality. The domestic staff when questioned have had training in infection control, however it was noted that they used cut-up pieces of towelling for cleaning that were then washed and used again; this could be seen to pose a threat in relation to infection control. Hassingham House Nursing Home DS0000066011.V352260.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The deployment of staff is not always sufficient to meet the assessed needs of the service users and can put service users at risk. Training could be improved which should result in better outcomes for people using the service. EVIDENCE: Staff themselves felt that they were very busy and could not spend as much time with the service users as they would like. This means that although the service users basic physical needs are met there are many areas that can be improved to ensure that the staff are able to respond to the sometimes complex needs of the individual. The home has 50 of carers with NVQ level 2, unfortunately the company that was doing the NVQ training has gone into liquidation and therefore made it difficult for those who were doing the NVQ training to complete the course. A training matrix has been developed, however more work is needed to expand the training given and in particular enhancement is needed with regard to safeguarding vulnerable adults. The manager is aware of the training needs for all the staff. Hassingham House Nursing Home DS0000066011.V352260.R01.S.doc Version 5.2 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 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 adequate. This judgement has been made using available evidence including a visit to this service. The management arrangements for the home do not entirely meet the needs of the service users and the quality of the service needs improving. EVIDENCE: Those service users and relatives to whom we spoke felt that they would like more contact with the manager, they felt that she was not readily available to discuss issues with them or listen to their concerns: they did however think that the sisters were approachable. The staff that we spoke to however felt that the manager was most approachable. Hassingham House Nursing Home DS0000066011.V352260.R01.S.doc Version 5.2 Page 19 Quality assurance systems are in place but it is questionable if they are effective. Formal supervision is continuing and staff members confirmed this. Some concerns were expressed from relatives and service users about the admission of some service users to the home and felt that at times that they had a disruptive element in the home. This was discussed with the manager who said that she was aware of the importance of doing through assessments and not admitting people who did not fit the registration of the home. Maintenance records were examined; these were good and up to date. Hassingham House Nursing Home DS0000066011.V352260.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 3 x X X x 2 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 x x 3 3 2 Hassingham House Nursing Home DS0000066011.V352260.R01.S.doc Version 5.2 Page 21 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. 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. The manager must ensure that she makes herself available to listen and address all concerns made by the service users and their relatives. All parts of the home must be kept clean and reasonably decorated. That the grounds are suitably maintained. Timescale for action 10/12/07 2. OP9 13 (2) 10/11/07 3. OP7 15.1 10/11/07 4. OP16 22 (2) 10/11/07 5. OP19 23 (2) (d) (o) 10/11/07 Hassingham House Nursing Home DS0000066011.V352260.R01.S.doc Version 5.2 Page 22 6. OP26 13.3 7. OP27 12,18 8. OP30 13 (6) The registered persons must ensure that the arrangements for cleaning the home are appropriate to prevent the spread of infection. The registered persons must review staffing levels to ensure that these are adequate to meet the increasing dependency of service users. The registered persons must ensure adequate training is put in place to ensure that the staff understand all areas relating to safeguarding adults. 10/11/07 10/11/07 10/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hassingham House Nursing Home DS0000066011.V352260.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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. Extracts may not be used or reproduced without the express permission of CSCI Hassingham House Nursing Home DS0000066011.V352260.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!