Inspection on 10/06/05 for Hastings

This inspection was carried out on 10th June 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hastings 10/11/09

Hastings 07/11/06

Hastings 17/11/05

Hastings 22/01/05

Hastings 06/07/04

Hastings 16/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Hastings 130 Barnards Green Road Malvern Worcestershire WR14 3NA Lead Inspector Yvonne South Unannounced Inspection 10 June 2005 08:00am 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. Hastings E52 S18685 Hastings V228706 100605.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hastings Address 130 Barnards Green Road Malvern Worcestershire WR14 3NA 01684 585000 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) hastings@heartofengland.co.uk Heart of England Housing and Care Limited Ms Johann Phelps Care Home 60 Category(ies) of DE(E) Dementia (over 65) - 60 registration, with number OP Old Age - 60 of places PD(E) Physical Disability (over 65) - 60 Hastings E52 S18685 Hastings V228706 100605.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: There are no additional conditions of registration to those listed on the previous page. Date of last inspection 22 January 2005 Brief Description of the Service: This purpose built home is situated in a residential area of Malvern. The home is built on three floors and has shaft lift access throughout. There are 24 single bedrooms on each of the two upper floors and 12 single rooms on the ground floor, providing accomodation for a maximum of 60 older people of either sex. Each bedroom has ensuite facilities. Each floor has lounge and dining areas for the service users. There is also a level garden. Heart of England (the company) state that they aim to provide a home for living in, where service users can expect to be treated as individuals and ‘live life to the full’. Mrs Phelps is the registered manager. Care is provided for a maximum of 60 service users over 65 years of age who may require care due to old age, a physical disability or a mental health problem. There are local amenities a few hundred yards from the home and public transport to Malvern town centre. Hastings E52 S18685 Hastings V228706 100605.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out from early morning to mid-afternoon over six and a half hours by two inspectors. Seven residents, the manager, senior staff and three members of staff were spoken to during the visit. Staff files, residents records and various management files were inspected as well as a “case tracking” exercise. What the service does well: The atmosphere in Hastings is relaxed and active. The people who live in the home walk around inside and in the garden as they wish. The staff when needed readily and pleasantly gives assistance. People confirmed that they were visited before they moved into the home and information was made available to help them make a decision on whether they wished to come and stay. People confirm that they are happy with the health and personal care they received and the staff respected them and their privacy. They feel safe in the home. Domestic staff are described by one person as ‘lovely’. Although perceptions vary, a variety of recreational activities are available from which people are able to choose to participate if they wish. Likewise the menus indicate that a variety of options are available to choose from. Opinions vary as to whether the choice and the quality of the meals meet individual tastes and expectations. Some people are very pleased and others less so. People are given the information and support they need in order to raise any anxieties they have and they are confident that they will be listened to. The home is kept in a clean condition and the maintenance, décor and furnishings are of a high standard and a credit the staff. New staff are recruited with due regard for the safety of the people who live in the home. Training is provided to ensure they are able to provide the service that is needed by the service users. Hastings E52 S18685 Hastings V228706 100605.doc Version 1.30 Page 6 The management teamwork well together, and the service users and staff find them approachable and supportive. 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. Hastings E52 S18685 Hastings V228706 100605.doc Version 1.30 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 Hastings E52 S18685 Hastings V228706 100605.doc Version 1.30 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, 5 Detailed information is provided about the services offered at the home to help service users make an informed choice about whether they can meet their needs. Arrangements are in place to carry out a full assessment of service users’ needs to ensure the home is suitable for them and can meet their care needs. EVIDENCE: The statement of purpose and service users’ guide were freely available. A new service user was able to confirm that he had been given the information pack. Staff who were spoken to could not confirm that they had read the statement of purpose but were able to say what the aims for the home were. The newly admitted service user was able to confirm that he had been assessed by a member of staff at the place he lived before, and had been to visit the home prior to moving in. Assessments seen were thorough and covered all areas of the service user’s needs. Hastings E52 S18685 Hastings V228706 100605.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 The systems in place for meeting service users’ needs are comprehensive, but records are not consistently filled in by staff. This could put service users’ health and welfare at risk. Medication administration is carried out safely, albeit late which could compromise the service users’ health care. The home provides a wide variety of choice for meals and caters for special diets. EVIDENCE: The care planning systems in place were comprehensive and provided a template for recording all aspects of the service users’ care needs. However, the three care plans that were seen were not all consistently recorded on by staff members. Staff spoken to about individual service users were aware of their specialist care needs. Hastings E52 S18685 Hastings V228706 100605.doc Version 1.30 Page 10 Good examples of recording showed detailed information of a service users’ dietary needs, risk assessments for self-medication and food and fluid monitoring when a service user was ill. A review of a service user who had infection control measures in place was carried out regularly. Regular reviews were held with the service users and some had signed their care plans. Some shortfalls, which were seen, included risk assessments not being updated or reviewed. One care plan had not been signed or dated when filled in. A service user who had a sore skin area did not have a risk assessment carried out although the correct pressure relieving equipment had been provided and the district nurse notified. There was no risk assessment in place for a service user who had on one occasion left the building without the knowledge of staff. It had been noted in the daily records and in a review that a service user had been aggressive and a behaviour-monitoring chart had been introduced. This information had not been transferred on to the care plan. Weight records were not always carried out monthly as stated in the plan. Not all moving and handling risk assessments had been reviewed as stated on the care plan. There was no nutritional risk assessment in place for a service user with noted dietary special needs. There is a very good system in place for short term care planning if a service user becomes ill but this had not been put into practice for one service user when they became unwell. Not all records of health care visits had been kept up to date. Bathing records had not been kept up to date. Service users who were spoken to said that they were happy with the health care provided to them and they felt safe with the staff. There was a system in place, which allowed for auditing the care plans and a discussion was held with the manager about how this was used. The morning medication round which was due at 8.00 am was being carried out at 9.45 pm. The senior member of staff administering the medication stated that she had to administer medication to two of the three floors of the home and this was the reason for it being late. This was common practice. The medication was seen to be administered appropriately and safely. Checks made on the administration of medication showed that it was being administered according to the policy and procedure for the home. All of the service users spoken to said that staff promoted their privacy and treated them with respect. One service user said, “They are very good in that respect”. Another said they are “polite, they always knock on doors” and another said, “I have no qualms about the staff”. One said, “They used to knock”. Observations made during the inspection showed staff knocking on doors and speaking respectfully to the service users. Hastings E52 S18685 Hastings V228706 100605.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 A varied programme of activities is available for services users, providing interest and stimulation. Although the activities on offer are varied they do not always meet the social needs and interests of all the service users. Facilities are available so that service users are able to maintain the contacts they wish in the manner they wish. Efforts are made to provide a varied acceptable menu of good quality meals for everyone to choose from. EVIDENCE: The early morning routine was relaxed and unhurried. There was a good variety of activities planned for in the home and in the community. The program was written in small print, which was hard to see. Activities on the day of the visit were energetic and service users were joining in with pleasure. Service users were encouraged to remain as independent as possible and go out as they chose. Service users who were spoken to gave differing opinions about the activities available. One said, “There is something going on everyday”. Another said, “There was not enough to do”. Another said, “ I can always find plenty to do”. Hastings E52 S18685 Hastings V228706 100605.doc Version 1.30 Page 12 All service users spoken to were happy with the visiting arrangements and could see family and friends in private if they wished. An example of a service user exercising choice was discussed with the service user and she stated that in making a decision the registered manager had been very supportive and helpful. The menus indicated a variety of options for the main lunchtime meal and teatime. Service users were also given a variety of choices at breakfast time. Again the opinions about food from residents were varied. They ranged from ”plenty of choice”, “not improved although trying to give more variety”, “very good, no quarrel with the food”, “not good, boring”, “improved bit not very good” and “very good, plenty of choice”. Hastings E52 S18685 Hastings V228706 100605.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17, 18 Service users receive information and support to enable them to express their concerns and are confident they will be responded to. Service use’s rights of citizenship are respected and they are protected from abuse by the provision of policies, procedures and staff training. Records do not provide documented evidence that the three complaints received have been appropriately dealt with. EVIDENCE: An acceptable complaint procedure and guidance for staff was available in the home. (When the documents are next reviewed the references to the National Care Standards Commission must be replaced with the Commission for Social Care Inspection.) All service users had received a copy when they moved into the home and were given support on how to use it if necessary. A service user who had been newly admitted to the home confirmed that he had been given a copy of the complaints procedure, and while other service users could not remember the document, they knew whom they would talk to if needed. The manager confirmed that an analysis’s of complaints was sent to the registered provider every three months. The records indicated that three complaints had been received since the previous inspection. The manager said that these had been actioned but the records had yet not been completed. Hastings E52 S18685 Hastings V228706 100605.doc Version 1.30 Page 14 One further complaint had just been brought to the Commission for Social Care Inspection and the responsible individual for the home has been asked to investigate the matter. Service users were registered on the electoral role and had been assisted to the polling station to vote in the general election. There had been some community difficulties for some service users in obtaining postal votes in time for the election and for others to physically gain access the polling station. The manager was advised to make a formal complaint on behalf of the service users. Records were seen that advocacy services had been considered for service users who needed their support. Policies and procedures relating to the protection of vulnerable people were readily available and training records indicated that staff were receiving appropriate training from induction onwards. This was confirmed by two members of staff. Hastings E52 S18685 Hastings V228706 100605.doc Version 1.30 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, 26 The home is well maintained and provides a comfortable and suitable environment for the service users. EVIDENCE: The home was a new, and purpose built to current standards, to provide care for people in need of residential care. It was clean, hygienic and well maintained. Staff who were spoken to, confirmed that they had received training in infection control and all were seen to wear appropriate protective clothing whilst carrying out their tasks. All service users spoken to confirmed that staff always wore gloves and aprons when giving personal care. Hastings E52 S18685 Hastings V228706 100605.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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) 27 to 30 Most needs of the service users are being met by the staff team but some delays in the delivery of care have an impact on them. Acceptable staff recruitment and training procedures were in force to protect service users and appoint suitable people. Training was provided to ensure staff were competent in their duties. EVIDENCE: The manager said that a recent recruitment drive had been very successful and a candidate had been identified for each vacant post. Clearance was awaited from the Criminal Records Bureau and the Protection of Vulnerable Adults Register before they commenced employment. In the interim the hours were being covered by agency staff. Copies of duty rotas were examined. When necessary the management team were also available to provide direct care. Staff opinions varied as to whether there was sufficient staff and three service users voiced concerns about the numbers of care staff on duty in as much as they sometimes had to wait for attention. Comments such as “staff are lovely when you can get them”, “always so busy” and “waiting 10 minutes for a carer” were made. Other service users did not raise this as an issue. Hastings E52 S18685 Hastings V228706 100605.doc Version 1.30 Page 17 The number of day staff rostered through the day was acceptable. However as concerns were expressed by some staff and service users, and medication was being administered late this would indicate that the deployment of staff should be reviewed. Immediately prior to the inspection a concern had been raised by night staff regarding a proposed change in their working arrangements. The current staff levels were for three waking care assistants and one lead carer sleeping in and available for emergencies. The numbers of staff on duty at night were not an issue but proposed changes in deployment had raised concerns. The manager confirmed that these were being discussed with all concerned. The manager said that all domestic staff were trained to NVQ level 1 and were working towards level 2. One service user said in particular that the domestic staff were “lovely”. There were a total of thirty care staff of which twelve had achieved NVQ level 2 or above in care, and a further eight were on courses. The manager had just completed her work for the Registered Managers Award and was waiting for it to be verified. Staff confirmed that they were given support and encouragement to undertake training. The training records were well organised and comprehensive. A member of staff considered she had received a good induction to the home and had felt well supported. She was looking forward to more training. There was a strong commitment to training. It was recommended that a system be developed to enable a calculation to be made on the amount of training each person received each year as the standard is for three days minimum per person. Two staff files were inspected and it was considered that an acceptable recruitment procedure was used. It was recommended that volunteers should also complete application forms and references should be taken up. Hastings E52 S18685 Hastings V228706 100605.doc Version 1.30 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, 35, 36, 37, The home is being well managed and the interests of service users are addressed. Financial procedures are sound and service users’ concerns are safe guarded. The frequency of staff supervision is insufficient to provide staff with regular, individual, planned support and guidance. Records are in place to protect the service users ‘ interests. EVIDENCE: The manager was well qualified and experienced to manage the home. It was observed that service users and staff were comfortable and came to the office for a variety of reasons during the morning. Hastings E52 S18685 Hastings V228706 100605.doc Version 1.30 Page 19 The senior team responded promptly and appropriately to everyone. The majority of service users found the manager to be kind and supportive. A member of staff also confirmed that she found the manager and senior team were approachable and supportive. The records indicated that meetings were held in small groups as well as full staff meetings. Service user meetings took place. All meetings were minuted and indicated that people were able to have their say and were listened to. It was observed that the operations of the home were well monitored and supervised. Questionnaires were distributed at regular intervals to ascertain people’s opinions on a variety of topics. Not all requirements set in the previous inspection report had been met within the time scales set. Further development was needed in the recording of care plans. There were clear procedures for the management of service users’ personal finances and valuables. It was observed that records were well kept and storage was acceptable. It was observed that service users were able to access their money when they wished. The manager said that the senior staff team supervised the staff team and the manager supervised the senior team but they had been unable to provide 1:1 sessions with each person every six weeks. The required records were being maintained although there was room for improvement in the care records, complaint records and a photograph was missing from one of the staff files inspected. Policies and procedures had been drawn up in 2002 and a programme of review should now be considered. References to the ‘NCSC’ should be replaced with ‘Commission for Social Care Inspection’ when this is done. The health and safety standard was not inspected in full. The fire log indicated that safety checks were being maintained and staff were receiving training. It was pointed out that the Fire Authority advised that induction training in fire safety should be repeated after one month for new staff and thereafter every three months. This training can be provided in house or from an external trainer. Hastings E52 S18685 Hastings V228706 100605.doc Version 1.30 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 3 x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION x x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 3 3 3 3 3 2 x x Hastings E52 S18685 Hastings V228706 100605.doc Version 1.30 Page 21 Yes 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 7 Regulation 15 Requirement Service users care plans must be recorded in a style accessible to the service users, agreed and signed by them whenever capable and/or their representative (if any). Care records must be filled in accurately to show how changing needs will be met, and to show the personal care residents receive on a daily basis. (These requirements are outstanding. A timescale of 31.08.04 had not been met.) Care plans must be signed and dated by staff when filled in. Risk assesments for nutritional and skin care needs must be completed. Moving and handling risk assessments must be reviewed regularly. Risk assessments for any aspects of challenging behaviours or when a service user places themselves at risk, must be completed. Records of visits from the primary healthcare team must be kept. Medication rounds must be Timescale for action 31st July 2005 2. 3. 4. 5. 7 8 8 8 15 13(4) 13(4) 13(4) 31st July 2005 31st July 2005 31st July 2005 31st July 2005 6. 7. Hastings 8 9 17(1)(a) 13(2) 31st July 2005 31st July Page 22 E52 S18685 Hastings V228706 100605.doc Version 1.30 carried out at the required times. 2005 8. 16 17(2) A record should be kept that includes details of complaint investigations and any action taken. All care staff must receive formal supervision at least six times each year. 31st July 2005 31st July 2005 9. 36 18 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 12 33 27 Good Practice Recommendations Activities programmes should be written in larger type. A programme of reviewing policies and procedures should be commenced. The deployment of day care staff should be reviewed. Hastings E52 S18685 Hastings V228706 100605.doc Version 1.30 Page 23 Commission for Social Care Inspection The Coach House John Comyn Drive, Perdiswell Park Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hastings E52 S18685 Hastings V228706 100605.doc Version 1.30 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. 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