Inspection on 25/02/09 for Hatfield Nursing Home

This inspection was carried out on 25th February 2009.

CSCI found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hatfield Nursing Home 09/07/09

Extracts from inspection reports are licensed from CQC, this page was updated on 21/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hatfield Nursing Home Tamblyn Way Hatfield Herts AL10 9AX     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julia Bradshaw     Date: 2 5 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Hatfield Nursing Home Tamblyn Way Hatfield Herts AL10 9AX 01707255270 01707255270 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sanctuary Care Ltd Name of registered manager (if applicable) Pervine King Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 118 The registered person may provide the following categories of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Hatfield Nursing home is situated on the outskirts of Hatfield and near to the Galleria shopping centre. The home provides nursing, dementia and residential care . The home is arranged on five floors and can accomodate a total of 118 men and women. The home was opened in 2008 and is purpose built with a range of extensive specialist equipment and modern facilities. Each room has an en-suite facility with ample bathing and communal areas throughout the home. The reception and managers office are Care Homes for Older People Page 4 of 29 care home 118 Over 65 0 118 118 0 Brief description of the care home located on the ground floor. The home has access to a variety of shops located within the Galleria shopping centre and there are public transport links approximately ten minutes away from the home. The information relating to the service is avalaible in the Serice User guide and Statement of purpose, which are displayed within the reception area of the home. The range of fees for Hatfield Nursing home are £496 to £863 per week. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of the inspections undertaken by the Commission is upon outcomes for the people who use the service and their views of the service provided. The primary method of inspection used was case tracking which involved selecting four people and tracking the care they received through looking at their care records, discussion where possible with the people who use the service, the care staff and observation of care practices. The visit was unannounced and planning for the visit included assessment of the notifications of significant events, which had been received from the service to the Commission. We looked at the information relating to the recent registration of the home and information on safeguarding and complaints. We also looked at the Annual Quality Assurance Assessment (AQAA) and reviewed what the service plans were for further next twelve months. During the visit information was Care Homes for Older People Page 6 of 29 gathered directly from the staff and people who use the service. The visit took place over one day and with one inspector. This enabled the inspector to directly and indirectly observe the care practices and the day to day operations of the service. A selected tour of the building was conducted during which the inspector spoke with people who use the service, staff and Commissioning manager. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides detailed written information which allows people to make informed choices about the home. Assessments are completed by staff who have the necessary skills to ensure that people using the service can be sure that all their needs are identified and met. Evidence: A copy of the Statement of Purpose and Service User guide were available and displayed in the reception area of the home. These had been compiled prior to the home opening in 2008 and are updated annually or when any relevant changes occur within the service. However although the Statement of Purpose has a completed index some of the sections it refers to are missing i.e. Layout of the home - this section states To be contained in this section. Sections 8 9,10,11 and section 14 was also incomplete. The admission notes and care plans of four people were examined and confirmed that Care Homes for Older People Page 10 of 29 Evidence: the assessment process of these four people had been completed appropriately. Records of the four people case tracked as part of this inspection had individual contracts that had been signed. These contracts listed all the relevant information. Care Homes for Older People Page 11 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans do not currently fully reflect the needs of the people living within this service and therefore could place people at risk. Evidence: Four care plans were case tracked as part of this inspection process. It was identified that some people who use the service do not have sufficiently detailed care plans and risk assessments in order to ensure that their needs are met at all times. Two care plans inspected did not reflect their diverse needs, current situation or discuss any future plans, clear and realistic aims and aspirations. The service has a key worker system in place, however the remit of this could be further managed and detailed in order to ensure that the care planning and person centered planning process is further expanded upon. There was limited evidence to confirm that the people living within the service had been involved in creating their care plans, with only one out of four care plans inspected being signed by the service user or endorsed by representative. It was evidenced that several risk assessments were duplicated, not signed or dated. There is a section within the care plan that explores an individuals cultural and religious needs Care Homes for Older People Page 12 of 29 Evidence: however there is scope for this to be expanded upon further to ensure that the specific needs of people are firstly identified and then services tailored and or adapted to meet that needs. The AQAA states that Care is delivered on a Person Centered Care approach and is within the principles of respect, dignity , privacy and encouragement of independence. However the care plans inspected on this occasion do not encompass the principles of being either holistic or person centered. Also care plans did not contain an end of life pathway. These issues were discussed with the acting manager and reassurances were given to the inspector that these care plans would be reviewed and amended as a matter of urgency, in order to ensure people living within the home are provided with care that meets all their needs. The service uses a four weekly dosette system for the dispensing of medication. The recording sheets were checked and no errors were found. However the administration of paracetamol did not include a running record for individuals and therefore could not be reconciled. The returns book was checked and had been completed appropriately. The policy of the home is that two members staff administer and witnesses all medication given. On the day of this inspection the inspector was able to observe medication being given appropriately. However one of the staff responsible for administering medication on this occasion, was unable to give the inspector any information on the medication they were giving and did not know the common side effects of two of these prescription drugs. This could place people living within this service at risk and dos not ensure peoples health and welfare is protected. Neither of these staff members were able to locate a copy of either the homes medication policy or procedures for administering medication. There is currently no internal auditing system in place for the administration or monitoring of medication. There was no date of opening on two bottles of lactulose within the medication trolley. There is a robust system in place for the maintenance of controlled drugs. Two peoples tamazepam was checked and reconciled by the staff member and the inspector and found to be accurate on both occasions. Fridge temperatures were being recorded daily. The home has links with the local specialist support services, within the community, when necessary. Hatfield Nursing home uses three local GP surgeries. Care Homes for Older People Page 13 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home should expect a range of activities to meet their varying interest however this still needs to improve and incorporate a more varied programme. People living at the home can enjoy a varied and wholesome diet to ensure that their nutritional and dietary needs are met. Evidence: The inspector was informed that a new activities co-ordinator had been appointed to the service. There was some evidence seen throughout the service that people had been involved and encouraged to take part in creating some art and craft displays to reflect peoples interests and to celebrate a variety of events throughout the calendar year. Peoples personal interests are assessed as part of their overall assessment of need. However the care plans inspected did not contain regular and consistent entries on how people spend their social and leisure time with one care plan having the last entry made on the 6th January. Although the service currently has adequate activity hours allocated because the service is only partially occupied there is a concern that these hours will not provide an adequate resources once the home is fully occupied. The service has a total of 36 hours for activities throughout the home. These hours Care Homes for Older People Page 14 of 29 Evidence: also need to incorporate the specialist needs and interest of people who have dementia. The service does not have any on site transport and requires people to take taxis or where appropriate, public transport. The service was currently in the process of advertising for some additional catering staff, with an agency chef being used on the day of this inspection. The inspector was able to sample the lunchtime meal and it was found to be both flavoursome and nutritionally balanced. Several people spoken to said that they together food was very tasty and lots of choice and there is always something different to choose from. Care Homes for Older People Page 15 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current system for managing complaints is effective. However people are currently at risk of financial abuse due to ineffective and unsafe systems of managing and auditing the financial aspects of the service. Evidence: The service has a detailed complaints procedure in place. This includes a section outlining the individual complaint and an action plan to resolve the issues raised. Although there is a policy and procedure in place to ensure people using this service are protected from abuse, the Commissioning Manager informed the inspector that a large sum of money belonging to a resident had gone missing. As a result of this two members of staff had been suspended pending a full investigation. Furthermore another sum of money has allegedly gone missing from the home and is still under investigation by the Commissioning Manager. Both these incidents are serious breaches in ensuring there is a robust systems in place to both protect and ensure there are people living within the service are protected. The inspector has referred this issue to Adult Care Services as a safeguarding matter. The Commissioning manager stated that the service user had been fully reimbersed for these missing monies. However both these incidents raise serious concerns for the monitoring and auditing of the financial systems within the home and must be seen by the acting manager as a priority in improving and implementing a more robust and secure system for handling peoples monies. Care Homes for Older People Page 16 of 29 Evidence: The recent AQQA stated that there have been 5 complaints and four of these are still awaiting a satisfactory outcome. One referral has been made to safeguarding by the home and three safeguarding referrals have been made by Care Quality Commission. Care Homes for Older People Page 17 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can enjoy a comfortable and safe environment in which to live. Evidence: The home has been open since August 2008 and is a purpose built facility, arranged over 5 floors. All rooms are en-suite consisting of hand basin, shower and toilet and lockable storage space. The garden areas are easily accessible and private. There are additional toilet facilities close to each communal area. In addition, there is an assisted bath room in each unit , to give people the opportunity to choose between a bath or shower. All bedrooms have been personalised reflecting peoples interest and some included items brought in from home. Each room has a large window with restrictors for safety. All bedrooms have thermostatic controlled heating. Throughout the home , there is adequate lighting and additional lamps are provided if required. Water Temperatures are checked monthly by the maintenance person. There are sluice rooms located on each unit. Each unit has a linen storage cupboard and a cupboard to store cleaning materials. There is adequate storage space within the home. There is an up to date fire risk assessments in place. Fire records were checked Care Homes for Older People Page 18 of 29 Evidence: and the most recent fire checks were carried out on the 23rd February 2009. The emergency lighting was last checked on the 15th February 2009. There are a team of domestic staff who maintain cleaning standards. No mal odours were detected on this visit. The service has a full time maintenance person who carries out all routine maintenance as well as the fire and hot water temperature checks. Care Homes for Older People Page 19 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The unsettled and temporary management arrangements currently compromise the effective running of this home and places the health and welfare of people using this service at risk. Evidence: The Commissioning manager is temporarily covering the registered managers post and the deputy manager was also working their notice period. The staffing structure for the service is one registered manager, one deputy and registered nurses on each floor throughout the day and nightime, plus care workers. The service currently covers staff vacancies with bank or agency staff. Also on the day of this inspection there was an additional manager on duty as the home was providing temporary accommodation for 26 people who had been moved from another Sanctuary Care home. The manager responsible for peoples care stated that these residents were being supported by their own staff team. Staff training could not be fully evidenced due to staff training records not being up to date. Also staff spoken to could not confirm when they last received formal supervision from a manager. A supervision schedule was unavailable on the day of this inspection to confirm that all staff have received the minimum supervisions required. There was an incomplete and out of date record of staff meetings held. The inspector asked to Care Homes for Older People Page 20 of 29 Evidence: see the induction records for the two most recent employees but this was unavailable. The inspector could only be shown a blank induction pack. The standards relating to staffing have not been met on this occasion and this is indicative of not having an effective and permanent management team in place to ensure staff are supported, trained and supervised effectively. These findings were fedback to the Commissioning Manager at the end of this inspection as a serious concern and requiring urgent action. A stable and effective management team is essential in order to ensure that people living at Hatfield Nursing Home are provided with a safe, efficient and effective service. Care Homes for Older People Page 21 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Ineffective management infrastructure and inadequate monitoring systems have placed people using this service at risk. Evidence: The current management structure of this service is temporary with the Commissioning Manager covering the Registered Managers post. The permanent deputy manager was also due to leave their post. This arrangement has created an unsettled management structure with staff feeling unsupported and undervalued. There was an air of confusion during this inspection process with staff on duty doing their best to locate files, policies and procedures with little management direction or leadership. This situation must be rectified as a matter of urgency for the service users, staff and everyone involved in providing a service at Hatfield Nursing Home. This service is a newly built project that could provide a very effective and valued service to people with nursing and residential needs as well provide a safe and fulfilling service to people with dementia. However there needs to be some radical Care Homes for Older People Page 22 of 29 Evidence: improvements to the current service to meet the minimum standards expected of this service. There have been three safeguarding referrals made by the inspector in the past two months , which is a cause for concern. Staff training, supervision and staff induction all need to improve. Care plans must contain all required information in order for staff to provide an effective package of care. These care plans must be signed and consented to by the service user or their representative. Risk assessments must be created whenever there is a risk identified and reviewed regularly. Staff who administer medication must have the underpinning knowledge to know what they are giving and the possible side effects of this medication. Activities must reflect the interests of the individual service user and must be relevant and meaningful. There must be a specialised activities provided to people who have dementia. The activity coordinator must be provided with appropriate training to carry out their role effectively. There must be a more efficient and effective quality monitoring system in place for every aspect of the service. The current quality assurance system has failed to identify the areas highlighted as part of this inspection. Financial irregularities have also compromised the effective running of this service and places people at risk of financial abuse. However it is recognised that the Commissioning Manager has worked hard since covering the managers post to improve systems and standards. Care Homes for Older People Page 23 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must reflect involvement of the person using the service and or their representative. To ensure that the care plan is accurate and written in the best interest of the person. Empowering individuality and protecting peoples rights. 31/05/2009 2 8 15 Everyone living within the 31/05/2009 service must have a detailed care plan that identifies their care needs holistically. To ensure that the needs of the people who use the service are adequately supported with their health care. 3 9 13 Medication policies and 30/06/2009 procedures must be adhered to at all times. Staff training in medication must be adequate to ensure that staff feel fully prepared and have the under pinning Page 25 of 29 Care Homes for Older People knowledge to administer medication safely. The service must ensure there is a system in place to monitor and reconcile the administration of paracetamol. Date of opening must be recorded for all non blister pack medication. To ensure the health and welfare of people is maintained and protected. 4 11 15 Care plans must identify the end of life pathway as part of the assessment and planning process . To ensure peoples wishes are respected and implemented 5 12 16 The range of social activities 31/05/2009 and opportunities should be further developed and documented within the individual care plan to ensure that everyone living at Hatfield Nursing home has opportunities and makes informed choices on how to spend their time. To ensure that people make an informed choice from a range of social and leisure opportunities. 6 18 21 The financial systems in place fail to ensure service users monies are protected and place people at risk of financial abuse. Monitoring 31/05/2009 31/05/2009 Care Homes for Older People Page 26 of 29 and auditing systems need to improve To ensure peoples financial interests are protected at all times. 7 28 18 There must be adequate and 30/06/2009 effective systems in place to ensure staff are competent to provide the care required to people using this service. To ensure people using this service are in safe hands at all times. 8 30 18 Staff must be provided with 30/07/2009 effective training and supervision to ensure the best possible care is provided to the people using the service. To protect people using this service from harm 9 31 8 The current fragile and temporary management arrangements are inadequate and require improving. A permanent manager must be in post as soon as possible. To ensure the effective running of the service 10 37 17 All records relating to the running of an effective service must be kept up to date, reviewed and amended where and when appropriate. People using the service must be consulted with all aspects of 30/06/2009 30/06/2009 Care Homes for Older People Page 27 of 29 their care and this must be evidenced. To ensure people are protected by the homes policies and procedures. 11 38 13 The health and welfare of 30/06/2009 people must be maintained and protected at all times by accurate records, policies and procedures kept within the home. To ensure people within the service are kept safe. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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