Inspection on 09/07/09 for Hatfield Nursing Home

This inspection was carried out on 9th July 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hatfield Nursing Home 25/02/09

Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

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:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Julia Bradshaw     Date: 0 9 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 27 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): Type of registration: Number of places registered: Sanctuary Care Ltd care home 118 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 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 Care Homes for Older People Page 4 of 27 2 5 0 2 2 0 0 9 118 0 Over 65 0 118 Brief description of the care home 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 £507 to £863 per week. Care Homes for Older People Page 5 of 27 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: one star adequate 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 Care Quality 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 six 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 gathered directly from the staff and people who use the service. The visit took place over one day and with three inspectors. One of the inspectors spent two hours observing residents and staff in the lounge using a methodology called a Short Care Homes for Older People Page 6 of 27 Observational Framework for Inspections (SOFI). This was done in an effort to understand what life is like in the home for the people who live there. We were available to speak to people who use the service and also to staff employed at Hatfield Nursing Home. The findings and outcomes of this SOFI are detailed throughout this inspection report. A selected tour of the building was also conducted as part of this Key unannounced Inspection. The manager was present though out this inspection as well as the head of quality assurance, the deputy manager and a variety of staff who were on duty. The inspectors were also able to speak to some visitors during the afternoon of this inspection. Care Homes for Older People Page 7 of 27 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 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 27 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 27 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 within the main reception area of the home. These had been compiled prior to the home opening in 2008 but have since been updated by the newly appointed manager in June 2009. The admission notes and care plans of six people were examined and confirmed that the assessment process of these four people had been completed appropriately. Records of the six people case tracked as part of this inspection had individual contracts that had been signed, with the exception of one. These contracts listed all the relevant information. Care Homes for Older People Page 10 of 27 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: Six care plans were case tracked as part of this inspection process. Whilst there were some omissions within two care plans of either the persons own signature or that of their representative and two care plans inspected still need to reflect the persons diverse needs, current situation and clear and realistic aims and aspirations, including specific care needs relating to their physical and mental health care needs. However the manager and staff have worked hard to improve on the standards of care planning since the at the last inspection was carried out in February 2009. The care plans inspected contained individual risk assessments in order to ensure that peoples needs are protected and met at all times. The service has a key worker system in place which ensures the person using the service has a nominated person with overall responsibility for the implementation of their care plan and its review. There is a section within the care plan that explores an individuals cultural and Care Homes for Older People Page 11 of 27 Evidence: religious needs 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 these needs. Two of the care plans inspected did not contain an end of life pathway, although the manager stated that these documents were all available on the homes computer. However these documents must form part of a working document and be accessible at all times, primarily to the person using the service and to the staff team. This issue was discussed with the manager and reassurances were given to us that these care plans would be reviewed and amended as a matter of urgency. Two of the care plans inspected did not contain specific or detailed information on how to manage and support the person with a complex and chronic medical condition and also a person with an enduring mental health need. Care plans must always provide information that ensures that the staff team are able to provide the best possible support and care to the person. The service uses a four weekly dosette system for the dispensing of medication. The recording sheets were checked and no errors were found. 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 we were able to observe medication being given appropriately. There is a robust system in place for the maintenance of controlled drugs. Two peoples medication was checked and reconciled by the staff member and we found it to be accurate on both occasions. There were two issues relating to medication that we identified as part of this inspection. These included some hand written notes on one of the MAR sheets with the words To be given at tea x 2. This is an unsafe practice and does not give clear and comprehensive instructions to the staff who administer medication. There was also an overlap of two types of medication for one persons but that provide the same treatment but should be be administered separately. These issues were feedback to the manager at the end of the inspection and asked to be rectified as a matter of urgency. 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. There has been a history of one of these GP surgerys district nurses being asked to attend to nursing procedures that the home should be capable of performing by their own registered nursing staff. However this situation appears to have now improved with the appointment of more permanent registered nursing staff being appointed. Care Homes for Older People Page 12 of 27 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 good 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 can expect a range of activities to meet their varying interest and social and needs. People living at the home can enjoy a varied and wholesome diet to ensure that their nutritional and dietary needs are met. Evidence: People who use the service have the opportunity to develop and maintain important personal and family relationships. Feedback from one person using the service on the day of the inspection confirmed that relatives and or representatives are always welcome. The service appears to respects the human rights of people using the service with fairness equality, dignity, respect and autonomy underpinning the care and support being provided. One person who uses the service commented that my daughter comes every week and friends and family come to see me as often as they can. The manager and staff had recently arranged a bar-b-q within the grounds of the home to celebrate a residents 90th birthday. We also had the opportunity on the day of the inspection to speak to this persons relatives who spoke very positively about the day and how much they had appreciated the commitment and kindness of the staff in organising this event. There was also a display of photographs around the unit that reflected the enjoyment of this event by residents, relatives and staff. Feedback obtained in a questionnaire from a relative stated that The home provides a Care Homes for Older People Page 13 of 27 Evidence: caring and comfortable environment. My relative always enjoys their meals and the laundry is always done to a high standard.. A number of people who use the service were seen to be very relaxed and calm within their own environment and engaging with staff in an equal manner. The people using the service had a variety of communal and or personal spaces to relax. The activity co coordinator is currently attending the NAPA (National Association for Older Peoples Activities) training and the deputy manager is also attending the dementia care trainers programme, which includes person centered dementia care knowledge and also person centered dementia care training skills. Once completed the deputy will then cascade this training down to the whole staff team. It was evident from observing both the activity co-ordinator and the staff on duty that there is a clear commitment by the whole staff team in ensuring the best possible care and staff training is provided to people using this service. As part of this inspection a SOFI (short observational framework inspection) was carried out by one of the inspectors and their findings were generally positive with examples of good interactions from staff to service users Staff explained to one person exactly how they were going to be hoisted, in a gently and understanding manner. Some areas of the environment had displays of people art and craft work and some areas appeared a little bare. There was a suggestion that memory boxes could be used to help people in locating their rooms more easily. A sensory room has also been created on the second floor of the home in which people can relax and enjoy a display of soft lighting and relaxing music. Part of the care planning process identifies peoples preferred activities and comments about their life history. The service currently has 57 hours , divided between one full time worker and one person doing 18 hours activities allocated to providing activities to people using this service. However the organisation should review and increase these hours in light of the needs of the specialist activities required for people within the dementia units once the home is fully occupied. There are notice boards advertising forth coming events and important updates for the people who use the service. Staff were directly observed simply sitting with a number of individuals and taking about every day life. Regular activities include, hairdressing twice a week, musical afternoons, armchair activities, art afternoons and trips to the Galleria shopping centre and also trips to the coast during the warmer months are also organised. The menus were seen as part of this inspection process and they provided a balanced diet and a variety of choices. The food provided appeared appetising and well presented. Comments received included, The food is usually good and if I dont like whats on the menu they will make me something else.. We had the opportunity to observe the teatime meal being served which appeared both nicely presented and plentiful. Several people spoken to after their meal on the day, stated that they found it to be very flavoursome. Although four of the service user questionnaires returned Care Homes for Older People Page 14 of 27 Evidence: to the Commission stated that the meals could sometimes benefit from more variety and one another stated that they only sometimes liked the meals provided. The general consensus regarding the standard of meals was positive. Meals and snacks are provided at a time and place to suit them. The care staff are sensitive to the needs of those people who find it difficult to eat and staff were observed assisting people in a respectful and unhurried way. The service should explore the option of producing pictorial menus, where appropriate, for people with dementia to assist them in making an informed choice about the meals/snacks they would like. Care Homes for Older People Page 15 of 27 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 good 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 and the management of peoples money is effective in ensuring people are protected from financial abuse. Evidence: The service has a complaints procedure in place. A record is maintained of any complaints made detailing actions and outcomes as necessary. People using the service have been informed about the complaints procedure. The AQQA stated that all complaints received since the last inspection was carried out in February 2009 have been resolved effectively and to the satisfaction of both parties. Records to confirm this were seen on the day of the inspection. All surveys/questionnaires we received indicated that people were aware of how to make a formal complaint. Issues raised in residents meetings are managed effectively and actioned appropriately to ensure that these issues do not escalate into formal complaints. A detailed procedure is in place to ensure that people using the service are protected from abuse and harm. Staff receive suitable and adequate safeguarding training. Staff employed within the home is all subject to enhanced Criminal Records Bureau disclosure. The service has had a series of safeguarding referrals over the past six months. Historically these referrals were made as part of the previous ineffective management of the service . However since the last inspection was carried out and with a series of serious concerns meetings being held by Hertfordshire Adult Care Services, this situation has now improved and the management team within this service are managing issues of both safeguarding and complaints more effectively, thus protecting the people using this service. Care Homes for Older People Page 16 of 27 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, although currently two of these units are unoccupied. All rooms are ensuite consisting of hand basin, shower and toilet and lockable storage space. The garden areas are easily accessible and private. These areas have been further developed and improved since the last inspection with new garden furniture being purchased, new turf being laid and a garden pond and several bird tables have being erected. 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, in order to adjust the room temperature independently. Throughout the home, there is adequate lighting and additional lamps are provided if required. Water Temperatures are checked monthly by the maintenance person, in order to ensure these temperatures are maintained within safe limits. The SOFI identified that the sitting room within the dementia unit Care Homes for Older People Page 17 of 27 Evidence: on the ground floor appeared quite cramped and noisy and with limited seating if everyone wanted to sit in the room at the same time. However the dining room facilities further down the corridor were much more spacious, light and airy. We fed back these observations to the manager at the end of the inspection and asked for a consideration to be made to swap these two rooms around to offer more spacious living room accommodation, but still maintaining adequate dining room space. 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 and the most recent fire checks were carried out on the 3rd July 2009 . The emergency lighting was last checked on the 1st July 2009. The most recent fire drill was carried out on the 3rd April 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 18 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are adequate numbers of staff to provide appropriate care to the people living within the service and staff are supported and trained to a standard that ensures that people using this service are supported and protected appropriately. Evidence: On the day of this inspection there were sixty one people in residence with adequate care support staff, trained staff, manager and deputy on duty plus administration and housekeeping support. These staffing levels provided appeared adequate given that the home is just over 50 occupied. However these staffing levels must be reviewed once the home is fully occupied to ensure people continue to have the appropriate and necessary support. The standard of training has improved since the last inspection was carried out and recent training includes, safeguarding training, health and safety, medication, in -house dementia training, fire safety, infection control and person centered planning have all been attended by the staff team in the past six months. There is a comprehensive record held on all training applied for and certificates and records of attendance were seen as part of this inspection. Staff meetings and staff supervisions are now being held more regularly with staff appraisals also being implemented throughout this year. Two staff spoken to stated that they receive formal supervision at least six times a year as well as informal discussions with the manager on a regular Care Homes for Older People Page 19 of 27 Evidence: basis. They both stated that they found the manager approachable and supportive. The manager and head of quality assurance has introduced a new and comprehensive induction package that is linked to the Skills for Care induction standards. Newly appointed staff confirmed that they had received an appropriate induction. Four staff files were checked as part of this inspection. All files contained the required information, including up to date CRBS, to ensure people using the service are protected from abuse. There has been several new appointments since the last inspection was carried out and these include trained nurses, care staff and also catering and ancillary staff. There has also been a new administrator appointed. The SOFI observations generally found that staff were respectful and caring in their approach and support of people with dementia. Two examples of this were when one person required hoisting in the lounge area where both staff were observed to be ensuring that they reassured the service user throughout the process and ensuring the whole procedure was carried out at the persons own pace. Another example of good practice was seen when staff were assisting people with their mid-day meal. This was also carried out in a relaxed and calm manner with several service users appearing to enjoy the meal and the social aspect of the mealtime. Care Homes for Older People Page 20 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the service has improved with the additional infrastructure currently being provided but must evidence that standards can be maintained within the normal management structure in place in order to ensure the effective management of the service can be maintained and peoples health and welfare is protected and maintained. Evidence: The newly appointed manager, deputy manager and supporting management staff from Sanctuary Housing have all worked hard to improve the standards from the previous Inspection that was carried out in February 2009 when the service received a poor rating from the Commission. Although there has been a general improvement in care planning, staff training, staff supervision, staff recruitment and the financial management of the service, this has been partly achieved as a result of a high level of additional support provided from Sanctuary Housing in the form of a full time head of quality assurance and a team of quality assurance staff being brought in to carry out a complete audit and improve systems within this service. Therefore although the Care Homes for Older People Page 21 of 27 Evidence: service has now improved standards in a variety of areas this needs to be evidenced and maintained under the normal management structure of the home which comprises of the manager, deputy manager and team of nurses, care support staff, ancillary staff and administrative staff. The manager stated that there is currently an advertisement out for a clinical nurse specialist to support the manager with clinical aspects of the service. The manager also told us that there has been a new appointment within Sanctuary Housing of a head of care for older persons, who will also be based at Hatfield Nursing home. The manager needs to improve the current systems of quality monitoring to incorporate all aspects of the service, as currently some areas are not formally audited on a regular basis and therefore errors that were identified as part of this inspection could have been identified at an earlier stage in order to reduce the risks to people using the service. Care plans should also be audited on a monthly basis as incorporated into the overall quality monitoring. Care plans must include an end of life pathway and people using this service must be invited to sign their care plan, if able and if not, a representative of the service user should sign on their behalf. Although the service now inducts all new staff using a formal and detailed induction procedure, there was insufficient evidence to confirm that staff who had been appointed between the months of February and June 2009 had received a formal induction. However the head of quality assurance was able to evidence that staff appointed since June 2009 had received a formal induction package and this was confirmed by records seen on the day. The general feedback from the SOFI was that staff were respectful of people using the service and treated people with dignity. There were several positive practices observed during the two hour observational period that included the hoisting of one person within the lounge area and assisting people with their lunch in a dignified and caring manner. There were however aspects of practice that could also be improved with staff not always responding to peoples requests for assistance, with one example we saw one person walking around holding up their trousers despite several staff approaching them to carry out a conversation but still not assisting the person to fasten their trousers. Care Homes for Older People Page 22 of 27 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 23 of 27 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 Individual care plans must include all aspects of their assessed needs in order to ensure the best possible support and care is provided. Each care plan must contain an end of life pathway, where possible in order to ensure a persons last wishes are honoured and respected. To ensure that the individual is offered the best care possible and to ensure their welfare is protected. 30/09/2009 2 9 13 Medication procedures must 31/08/2009 be monitored and adhered to at all times to ensure the health and welfare of the person is protected. There should be a system in place to ensure that medication is audited on a regular basis to identify any errors that occur and to ensure these errors are eradicated. Page 24 of 27 Care Homes for Older People 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 To protect the health and welfare of individuals using this service. 3 30 18 All staff must be formally inducted into the home using an effective and comprehensive induction package to ensure the best possible service is offered to the people living within Hatfield Nursing home. To ensure staff are provided with the appropriate knowledge of the homes policies and procedures to carry out their role effectively. 4 32 24 There must be an effective 31/08/2009 monitoring system in place to audit all areas of the service in order to ensure any failings or improvements to the service can be made at the earliest possible stage. To ensure standards are monitored and maintained effectively. 14/08/2009 Care Homes for Older People Page 25 of 27 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 1 15 Pictorial menus could be provided to assist people with dementia in having more of an informed choice regarding the homes meals and menu. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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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