Inspection on 23/10/06 for Hatfield Peverel Lodge Residential and Nursing Home

This inspection was carried out on 23rd October 2006.

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

Hatfield Peverel Lodge... 08/03/06

Hatfield Peverel Lodge... 27/02/06

Hatfield Peverel Lodge... 08/11/05

Hatfield Peverel Lodge... 24/05/05

Hatfield Peverel Lodge... 02/02/05

Hatfield Peverel Lodge... 16/11/04

Hatfield Peverel Lodge... 24/08/04

Hatfield Peverel Lodge... 17/08/04

Hatfield Peverel Lodge... 25/11/03

Similar services:

Henrietta House

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Hatfield Peverel Lodge Residential and Nursing Home Crabbs Hill Hatfield Peverel Chelmsford Essex CM3 2NZ Lead Inspector Mrs Bernadette Little Unannounced Inspection 23rd October 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hatfield Peverel Lodge Residential and Nursing Home Crabbs Hill Hatfield Peverel Chelmsford Essex CM3 2NZ 01245 380750 01245 380906 Address Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.bupa.co.uk BUPA Care Homes (CFCHomes) Limited Care Home 71 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (8), of places Physical disability over 65 years of age (41) Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Mallard House Persons of either sex, aged 65 years and over, who require nursing care by reason of dementia (not to exceed 30 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 2 persons) Kingfisher House Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 41 persons) Persons of either sex, aged 65 years and over, who only fall within the category of old age (not to exceed 8 persons) The total number of service users accommodated must not exceed 71 persons 8th March 2006 2. 3. Date of last inspection Brief Description of the Service: Hatfield Peveral Lodge has two separate houses. Mallard House provides nursing and care for up to 30 people over the age of 65 with dementia. Kingfisher House is registered to provide nursing and care for up to 41 people over the age of 65, although only 40 beds are in use. Both houses are two storey buildings with passenger lifts. The home has 67 single rooms, with two shared rooms on Mallard House. Hatfield Peveral Lodge is located approximately half a mile from the centre of Hatfield Peveral Village and about one mile from local shops and facilities. There is a bus stop within a quarter of a mile of the home and Hatfield Peveral is on the main London to Colchester train route. The current weekly fee ranges from £367 to £785 per week. Additional charges/costs are incurred by residents relating to chiropody (£6.50) hairdressing (£7.05- £36), and personal items such as newspapers etc. This information was contained in the Pre-inspection Questionnaire. Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was undertaken as part of the key inspection of Hatfield Peveral Lodge. Fifteen hours were spent at the home over a two-day period. Several residents were spoken with although because of advanced dementia in some cases, not all were able to fully express their views. More detailed conversations took place with eight residents. Seven staff, including care and ancillary staff, and the manager were spoken with. A tour of the premises was undertaken and records, including care management records, as well as policies and procedures were sampled. The manager advised that there were five resident vacancies and one resident in hospital at the time of the site visit. Written information was kindly provided during the site visit and a well completed pre-inspection questionnaire was subsequently received within the requested timescale. Information from these documents was also used to inform this report. Discussion of the inspection findings took place with the manager and guidance and advice was given. Completed questionnaires were received from sixteen users of the service or their relatives/visitors. The majority felt that they received adequate information about, and from the home, were satisfied with the meals, the environment, the care and support provided, the staff and felt listened to. The surveys indicated that, while the home provides activities, they are not always activities that people can take part in. Some very positive comments were received and all comments are reflected in the appropriate sections of this report. Last year, each of the two houses at Hatfield Peveral Lodge received a separate inspection and a separate report. As the home is registered as one service, the home received one inspection on this occasion. This one inspection report incorporates aspects raised in each of the previous reports and combines all the requirements and recommendations at the end of the report. What the service does well: Residents had a wide choice of food at all meals and could also choose whether to eat in the pleasant dining rooms or in their own room. Visitors were welcomed. Relatives and visitors felt that the staff told them things that they needed to know about residents and how they were doing. The home was working hard to give residents a choice of things to do such as quizzes and flower arranging. Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 6 Residents and relatives/visitors had only nice things to say about the staff and the way they cared for residents. What has improved since the last inspection? What they could do better: While lots of training had taken place, there were still a number of staff that the record showed had not had training on lots of the basic things like health and safety or infection control. Also, it is important that staff who work in a unit looking after people who have dementia should have good training on dementia and how to understand and manage different behaviours. Some parts of the premises need to nicer for residents and some things need to be made safe. The list of things that the home needs to do to meet the National Minimum Standards and the Regulations are is at the end of this report and called Requirements and Recommendations. The new manager said she knew that things that needed to be put right from the last inspection reports and would be working hard to do them as soon as possible. Please contact the provider for advice of actions taken in response to this Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5, 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The statement of purpose and service user guide provided prospective residents with information to enable to make an informed choice about the home. Pre-admission assessments were undertaken and will ensure that the specific unit was appropriate to meet individual residents needs. Residents/relatives were encouraged to visit the home prior to admission to ensure its suitability for them. EVIDENCE: The statement of purpose had been reviewed in September 2006 and informed of the appointment of the new manager. The document provided a good range of information and generally complied with that information required by Regulation. However it did refer to itself by the name of another care home and information on the category of persons that the home is registered accommodate was not accurate, for example the home is not a specifically registered service for people with the past or present alcohol dependence. Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 10 The service user guide was written in large clear print that was easy to read and also used pictures and symbols. It did not explain the relevant qualifications and experience of the registered manager and did not include any service users views of the home. It did tell people about the availability of inspection reports. The service user guide needed to include additional information about fees so that it complies with the change in Regulation in September 2006. The statement of purpose did not clarify the homes position on emergency admissions and this needs to be included. A copy of BUPA’s terms and conditions of residents was provided with confirmation that each resident is provided with a copy. In addition there is a statement of terms and conditions provided for authority funded residents. One of the care files tracked evidence that a resident with a clear history of dementia had been admitted to Kingfisher, a unit that is not registered to admit people with dementia. There was no pre-admission assessment available and no social services COM5 form identifying the care needs of the person. Records evidenced the inappropriateness of this on the first night of admission, and although the resident was later transferred to Mallard, this could not be undertaken for some time, as there were no vacancies. This occurred prior to the appointment of the current manager. The homes current manager and the documentation confirmed that all residents will have a full assessment in their current care environment prior to admission. This was also confirmed by one of the unit’s head of care. BUPA have introduced a QUEST individual assessment, which, it was advised, will be used as the preadmission assessment format. This identifies the different areas of needs to be assessed and, dependent on score outcome, identifies further action to be taken including the assessment/equipment tools to be used and inclusion in the care plan. The current manager advised that confirmation of the homes ability to meet the residents needs based on the assessment would be verbally by telephone. Regulation requires this to be done in writing. The statement of purpose invites the prospective resident and/or their family to visit the home prior to admission. The service user guide clearly explains that all residents are offered a trial period during the first six weeks. Some residents/relatives spoke with during the site visit confirmed that they/their representative had visited prior to admission. Hatfield Peveral Lodge does not offer intermediate care. Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 11 Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Users of the service were satisfied with the care provided. Care plans generally provided clear details to ensure consistency of care for residents. Staff training on resident specific areas did not best support resident needs. Medication systems safeguarded residents. Residents’ privacy and dignity was respected. EVIDENCE: Five anonymous questionnaires were received that confirmed that the person always received the care and support they needed. All eleven relative/visitor comment cards completed stated that they were satisfied with the overall care provided at Hatfield Peveral Lodge. All residents spoken with who expressed their views said they were satisfied with the care they received at Hatfield Peveral Lodge. Comments from residents included ‘I feel very spoilt and am very satisfied with the care’, ‘I am ever so happy here’, ‘care is very good’. Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 13 There is an active keyworker system in place and those residents/relatives asked were aware of who their keyworker was. Comments from relatives included ‘staff do tell us how (relative) is doing, they ring us’, ‘seems to be well cared for, saw the keyworker today, they do talk with you if you want to know things’, ‘skin is beautifully cared for though hair not well cared for’, ‘hair is messy’, ‘clothes are not co-ordinated’. Three care plans were sampled on each unit and three assessed fully. On Kingfisher there was a life history map, information on assessed/medical needs and daily living preferences. Up to date assessments relating to moving and handling, continence and tissue viability were in place along with regular recordings of weight. The care plan identified nine areas of need including diabetes, mobility, communication, personal care, epilepsy, skin condition, continence and the risk of choking. These included a clear list of actions or equipment needed to achieve the care need and referred to each other or risk assessments appropriately. A recent additional care plan was in place in relation to pressure area care. Actions included the use of an appropriate mattress, encouraging the resident to sit in their chair and to move position in bed, explanation to the resident and care of the skin in relation to washing etc. A body map was in place along with clear photographs for an up to date record. There was a requirement in one of the previous reports that all staff were to have training in wound care and the prevention and management of pressure sores, which was to be cascaded to care staff. There was no confirmation of this on the training matrix and it remains an outstanding requirement. A detailed assessment was in place in relation to the use of bedrails, how and when they were to be protected and of their maintenance. Both of the care plans on Mallard contained incomplete dependency rating assessments. The head of care advised that these were being introduced. An assessment of needs had been undertaken for one resident on their move to Mallard from Kingfisher and a multidisciplinary review of the placement recently undertaken. One file had a record of daily living preferences and a life history map. Both contained a list of care aims on basic or personally relevant issues, for example challenging behaviours or epilepsy. One had been rewritten by the head of care and contained information on oral care. The other did not have this information and while it refers to aspects of personal care, it did not have a clear plan as to when these were to be implemented. One of the care plans had individual risk assessments relating for example to the use of individual equipment or bathing/showering. The risk assessment relating to the use of bedrails was not properly completed or dated and the Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 14 maintenance of bedrails recorded in May and October 2006. A risk assessment was in place relating to the use of a bedroom key, as well as to tissue viability and moving and handling. A nutritional assessment had recently been completed. It was recorded that the resident had deferred the opportunity to include their wishes etc. for end of life care and practice. Care plans were reviewed monthly and this included an active invitation to the family/advocate to participate. Care plans had been updated to include a change to the residents’ need, for example in relation to being unwell and prescribed antibiotics. Care notes were written regularly but were often repetitive and at times limited in information. Healthcare records show access to local healthcare services, which was confirmed by residents spoken with. A resident also confirmed that the home were supportive in gaining referral to the hospital for their cataracts. Accident records were sampled. They contained appropriate detail and were monitored and signed off by the manager. Medication was assessed on Kingfisher House. The medication trolley was securely sited. No omissions were noted on the Medication Administration Recording sheets. Those sampled contained a photograph of the resident. Medications sampled were labelled appropriately. Only qualified nurses administer medication and a system is in place whereby the qualified nurse must check the MAR sheets at the end of each shift. The temperature of the medication room and fridge was monitored and recorded. Security rails had been fitted at the window to allow safe ventilation. Staff confirmed and demonstrated the availability of the suction catheters by the machine for emergency use. The medication room was well organised and clean. The medication policy was available. The tablet counter was not sufficiently clean to be able to use it accurately. A staff member was advised not to directly handle tablets. Residents spoken with stated that staff respected their privacy and dignity, advising that this is evidenced by knocking on doors and waiting to enter, or closing doors when personal care is being offered. Staff spoken with were also aware of their responsibility on this aspect of care and added that signs are used on doors to advise others that personal care is in progress. Staff also added that this issue is covered within their induction training. The training matrix identifies that a very limited number of staff have attended training on terminal care and bereavement counselling, training on dementia and management of challenging behaviour and wound management and pressure area prevention as identified as needed in the last report. Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents had varied opportunity to participate in a range of leisure and social activities. Residents did not always have activities that suited them. Residents were supported to make choices and decisions. Relatives and friends were welcomed at the home. Residents were provided with a varied and nutritional diet. In some instances, staffing levels did not provide residents with the best mealtime experience. (please see Staffing section) EVIDENCE: A comment card received advised ‘this home has improved (relative’s) quality of life’. Each unit has the support of an activities co-ordinator. Residents are asked each week what activities they would like on this is turned into a plan and displayed. This included gentle exercise, dance to music, sing along, knitting, quiz, painting as well as some outings. The home had joined the local Dial a Ride scheme which allows transport for five carers and five residents including two wheelchair users. Events have included a trip to a pub restaurant and a shopping trip to Chelmsford. The local school have visited the home at Easter, and at Christmas for carols. Outside musical entertainers are also provided. A Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 16 clothes party was booked for the following week. Members of the local church provided a religious service in the home once a month. The home has a hairdresser who visits each house once a week. Those who were confined to bed were visited each morning by the activities coordinator. Activities described indicated a good knowledge of individual residents’ preferences and abilities and included brushing a persons hair or talking with them about a special car they used to have. A tape recorder was provided for a resident who has a sensory impairment, the library brings tapes and staff read the paper for them. Residents spoken with on Kingfisher/Robin confirmed that they choose which activities they participate in. Many said they really enjoyed the activities available. Five questionnaires completed advised that there are usually (but not always) activities available that residents feel able to join in with. One resident said that while the activities are good, they could do with something going on at weekends, even if it was just a chat. A visitor on Mallard advised that they had not seen any activities being undertaken with their relative. Observation on Mallard showed staff assisted some residents to have a walk around the lounge to maintain mobility and stimulate as per their care plan, others were encouraged to sit for minute and talk, staff played the piano and sang with residents and talked to residents giving eye contact and time for responses. Residents had memory boxes. A small room was available for activities and was used for one to one activities or occasional small group cinema afternoons. The home has the support of two regular volunteers who undertake flower arranging and play the organ, activities that residents participate in. Six visitors spoken with at the time of the site visit stated that they felt welcome to visit the home and residents spoken with said they felt that there are visitors were welcomed. Eleven written responses were received from friends/relatives that also confirmed that they were welcome in the home and could visit in private. A mealtime was observed on both Mallard and Kingfisher/Robin houses. Staff wore appropriate aprons and gloves and demonstrated good food handling practice. Residents spoken with said that they are able to make choices for example in relation to food, where to have their meals, spending time alone or with others, joining in activities, times for going to bed and getting up, what to wear, and where possible to maintain independence skills. On Kingfisher there was much choice and ample food, and tables were set with attractive crockery, cloths, flowers and condiments. Staff were observed to offer choices and to show patience in allowing those who were slower to Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 17 answer time and opportunity to indicate their preferences. Although this took quite a lot of time staff sat with those who needed feeding and gave encouragement and prompts. This did mean a wait for some residents. Staff were aware which residents were diabetic and that these were served appropriate foods to meet their dietary needs. Residents spoken to on Kingfisher all expressed satisfaction with the food, in terms of choice, quantity, quality and presentation. On Mallard, the dining area had been recently redecorated and tables were set with brightly coloured protective cloths, providing a pleasant environment. Residents in this unit were provided with the same choices although many were not able to express them so clearly. While some residents did feed themselves, a large number of the residents needed assistance/feeding. Many needed encouragement to remain at the table and/or prompting to continue to eat and drink. Staff remained calm and cheerful in assisting residents, and demonstrated awareness of the importance of good nutritional and fluid intake. The head of care on Mallard advised that all residents were offered and supported to have drinks on at least six regular occasions during the day. Some relatives were visiting and assisted with feeding residents. Even with this additional support, the staffing levels at mealtimes also meant that some residents had a wait for their meal or their meal may have cooled before a staff member was free to give them the assistance needed. This issue is assessed in the judgement in the section on Staffing, later in this report. Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and relatives were confident to express views. Some aspects of staff training and knowledge protected residents. Additional training would better support and protect residents and staff. EVIDENCE: BUPA has a complaints procedure that was displayed. This needed to provide more clarity on the commissions role in relation to complaints and also to include correct contact information. Information on the complaints procedure and how to make a complaint or raise a concern was identified in the statement of purpose and the service user guide. Residents spoken with said that they would feel able to tell a member of staff if they had a concern or if anything was worrying them. Relatives spoken with also said that they would feel comfortable to bring any concerns to the attention of the staff on duty or the manager. Six questionnaires confirmed that staff listen and act on what is said to them. Of eleven relatives/visitors comment cards received, nine stated that they were aware of the homes complaints procedure. The acting manager advised that five complaints have been received since the last inspection. These were clearly recorded and logged with an identifying number. They related to, for example, a complaint that the meat was tough Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 19 one weekend, of an odour in a room on an occasion, poor laundry and care and moving and handling practices. All had been responded to promptly by the appropriate person, for example, the chef or manager and had being investigated with appropriate action taken. The manager was advised to ensure that all had a recorded outcome/response. The acting manager confirmed that she had recently attended training on the protection of vulnerable adults (POVA) and was able to describe appropriate actions. A copy of BUPA’s policies and procedures on protection of vulnerable adults was readily available and the whistleblowing procedures included in the staff handbook. The issue of protecting vulnerable adults is included in the induction/foundation skills book for new staff. The acting manager advised that she had arranged for the manager of another BUPA home to come in and do two recent training sessions for staff on protecting vulnerable adults. This was confirmed in the staff training matrix. Six staff spoken with demonstrated awareness of the ways that abuse can operate and confidence in how to report it. Up-to-date training records provided by the acting managers subsequent to this site visit identified that all permanent qualified staff and the majority of care staff, ancillary and bank qualified staff have completed training on protection of vulnerable adults. However, this also identifies that only three of the trained nurses (including the head of care on Mallard) and five of the carers on Kingfisher have attended training on positively managing behaviour that challenges. None of the care staff on Mallard have had this training. Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24, 25, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Hatfield Peveral Lodge provided residents with a range of communal areas both indoor and outside. Many aspects of the home provided residents with a safe and pleasant environment to live in, while others did not. All areas used by residents were free from unpleasant odours. EVIDENCE: Hatfield Peveral Lodge is set in pleasant grounds. Mallard House has its own small, enclosed sensory garden. Kingfisher House had easy access to paths and seating areas. The small pond in the garden outside Kingfisher House presented a hazard as part of the fencing was missing. The manager advised that it would be repaired immediately. The communal areas in both houses were pleasantly decorated and furnished. Those on Mallard had recently been redecorated. Kingfisher had a range of Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 21 seating areas. The smoking room in Kingfisher house had a badly marked carpet and the walls were very stained. All but two bedrooms are single and all had ensuite facilities. All bedrooms have been fitted with locks that allow residents to open them easily by use of a push down handle from the inside. Bedrooms sampled in Kingfisher/Robin were generally pleasantly decorated and some were highly personalised. Residents had the option of having their own phone and others had their own bed linen and small pieces of furniture etc. Residents spoken with said they were satisfied/comfortable/warm in their rooms. Many bedrooms on Mallard were well presented and personalised. Others had walls where paint was marked and scraped off, and curtains were hanging off the rails in a small number of rooms. Two beds had no headboards, in one room it was stated that this had not been replaced after the room’s recent decoration. The carpet in one room was rucking and stained. Screens were available in double rooms to respect resident privacy. Relatives spoken with said that the environment was always clean and pleasant. Each resident’s bedroom door showed their room number, name and photograph, and signs to assist residents in other areas were also clear well maintained. Clock faces were large to be easy to read and showed the correct time. Assisted bathrooms in both houses were being used for storage, which was reported on both houses to be very limited. This did not present a pleasant environment for residents. The hoist in one bathroom in Kingfisher House was out of order. Some bathrooms needed a good cleaning. Hazard identification was not displayed in relation to outward opening doors and risk assessments were not available. Surfaces in the sluice room were in poor condition and there was an unpleasant odour. A hairdressing room was available. This did not have a window, was being used to store mattresses and a large number of boxes, and the strip light was loose from its mounting. Other than those areas identified, the home was clean and odour free. One comment card advised that a request for a new bedroom carpet for a resident had been made three months earlier for hygiene reasons, but to no avail. The laundress confirmed a safe system of work and appropriate infection control measures. Staff spoken with also confirmed access to ample protective clothing. Appropriate facilities for hand washing were observed. Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Relationships between staff and residents were positive. Staffing levels did not best meet residents’ needs at all times. Aspects of staff recruitment practices did not best protect residents. Training for staff on mandatory areas was progressing. Specialist training needs to develop to ensure staff are best equipped to meet resident needs. EVIDENCE: All comments received and relating to staff were positive and complimentary. These included ‘staff are quite nice’, ‘staff are all kind to me, they have lots of patience’, staff are nice’, ‘all the staff work hard’, ‘staff show patience and kindness’. Minimum staffing levels on Mallard House were seven staff on the morning shift, six staff on the afternoon shift, and four at night, each including the qualified member of staff. On Kingfisher staffing levels were eight or seven staff on the morning shift, seven staff on the afternoon shift, and four at night, each including the qualified member of staff. Staff deployment was clear to both senior and care staff on the houses, and staff knew what area they were covering. An activities co-ordinator works on each unit for thirty hours each week. There is laundry cover forty eight hours each week and chef/cook cover form 7am to at least 6.30pm each day. Housekeeping hours are also available each day. Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 23 Staff were observed to be supervising residents in the communal area of Mallard at all times spent on that unit. A relative spoken with said that this was not always their experience. There were times when staff were not always present in communal areas on Kingfisher, although residents spoken with who were able to express a view were generally comfortable with this and had access to call bells or were with visitors. It has been identified earlier in this report that staffing levels at mealtimes were observed as stretched, particularly on Mallard. Consideration should be given to reviewing these. Residents able to express a view said that there is often a wait for a response to call bells used in bedrooms. They viewed this as staff being just very busy, rather than any lack of response from staff. Comment cards from three relatives/visitors said they felt there were not always sufficient numbers of staff on duty. Eight comment cards said that they felt there was sufficient staff on duty although one added that they felt it was less at weekends and also that the activity co-ordinator is used as a carer to ensure continuity of care, but with the loss to residents of the opportunity for stimulating activities. Six separate questionnaires were also received, three confirmed that staff were always available when needed and three felt they were usually available when needed. The manager confirmed that the home has its full quota of qualified staff and also have regular bank staff who provide cover. Following an audit undertaken by the new manager, issues were noted with work permits and this affected the number of care staff hours available. The home is now recruiting locally as well as from overseas and while vetting is to be completed, it is considered that all vacancies are filled and the home fully staffed. The training matrix advised that seven care staff have attained NVQ Level 2 in care. The recruitment files for three staff appointed since the last inspection were sampled. All contained an application form that included a declaration of health and offences, as well as a statement of conditions of employment, and evidence of identification. Two did not contain a photograph. Two had not received a second reference for the applicant until after the recorded start date of employment. There was evidence of a Povafirst check or Criminal Records Bureau check being in place prior to employment on all three files. The last inspection report for Mallard house identified requirements that all staff received training in the range of activities and stimulation appropriate for older people at different stages of dementia, POVA training, training in the management of behaviour that challenges, and then a minimum of one day training in dementia care and progressing towards the target of all staff Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 24 undertaking the three-day course, health and safety training, infection control training and food hygiene training. The staff training matrix shows that this has not been achieved, as shown for example in the section on Concerns and Complaints in relation to challenging behaviour. However, the head of care advised that she had attended basic training in this area and will cascade to all staff. Two qualified staff attended the three day dementia care course and all but four of the care staff are recorded as having the one day dementia training. Two qualified and eight carers on this unit are recorded as not having attended training on activities. Three qualified staff and six carers have attended infection control training recently leaving one qualified and ten care staff recorded as not having this training. Gaps are also noted in relation to food hygiene and health and safety. The majority of staff on Kingfisher were recorded as having attended training on POVA, health and safety and food hygiene. There was no recorded training for staff on terminal care and bereavement or on restraint and the safe use of bed rails as required in the last inspection report. The last reports identified that the previous manager advised that all the nurses over the site were in the process of/or had received training Parkinson’s disease and the older person. There was no evidence of this in the training matrix. The home has its own trainers for moving and handling and fire awareness. The majority of staff were recorded as having attended fire and manual handling training within the past year, with some updates due. Training on manual handling was being undertaken during the site visit. Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. In her short time in post, the manager has demonstrated an inclusive and open style of leadership. BUPA have effective quality assurance systems to gain the views of service users and monitor the conduct of the home. Health and safety checks to protect residents and staff were recorded as routinely completed. An aspect of fire safety/resident need presented a continued concern. EVIDENCE: The manager had been in post for approximately two months and is in the process of making an application for registration. She advised of being a Registered General Nurse and Registered Mental Health Nurse. She also advised that she has completed NVQ level 4 Registered Managers Award and is Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 26 awaiting a certificate. Prior to this position, the manager has worked in other BUPA homes and has previous experience at a deputy management level. The manager advised that she walks the floor each morning on both units to ensure that she is available and known to staff, residents and visitors and also is aware of any issues that arise each day. This also allows her to be supportive to staff for example in the provision of clinical advice. Both Mallard and Kingfisher/Robin are led by a Head of Care, both of whom are appropriately qualified nurses. Heads of department meetings occurred six weekly, with one undertaken soon after the manager came into post and another one last week. The manager stated that she is very aware of the requirements of the last inspection reports and has endeavoured to address them as far as possible in the limited time she has been in post. BUPA undertake an annual satisfaction survey of its residents, which has recently been sent out. The acting manager advised that this will be returned in an envelope and send out for independent assessment. Residents meetings were noted as having had occurred and this is an area where relatives and residents can feed back verbally. Evidence of this was seen in minutes for example feedback on having too much of the same sort of food in one week and an improvement in the activity programme on Mallard. Regulation 26 reports had been undertaken regularly, a copy of an October report was available on site and visits were confirmed as unannounced by the acting manager. BUPA also run a personal best course which all staff are expected to undertake. This includes staff attending one training session to enable them to identify personal goals and are resident centred. Examples included ensuring that one resident got a fresh food basket each week and another to take a resident out for a meal. Evaluations are undertaken by the manager to monitor their success. The home does not look after any money for residents. Services such as hairdressing and chiropody are billed directly to the residents’ representatives. Valuables can be stored in a safe and relatives are asked to sign for their release. The manager advised that it is expected that all staff will have six supervision sessions each year. She has undertaken two sessions to date with the qualified staff and given them a matrix to complete for care assistants. A session was undertaken following the complaint regarding moving and handling. This contains the same content for numerous staff and was individually signed. Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 27 Current inspection certificates were available in relation to water chlorination, portable appliance testing, both lifts, gas, electrical fix wiring and fire alarm and emergency lighting. It was advised that the certificate is awaited following inspection of the fire equipment. The maintenance manager advised that fire drills, (annually two during the day and two at night) had been undertaken but had not been logged. He is to undertake a training next month as a fire safety trainer. Records were available to demonstrate that emergency lighting, fire alarm and equipment checks were undertaken regularly on both houses on a weekly basis. Water temperature checks, both hot and cold were recorded as being tested monthly for each unit. Records were also available of checks of the slings and hoists, including bath seat hoists. The last inspection report recorded that one resident became very distressed if their bedroom door was closed at night and that an automatic closure had not been fitted. Leaving the door open would present a potential fire risk. No action was shown of this being addressed by BUPA and the situation remains. Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 X 2 X 2 3 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 2 X 2 X 2 Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES 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 OP1 Regulation 4 & Sch 1 Requirement The statement of purpose must contain all information required by regulation and schedule and be accurate. The service user guide must be amended to reflect the changes in regulation and include the required information. The registered person must ensure that residents are not admitted to the home, and specifically registered units, unless the home can fully meet their needs and the unit is registered to meet that specific need. The registered person must not to provide accommodation to a service user until they have ensured to confirm in writing to the service user, that having regard to the assessment, the care home is suitable to meet the residents’ needs in respect of their health and welfare. Timescale for action 01/02/07 2. OP1 5 01/02/07 3. OP3 14(1) 23/10/06 4. OP3 14(1)(d) 23/10/06 Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 30 5. OP7 15(1&2) The registered person must ensure that care plans cover all assessed needs and identified risks, with clear instructions on how the plan is to be met and the risk is to be minimised. Requirement from previous reports met in part except for the above - timescales of 24.08.04, 16.11.04 and 01.08.05 not met. 23/10/06 6. OP8 18(1) The registered person must ensure that all nursing and care staff on Mallard House have training on the prevention and treatment of pressure sores. (Previous timescale of 01/08/05 not met) 01/02/07 7. OP8 14(2) The registered person must ensure that effective monitoring of residents food and fluid intake are put in place, when residents are assessed at very high nutritional risk. Not fully assessed on this occasion. Carried to a future inspection. 23/10/06 8. OP8 18(1) The registered person must 01/02/07 ensure that all staff receive training in dementia care and the management of challenging behaviour. Requirement in previous reports (dementia care) - timescales of 1.12.04, 1.04.05 and 01.10.05 not met. Requirement in previous reports (challenging behaviour) timescales of 1.12.04, 1.02.05 and 01.10.05 not met. The registered person must DS0000015350.V316779.R01.S.doc 9. OP8 12(1) 23/10/06 Version 5.2 Page 31 Hatfield Peverel Lodge Residential and Nursing Home ensure that the daily progress records have details of residents physical and psychological health and how they have spent their day, as well as documenting the physical care given. (Previous timescale of 01/08/05 not met) 10. OP9 13(2) The registered person must ensure that the administration of homely remedies is recorded in both the homely remedy book and the medicine administration record, and that a record is made of the multidisciplinary decision making process in relation to the covert administration of medicines. Not assessed on this occasion. Carried to a future inspection. 11. OP9 13(2) The person registered must ensure the safe handling of medication and cleanliness of appropriate equipment. The registered person must ensure that all staff receive training in the range of activities and stimulation appropriate for older people at different stages of dementia. (Previous timescales of 1.03.05 and 01.10.05 not met). 13. OP12 16(2m&n) The registered person must ensure that activities are provided that suit all residents. and this includes at weekends. The registered person must ensure that the complaints procedure contains accurate information in all documents. DS0000015350.V316779.R01.S.doc 23/10/06 23/10/06 12. OP12 16(2m&n) 01/02/07 01/01/07 14. OP16 22 01/02/07 Hatfield Peverel Lodge Residential and Nursing Home Version 5.2 Page 32 16. OP18 13(6) The registered person must ensure that all staff receive protection of vulnerable adults training. (Previous timescales of 1.11.04, 1.02.05 and 01.09.05 not fully met. 01/02/07 17. OP18 18(1) 13(6) The registered person must 01/02/07 ensure that all staff receive training in dementia care and the management of challenging behaviour. Requirement in previous reports (dementia care) - timescales of 1.12.04, 1.04.05 and 01.10.05 not met. Requirement in previous reports (challenging behaviour) timescales of 1.12.04, 1.02.05 and 01.10.05 not met. The registered person must ensure that all areas of the home are well maintained, well decorated and safe. This refers to the issues identified in the report including the safety of the pond, the decoration in the smoking room and some bedrooms, the maintenance of the bath hoist, the outward opening doors and the strip light in the hairdressing room. The registered person must ensure that there are toilets in close proximity to all communal rooms, and that they are accessible to residents. This has been a requirement in previous reports - timescales of 1.12.04 and 1.04.05 not met. Not assessed on this occasion. Carried to a future inspection. 01/01/07 18. OP19 23(2) 19. OP21 23(2j) 23/10/06 20. OP22 23(2)m The registered person must ensure that there is adequate DS0000015350.V316779.R01.S.doc 23/10/06 Page 33 Hatfield Peverel Lodge Residential and Nursing Home Version 5.2 storage in the home so that areas to be used by residents are not being used to store equipment, for example mattresses. 21. OP24 16(2)c The person registered must ensure that residents’ bedrooms are safe and comfortably furnished. This refers to the issues identified in the report for example the lack of headboards, the carpet and the falling down curtains. The person registered must ensure that all the areas of the home are kept clean and free from odour. This refers to the cleaning in the bathrooms, the damaged worktops in the sluice room and the odour in the sluice rooms. The person registered must review staffing levels to ensure that there are adequate staff available to meet residents needs at all times, this includes for example at mealtimes or for social activities at weekends. 23/10/06 22. OP26 23(2)d 23/10/06 23. OP27 18(1)a 01/01/07 24. OP29 17(2)Sch2 The person registered must ensure that appropriate references are in place prior to the person commencing employment. 23/10/06 25. OP29 17(2)Sch2 The person registered must 23/10/06 ensure that all records required by regulation are maintained and available for inspection. This refers to a photograph of all staff. 18(1)c The person registered must ensure that all staff receive training and updates as required DS0000015350.V316779.R01.S.doc 26. OP30 01/01/07 Hatfield Peverel Lodge Residential and Nursing Home Version 5.2 Page 34 in basic subjects such as health and safety, food hygiene, fire, and infection control, in addition to those other training requirement identified in this report. Previous timescales from three inspection reports (from 1.01.05) not met. 27. OP38 23 (4) The registered person must ensure that they take adequate precautions against the risk of fire. A record must be kept of fire drills. 23/10/06 28. OP38 Sch4 (14) 23/10/06 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. 4. 5. Refer to Standard OP11 Good Practice Recommendations Staff should be provided with training on terminal care and bereavement counselling. The registered person should ensure that all complaints have a formal recorded conclusion. At least 50 of care staff should achieve NVQ 2. The registered person should make an application to register the manager without delay. Staff should be provided with supervision at least six times annually. OP16 OP28 OP31 OP36 Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hatfield Peverel Lodge Residential and Nursing Home DS0000015350.V316779.R01.S.doc Version 5.2 Page 36 - 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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