Inspection on 17/09/07 for Hatton Court

This inspection was carried out on 17th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Hatton Court 26/02/08

Hatton Court 27/04/06

Hatton Court 27/09/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Hatton Court Whitchurch Road Cold Hatton Telford Shropshire TF6 6QB Lead Inspector Janet Adams Draft - Unannounced Inspection 21st September 2007 09:30 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 Hatton Court DS0000064716.V345193.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. Hatton Court DS0000064716.V345193.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hatton Court Address Whitchurch Road Cold Hatton Telford Shropshire TF6 6QB 01952 541881 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) hatton.court@hotmail.co.uk Springcare (Hatton) Limited Christine Ann Simcock Care Home 64 Category(ies) of Dementia - over 65 years of age (14), Old age, registration, with number not falling within any other category (44), of places Physical disability (6) Hatton Court DS0000064716.V345193.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home may accommodate a maximum of 44 Older Persons requiring nursing care, 6 can be Younger Persons with a Physical Disability, and 14 persons with Dementia. The minimum staffing levels required throughout the 24 hour day, including weekends, for service users who have low to medium dependency nursing needs is as follows:08:00-14:00 22:00-08:00 3 Qualified Nurses Qualified Nurse 9 Care Assistants Care Assistants 14:00-22:00 3 Qualified Nurses 7 Care Assistants 2 6 Additional staff must be on duty when service users requiring high direct care provision are accommodated. This is exclusive of the manager (when he/she is carrying out managerial duties). Date of last inspection 18th June 2007. Brief Description of the Service: Hatton Court is one of several care homes owned by Springcare (Hatton) Limited. Registered to accommodate a maximum of 64 Residents who may require personal care or nursing and may specifically comprise up-to a maximum of 44 ‘Older Persons’ requiring nursing care, up to 6 ‘Younger’ Persons with a Physical Disability’, and up-to 14 persons with Dementia Fees charged range from a minimum of £370 per week up-to a maximum of £658 per week. The home is located in a rural area with a public house and garden centre nearby. Public transport to this home is limited due to its location. The single storey property was initially purpose built and provides spacious communal rooms, single or shared bedrooms, some of which have en-suite facilities, plus an additional six bedrooms and a large lounge housed in the extension. The Home benefits from well-maintained gardens laid to lawn, with flowerbeds, patio and car parking to the front of the property. Hatton Court DS0000064716.V345193.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this key announced inspection. It was carried out in the form of three separate visits to the home and lasted a total of eleven hours. Since the last Key inspection in April 2006, the home has had three further unannounced inspections in September and December 2006, and more recently, in June 2007, as a result of concerns expressed to us about the home. Copies of these reports are available upon request. Some time before the inspection was carried out, we wrote to the home to request information to assist with this process. This meant that although Hatton Court knew the inspection was imminent, they were not aware of the date or time the inspection would be carried out. On the afternoon before the main inspection day, two hours were spent observing the care being given in the communal lounge of the unit occupied by people with dementia related medical conditions. The care of four people was looked at in depth, when comparisons with the observations were made with the home’s records and the knowledge of the care staff. The inspection also included observing activity within the home, inspecting the premises, an ‘in depth look’ at records for residents and staff, as well as observing, talking and listening to over half of the 51 people living there. Several of the staff on duty at the time of the inspection also shared their views about working at Hatton Court. Discussions with people were carried out in private with people on their own, or together in groups in the lounges. Everyone was happy to share valid comments, which are included in the main body of the report. A total of 17 residents and 4 staff members made written comments about the home to CSCI. Everyone, including residents and staff, was very welcoming and helpful throughout the inspection. A total of 25 out of a possible 38 National Minimum Standards for Older People were assessed on this occasion. Discussions with the management team took place throughout and feedback about the conclusions of the inspection was given at the end of the inspection days. Hatton Court DS0000064716.V345193.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? It is positive to report that the ongoing efforts of the management team has resulted in twelve of the fourteen statutory requirements made since the key inspection of April 2006 being fully or partly met. This confirms that the management team and staff group are committed to ensuring the service continues to improve. The home continues to improve the surroundings where the people live. Several bedrooms and different parts of the home have been redecorated. The dining room has been upgraded and new furniture and tableware has been provided. A room used by people who smoke has been improved so staff can observe and monitor individuals who choose to use this facility. The newly appointed activities coordinator has embraced her role since starting work at the home in May this year. This person has had a very positive impact on the daily lifestyle of all of the people living at Hatton Court. Management and administration systems continue to be developed in line with the policies of the company who owns the home. The company area managers currently carry out monthly audits of standards in the home. A recent internal medication audit has resulted in more robust medication procedures being adhered to. Staff rotas have improved and clearly show which team members are allocated to work on the specialist unit for people with dementia related conditions. Hatton Court DS0000064716.V345193.R01.S.doc Version 5.2 Page 7 Staff training has improved – new recruits to the staff team receive a good start with a detailed induction programme.The majority of established staff have been updated with most training to meet the needs of the people living at the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hatton Court DS0000064716.V345193.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 Hatton Court DS0000064716.V345193.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. Quality in this outcome area is good. People are provided with information they need to make an informed choice about whether the home can meet their needs. The assessment process ensures that the home has adequate information to judge whether the person’s needs can be met This judgement has been made using available evidence including a visit to this service. EVIDENCE: Springcare, the Registered Providers for the service, have introduced a new corporate styled information pack for prospective residents, which contains the home’s Statement of Purpose and Service User Guide. It is presented in an eye catching, easy to read and understand folder. Although it has been fully updated to comply with recent changes of The Care Homes Regulations of September 2006, the information pack did not describe the specialist service and support Hatton Court offers for up to 14 people with dementia related Hatton Court DS0000064716.V345193.R01.S.doc Version 5.2 Page 10 conditions. The Registered Manager is aware of this shortfall, and remedial action was stated to be in progress following a random inspection to the home in June 2007.This issue is currently being addressed by senior management within the company. An in depth look at the admission records of two people admitted to the home since the last inspection confirmed that good standards of recordkeeping have been maintained for this matter. Details seen written down confirm staff collect as much information as is necessary for the home to decide whether they can meet the person’s personal and health care needs before they move in. The home is implementing an assessment tool especially designed to make sure the needs of people with dementia related conditions can be fully met. There have been no recent admissions to the unit for people with dementia since this assessment tool was introduced therefore this paperwork was not assessed for this part of the inspection. It is positive that a total of 88 of people who sent written comments to CSCI confirmed they received enough information about the home before they moved in. Hatton Court DS0000064716.V345193.R01.S.doc Version 5.2 Page 11 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. Quality in this outcome area is adequate. Care plans are improving but are not yet sufficiently detailed to ensure that all residents’ needs are met. Staff are sensitive to the individual needs of each service user and meet these in a professional manner. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three inspections carried out by CSCI in September and December 2006 and June 2007 were as a result of concerns expressed to CSCI about standards of care in the home. Findings as a result of the inspection visit in September 2006 confirmed that in fact there were signs of improvement. The inspection carried out in December 2006 as a result of concerns expressed by a health professional that visited the home regularly did confirm that Hatton Court DS0000064716.V345193.R01.S.doc Version 5.2 Page 12 standards of care were not consistent. Likewise, information shared by an anonymous caller which resulted in unannounced inspection in June 2007 confirmed that the care needs of some of the people living at Hatton court were not being fully met. Due to their medical conditions, some people in the home are not able to communicate their opinions. The two hours spent observing people in a communal lounge the day before the main inspection day was helpful in confirming findings of the inspection process. Permanent staff were seen to be attending the needs of residents in a respectful, caring manner and were very knowledgeable about the individual needs and preferences of the people they were caring for. Information provided by the home before the inspection stated: ‘All residents have comprehensive care plans which are updated when needed and evaluated monthly.’ In order to check out this comment, an in depth look at the records of five people as well as ‘spot checking’ of four sets of records for individuals living at the home who have a variety of support and nursing needs, was carried out. Although the care records confirmed that the majority of health needs are accounted for, there was some lack of detail about the person they were written about. Several care plans lacked detail to keep individuals safe whilst promoting personal well being and independence. • The care records of a person who has recently experienced four accidents as a result of falls did not have the detail in his handling assessment to inform staff how to safely pick the person up from the floor in the event of another fall. • One lady had a large bruise to the back of her hand. Her care records had no details to show it had been accounted for or investigated. • One gentleman encountered during a tour of the home was seen to be shaving his cheek aggressively with a razor which had caused slight facial bleeding. His care records did not have appropriate details to show how the gentleman could be supported to carry out this task safely. In addition, slow progress has been made to develop care plans for residents with dementia to show the home is doing all they can to keep these people safe and ensure all their behavioural needs are being met. This was also an issue of concern identified at both the December and June inspections. Information provided to CSCI as a result of a staff survey confirmed 75 agreed they were always given up to date information about the people they care for although when asked how information about people who live at Hatton is passed on between the staff there was a mixed response. One person commented ‘You don’t always get chance to read care plans at handover as it is held in the staff room and care plans are kept in the office’. Hatton Court DS0000064716.V345193.R01.S.doc Version 5.2 Page 13 It is positive to report that the care records of individuals with dementia related conditions are now kept on the unit where they live, so that staff can refer to them easily. This was an issue of concern raised at the June 2007 inspection but now resolved. Written comments received about the care the staff team carries out for its residents was complimentary. One person wrote to CSCI to say, ‘Hatton Court is a very happy place to be.’ 100 of comments received from people living at the home confirmed the staff listen and act on what they say, and 90 stated they received the medical support they need. Assessment of the home medication management systems showed they have continued to improve. One very knowledgeable and enthusiastic staff member took the time to demonstrate how they were following good practice guidance, and explained how medication management systems have been improved in the home. It is positive to report the company conducted its own ‘in –house’ medication audit recently, and as a result the home has taken appropriate steps to make systems even more robust. Hatton Court DS0000064716.V345193.R01.S.doc Version 5.2 Page 14 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. The daily life and social activities arranged for people living at Hatton Court takes into account the differing expectations, preferences, lifestyle and capacities of each individual. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of comments received about the activities and daily lifestyle of people living at the home were positive. 77 of residents agreed there were activities arranged in the home that they could take part in. One person commented, ‘The home does a good job to get you interested in doing something you feel is worthwhile.’ Hatton Court DS0000064716.V345193.R01.S.doc Version 5.2 Page 15 This was reflected in most of the care records looked at. Good recordkeeping in the social activities section to accounted for both 1:1 activities as well as group activities people get involved in. It is positive the activities planner is kept flexible to make sure certain activities fit in with residents’ other pastimes or appointments so people do not miss out on their favourite session. This shows this part of the service is run in the best interests of its residents. All people spoken to were in agreement they appreciated the support of the newly appointed activity coordinator. Discussion with this person confirmed she has a list of people who choose not to mix with other residents, and makes a point of visiting them regularly to offer encouragement and quality time to involve them in an activity they may be interested in. This individual has also explored the residents’ religious and spiritual beliefs in order to ensure planned activities account for this part of a person’s life. The involvement of the local vicar when for a recent harvest festival was reported to be a success as a result of this. Several people were seen enjoying walks round the grounds of the home with the activity coordinator. One resident was pleased to have been able to pick a pear off a tree, peel it and eat it upon return from his walk. On the first day of the inspection ‘Rocky’ the ‘Pets as Therapy’ dog was seen to be a most welcome regular visitor on the unit where people with dementia related conditions live. People’s face lit up with delight upon recognition of their four-legged visitor. The owners of Hatton Court, Springcare, also produce a newsletter – Issue 2 was seen to be freely available around the home. As well as containing activities and competitions it also features an article about Hatton Court’s new activity coordinator. Observations and discussions with staff on duty confirmed they were knowledgeable about people’s dietary needs and the best way to serve their residents’ food so they can dine independently. The majority of people commented they always or usually liked the meals in the home. It was positive to receive a comment from a staff member stating, ‘Family and friends are always made welcome and invited to dine with the people they are visiting, especially if they have travelled a long distance.’ This is one of the ways the home makes efforts to establish and maintain links to ensure a good social rapport with families and friends. Hatton Court DS0000064716.V345193.R01.S.doc Version 5.2 Page 16 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 good. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected This judgement has been made using available evidence including a visit to this service. EVIDENCE: Review of the complaints management system shows that the company welcomes this type of issue in order to improve the service it provides. Information about making a complaint or comment is clearly outlined in the Service User guide as well as being displayed in the home. Findings of the CSCI survey of the home for this matter confirmed: 95 of the people living at Hatton Court stated they always knew who to speak to if they were unhappy. • 100 of staff stated they knew what to do if anyone had concerns about the home. It was positive to receive the following written comment from a junior staff member, ‘The home promotes independence and encourages its residents to express their thoughts and concerns.’ Hatton Court DS0000064716.V345193.R01.S.doc Version 5.2 Page 17 • The above findings confirm the complaints management system has greatly improved, as the December 2006 inspection showed that staff were documenting concerns raised by residents and their families, but were not informing the management team so that any issue people were not happy about could be put right. In August 2007 CSCI were told about a complaint about the home by a social worker. It is positive to report the Registered Manager had dealt with the issue professionally and record keeping clearly confirmed all necessary people including family members had been involved in sorting the issue out within nine days. Improvement in staff training and the home management systems now show many satisfactory systems are in place to safeguard residents. Inspection findings confirmed the following information provided by the Registered Manager when she commented, ‘86 of my staff have attended abuse awareness training. We have a policy in place for the protection of vulnerable adults which can be found in the sisters office and is easily accessible.’ In the past twelve months the home has been involved in three ‘Safeguarding Adults’ investigations, which has given the home management team the opportunity to demonstrate their professionalism in cooperating with external agencies to make sure any issues are resolved to the satisfaction of all involved. Hatton Court DS0000064716.V345193.R01.S.doc Version 5.2 Page 18 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, 21 & 26 Quality in this outcome area is adequate. The physical design and layout of the home enables the majority of the people who use the service to live in a well-maintained and comfortable environment, which encourages independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the last key inspection in April 2006, CSCI made a requirement for the home to provide a programme for routine maintenance and renewal of the premises with ‘target’ dates for completion of any jobs. This information was not forwarded to CSCI until July 2007, and several jobs identified to be carried out lacked detail to confirm when they would be done. For example, during the Hatton Court DS0000064716.V345193.R01.S.doc Version 5.2 Page 19 tour of the home some double glazed windows in people’s rooms were misted up. The works schedule did not identify how many were in need of replacement and did not detail when the work would be carried out. This list of works was discussed with the manager at the time of the inspection, who pointed out work already done, which included some redecoration and upgrade of the dining room facilities. At the inspection of the home in December 2006, a complaint about the smell at the home entrance caused by poor smoking facilities resulted in this part of the home being upgraded, although the new floor covering provided in the smoke room has already been extensively damaged. This is to be replaced in the very near future with something more suitable. Following this complaint, it is positive to receive comments from 94 of residents that told CSCI the home always smelled fresh and had a welcoming, clean and tidy appearance. It is positive that the home is already planning on improving the ramps to aid access in and out of the home as three residents expressed dissatisfaction about not being able to get their wheelchairs/scooter out into the garden independently. One person commented ‘I can’t get out very well into the garden as the ramps are not easy to use’. At the inspection of June 2007 standards of cleanliness seen on the unit accommodating people with dementia were not satisfactory. The lounge carpet was badly soiled, the fridge was not clean and the whole unit had an unpleasant smell. During this inspection carpets were seen soiled from food spillages 2-3 hours after a meal and the fridge was also unclean. Upon the inspectors planned return to the home these issues had been resolved. During the tour of the home it was seen that the bathrooms and toilet facilities were especially showing signs of wear and tear. On the first day of the inspection two bath seats were in a soiled condition, which posed an infection risk. The only fully operational bathroom on the unit for people with dementia conditions was unsafe as two of the three bath panels were broken with sharp edges exposed. The flooring in this area was also damaged. By the next day it was positive to see that bath seats in the process of being thoroughly cleaned and the bath panels were replaced. One of the main causes for concern on this unit was the lack of hot water for washing facilities. Discussion with two staff members confirmed that this had been a problem for some time. As a result, an Immediate Requirement Notice was issued in order for urgent action to be taken to remedy the situation. Clinical waste disposal bins in these areas and a sluice were all seen to be hand operated. This also challenges management of infection. Commodes provided for people to use were unclean and in a state of disrepair. This was pointed out to the manager on the first day of the inspection. Upon Hatton Court DS0000064716.V345193.R01.S.doc Version 5.2 Page 20 following this up the next day it was seen that an unsafe commode had been replaced by another, which was also broken. As a result all of the commodes in the home were checked immediately and damaged ones taken out of use. Hatton Court DS0000064716.V345193.R01.S.doc Version 5.2 Page 21 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. Staff in the home are being trained and are in sufficient numbers to fill the aims of the home and meet the changing needs of residents. People living at the home are supported and protected by the homes recruitment policy and practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As recorded earlier in the report, the home has had three unannounced inspection visits by CSCI since the last key inspection. On two of those three occasions, in December 2006 and June 2007 the unit which is occupied by people who have dementia related medical conditions was not adequately staffed. ‘Immediate Requirement’ notices were issued at both inspections to ensure appropriate staff are allocated to this unit at all times. The home has now implemented a system, which clearly identifies which staff are allocated to this unit. Observation of working practices in this part of the home for several hours confirmed the staff have a good working knowledge of Hatton Court DS0000064716.V345193.R01.S.doc Version 5.2 Page 22 their responsibilities to make sure this is adhered to. Comments received from staff also confirmed this, one person wrote, ‘The home has improved – especially staffing levels’ Rotas examined for the fortnight before and after the inspection confirmed the home is adequately staffed with the right numbers of personnel, although many shifts continue to be filled by agency staff. During the week of the inspection four 14-hour shifts and three 7-hour shifts had been covered by these staff on day and night duty. One of the main challenges the home has experienced over the past year has been staff recruitment. This situation is starting to have a negative impact on the morale and wellbeing of the people living at the home, as well as the core of loyal staff who are permanently employed at Hatton Court. One staff member wrote: ‘ It has been difficult during the annual leave period due to use of agency staff – they don’t know the home or residents ‘ Another told us that she found it frustrating working with agency staff all the time, having to continually show people what to do. A resident also commented, ‘Employ more permanent staff so agency can be reduced to maintain continuity of care.’ In balance of these comments, 41 of residents confirmed the staff were always available when needed, and 53 said they usually were. It was reported that the home currently has vacancies for four full time carers. In addition, it has been without the support of a trained nurse to oversee the needs of people on the unit who have dementia related conditions for 4 months. Therefore it was positive to meet a newly appointed mental health nurse being inducted to this role during the inspection. Examination of the records of two new starters since the last inspection demonstrated a thorough recruitment and vetting process for this matter. 100 feedback from all new starters confirmed they were fully vetted and the induction covered everything they needed to know to do the job. One wrote ‘I was given a mentor to help me for the first weeks when I started.’ Another new recruit was complimentary about the support and training received. One of the two company trainers meets up with her on weekly basis to ensure her induction training needs are being met. Many other aspects of staff training have improved in recent months, as information the home provided before the inspection confirmed that less than half of the carers have the minimum expected care qualification. • An NVQ assessor was seen on site working with three staff that had just enrolled on a course to attain their care qualification. Hatton Court DS0000064716.V345193.R01.S.doc Version 5.2 Page 23 The home now have devised a new ‘at a glance’ training tracker form which has been kept up to date and shows progress the staff team have made with their training and development. • The majority of the care team have attended a two-part dementia training course. One staff member confirmed training had improved, and another wrote, ‘At Hatton Court we are given training to keep up to date with new procedures’. • Hatton Court DS0000064716.V345193.R01.S.doc Version 5.2 Page 24 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 adequate. The management team is committed to improving the quality of the service Some systems for the health, safety and welfare for residents, staff and visitors need to be improved and adjusted to make sure that they are kept up to date, to meet people’s changing needs and safeguard their well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Christine Simcock, the Registered Manager, continues to show her ongoing commitment to be a competent home manager. Since the last key inspection she has attained her Registered Managers Award. Since the last key inspection a new deputy manager has been appointed to support Mrs Simcock in her role. Hatton Court DS0000064716.V345193.R01.S.doc Version 5.2 Page 25 It is positive the home has had the support and guidance of two Springcare Area Managers who carry out monthly quality audits to monitor the progress the home is making to meeting National Minimum Standards for Older People. Internal auditing as seen in their monthly visit reports show that many areas of improvement in the home continue. Auditing on many aspects of home management including care plan records, medications, complaints, accidents, and the environment itself has been carried out. Training is implemented to make sure staff are aware of any changes in working practices the audits identify to be necessary. Recently we were concerned that there had been an increase in the number of pressure sores in the home – whereas this was not the case –Springcare’ s quality monitoring showed the home’s recordkeeping had not reflected the right information. As a result, training for all nursing staff is being held in October to rectify this misunderstanding. Shortly before this inspection the home carried out a quality assurance survey of residents and received feedback from 35 residents. The results of this are on display in the foyer of the home. The management team are already acting upon some of the comments people made, which shows the home aims to being run for the best interests of the people who live there. However, the quality the service the home provides will only improved when staff receive appropriate monitoring and supervision of their working practices. This appears to be in hand. Records of recent staff meetings show that team building is improving, and 26 of the team have had at least one formal supervision session with their manager. A revised method of the way the home manages all monies held in safekeeping for its residents now assures us that this aspect of resident well being is safeguarded. This needs to be further developed to make sure any other valuables held on behalf of a person is documented the same way. Review of the paperwork and records for the regular maintenance of equipment such as lifts and hoists show this to be all in order although the inspection findings described in this report do highlight lack of monitoring to make sure all equipment in daily use is kept in clean working order. At the inspection of December 2006 concerns were raised about the way the home responded to any accidents a resident may have experienced. As a result, further steps have been taken to make sure the staff team follow the robust accident reporting system of Springcare, to make sure the person in Hatton Court DS0000064716.V345193.R01.S.doc Version 5.2 Page 26 charge of the home is fully informed of any incident which affects a resident’s well being. On the main inspection day, during a tour of residents’ bedrooms a number of bed rails were found fitted incorrectly. Bed rails checked were not fitted in accordance with the relevant health and safety legislation. At least two bedrails were fitted in an unsafe manner, and several others had pressure relieving overlay mattresses in place on top of a mattress, which would compromise the safety of a person, as the bed rail was not of a necessary height. Inspection findings also confirmed staff responsible for checking the bedrails had not received appropriate training or guidance for this matter. It was of further concern that agency staff were carrying out this task. As a result an ‘Immediate Requirement ‘ notice was issued for this matter for urgent action to be taken to put this matter right within forty-eight hours. The inspector then revisited the home to confirm appropriate actions were being carried out. Hatton Court DS0000064716.V345193.R01.S.doc Version 5.2 Page 27 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 1 X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 1 Hatton Court DS0000064716.V345193.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15 Requirement Care plans for people with dementia related conditions must be devised from an assessment tool specifically for this need, to properly account to show all their individual physical and behavioural needs are being met. (Timescales for 20/01/07 and 26/07/07 not met.) Timescale for action 21/09/07 2 OP7 14 (2) 3 OP19 23.(2)(b) (c)(d) Care plans for people living at 01/01/08 Hatton Court must contain up to date risk assessments to ensure the safety and well being of a person is being addressed, and show details that all resident’s health care needs are met, as they should be. 21/09/07 The ‘Responsible Person’ must forward to the CSCI (Shrewsbury) a programme for routine maintenance and renewal of the fabric and decoration of the premises. The programme should have ‘target’ dates for completion and relevant records kept. (Timescales for 31/10/06 and 26/07/07not met.) DS0000064716.V345193.R01.S.doc Version 5.2 Page 29 Hatton Court 4 OP21 13 (4) (c) 5 OP38 23 (2) (c) People who use the service 21/09/07 must be provided with an adequate supply of hot water to hand basins and bathrooms at all times in all parts of the home they have access to, to make sure hygiene needs can be met. Immediate Requirement 19/09/07 Competent individuals must 21/09/07 assess bedrails in use within the home for the risk they present to the people who use the service, to ensure they are correctly installed. Any actions taken to minimise risk must be carried out and monitored by appropriately trained personnel in accordance with the relevant Medical Hazard Reporting Agency and Health and Safety Executive Guidance for this equipment. Immediate Requirement 19/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations It is recommended the information the home provides to inform prospective residents they can meet their needs is further developed to include details about the services and accommodation provided for people with dementia related medical conditions. It is strongly recommended the home revisit the infection control audit carried out at the home by the Health Protection Agency in 2006, and follows any good practice guidance advised, especially with regard to the disposal of DS0000064716.V345193.R01.S.doc Version 5.2 Page 30 2 OP26 Hatton Court clinical waste. Hatton Court DS0000064716.V345193.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 Hatton Court DS0000064716.V345193.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!