Inspection on 27/09/05 for Hatton Court

This inspection was carried out on 27th September 2005.

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

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

Other inspections for this house

Hatton Court 26/02/08

Hatton Court 17/09/07

Hatton Court 27/04/06

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 Karen Powell Announced Inspection 27th September 2005 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.V253115.R01.S.doc Version 5.0 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.V253115.R01.S.doc Version 5.0 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) Springcare (Hatton) Limited Care Home 64 Category(ies) of Old age, not falling within any other category registration, with number (58), Physical disability (6) of places Hatton Court DS0000064716.V253115.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home may accommodate a maximum of 64 Older Persons requiring nursing care, of whom 6 can be Younger Persons with a Physical Disability. 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 2 Qualified Nurses 9 Care Assistants 14:00-22:00 2 Qualified Nurses 7 Care Assistants 22:00-08:00 1 Qualified Nurse 6 Care Assistants 3. 4. 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). Any requirements made by the Fire Office must be complied with. Locks must be fitted to all bedroom doors. Date of last inspection 07/04/05 Brief Description of the Service: Hatton Court is one of eleven care homes owned by Springcare (Hatton) Limited. The home is registered to accommodate a maximum of 64 service users who may require personal care or nursing. Accommodation is in shared or single rooms some of which have en-suite facilities. The single storey property was purpose built and has spacious communal rooms, a recent extension provides an additional six bedrooms and large lounge. The home is set in gardens, which have lawns and a patio area surrounded by flowerbeds, there is also a car park at the front of the home. The home is currently managed by Christine Simmcock who has been in post since April 2005. An application for registration has not yet been submitted to the Commission for Social Care Inspection. Hatton Court DS0000064716.V253115.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced and started at 9.30am and lasted 7 hours, it was carried out by two inspectors. 48 places were occupied at the time of the inspection, two of these places were occupied by service users on respite stays. The inspection included discussion with service users, staff and management and observation of daily routines, examination of service user and staff records, policies and procedures. The majority of requirements made at the last inspection have been carried out. Springcare (Hatton) Limited purchased the home on 7th June 2005. This was the first inspection under the new ownership. The main focus of this inspection was to address the requirements made at the last inspection on 7th April 2005. The majority of requirements have been carried out. What the service does well: What has improved since the last inspection? A full environmental audit of the premises has been undertaken since the purchase of the home. The ongoing programme of refurbishment was seen to be in place with further plans to improve the health, safety and welfare of both service users and staff. The purchase of some nursing beds to replace divans for nursing service users has taken place. Hatton Court DS0000064716.V253115.R01.S.doc Version 5.0 Page 6 A new kitchen floor has been laid. The recruitment procedure and improvement in record keeping confirms that the home operates a thorough and robust recruitment procedure. Some staff have completed specific training courses to improve their competence and enhance service delivery to individuals within their care. The vacant administrators post has been recruited to since the last inspection. Removal of hedges and ivy from the home has begun the external improvements to the grounds. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Hatton Court DS0000064716.V253115.R01.S.doc Version 5.0 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hatton Court DS0000064716.V253115.R01.S.doc Version 5.0 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.V253115.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 4 Standard 6 does not apply Although currently in a disorganised fashion, service users do have access to relevant information about the home and what they can expect from it. However, the home is not currently addressing service users’ needs, particularly specialist needs, in a consistent manner EVIDENCE: The home is still working on provision appropriate information to form a Statement of Purpose and Service User Guide. The Statement of Purpose supplied with the home’s pre-inspection questionnaire covered all the required elements of Schedule 2 but needed updating; the information currently available in the home’s reception pack does not cover everything, although is better presented. The documentation in the home referred to as the Service User Guide does not cover all the elements as in Standard 1.2 but overall, with the presence of two public reports in reception and the complaints procedure on display, all the information required by Standard 1 can be accessed. The home now needs to bring it together to form two complementary but different documents. Since the last inspection of the home contracts for private clients Hatton Court DS0000064716.V253115.R01.S.doc Version 5.0 Page 10 and statements of terms and conditions for people placed by local authorities have been created and the home is in the process of getting these agreed and signed. The home currently uses the “Standex” format for assessment and care records, which provide a structure for all elements of the standards to be met. The home is considering replacing this documentation with their own “home grown” formats. This might well assist in overcoming the present problem of having documents on file where the information has been inadequately or inconsistently completed, overlooked or, in some cases, duplicated. One person recently admitted with dementia had been subject to a pre-admission assessment but this had not been followed up with a full assessment document or care plan which addressed her needs, or how staff should respond to her behaviour, in sufficient detail. For another service user who has Grade IV pressure sores and clearly in need of pain relief, there was no detailed plan for pain management during dressings or personal care. One record seen evidenced a four week gap between bowel movements. Some individual elements of other care plans seen were detailed and provided good guidance for managing particular needs. At present staff have not undertaken training in dementia care, which will be necessary in developing services in this area, and information in some care plans suggested a need for staff to understand more about particular physical disabilities. Springcare is currently working with local professionals who have expressed concerns about the home’s perceived inability to meet the nursing needs of people accommodated there. Hatton Court DS0000064716.V253115.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 9 Service users’ health care needs are not currently fully met by the home. The new proprietors are taking steps to liaise with local health professionals and work with the existing staff team to improve this situation. Although the home has created new protocols to ensure safe administration of medication, these are not being adhered to and are placing service users at risk. EVIDENCE: The home’s care planning documentation has the capacity to be comprehensive and detailed but, as reported earlier, has recognised shortfalls in day to day use and is to be revised. Some care plans lacked detail, some plans omitted key areas of work. Although each file contained a falls risk assessment/falls record, when four falls relating to two individual service users were “tracked” none were reflected in the care planning records, for example the “mobility” section was unchanged, and the falls risk assessment had not been reviewed or amended. Records showed that some service users had signed to say that they had been involved in the creation of their care plans. Records showed involvement of health professionals, GPs, audiologist, chiropodist, etc. and the organisation now employs its own physiotherapist, Hatton Court DS0000064716.V253115.R01.S.doc Version 5.0 Page 12 however concerns have been aired about the home’s ability to promote service users’ health and this is being addressed by Springcare. The home has had two inspections this year from the CSCI Pharmacist and his conclusions in May 2005 were that all but two requirements made in March had been complied with. One related to risk assessments relating to service users choosing to self medicate, which were seen on file at this inspection, and the other to protocols for handling medication in the home. A new medication administration policy was provided as part of the pre-inspection documentation. However, on the day of inspection medication was seen given to a service user with the intention that it be left and signed for later when taken. The stated reason for this was that the drug needed to be taken after food and the drug round was just before lunch. This raises concerns in that the person signing the record could only assume that the drug had been taken and also poses the risk that someone else take the drug whilst a dining table is unsupervised. In fact the service user concerned was seen to take the medication before her lunch while the nurse was otherwise occupied – the drug then taken inappropriately and unwitnessed, in breach of the home’s own protocol. Storage of medication was satisfactory and the three controlled drug records sampled were accurate. Hatton Court DS0000064716.V253115.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Hatton Court DS0000064716.V253115.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 There is a clear and accessible complaints procedure. The home’s procedures and security arrangements have improved, safeguarding service users money and financial affairs. EVIDENCE: The pre inspection questionnaire completed by the area manager prior to the inspection documented four complaints had been received since the home was purchased by Springcare (Hatton) Limited on 7th June 2005. These were seen to be recorded in a central record of complaints along with a further complaint received after completion of the pre inspection questionnaire. All complaints were recorded well with details of the complaint, action taken and outcome of the complaint. Not all aspects of standard 18 were inspected. However, following a multiagency adult protection process relating to a service user’s money, the home has improved security arrangements and amended its recording of deposited valuables and money. Individual records are maintained of money managed on behalf of the service users and their cash stored in the safe. The home’s administrator explained the process and was able to show that cash available mirrored the records. All service users have now been provided with a lockable piece of furniture and those who are assessed to be able have keys to Hatton Court DS0000064716.V253115.R01.S.doc Version 5.0 Page 15 their bedrooms. The person who was involved in the adult protection process expressed his satisfaction with the new arrangements. Hatton Court DS0000064716.V253115.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21 & 26 Ongoing maintenance and refurbishment plans continue to address the safety and comfort of all who live and visit the home. The standard of cleanliness is good throughout the home. EVIDENCE: The area manager and home manager furnished inspectors with an up to date plan of recent and planned improvements to the home. It was stated that a contractor has now been secured who will carry out the majority of major refurbishment work identified. A date for commencement of the work is being awaited. Inspectors toured the home together to look at proposed changes including the application to vary registration by developing services for elderly mentally ill service users. The proposals being the conversion of an existing unit into a 14 bedded provision. It was agreed that considerable work both internally and externally is required to make this area a safe and appropriate place for these service users to live, along with appropriately qualified nurses and care staff to Hatton Court DS0000064716.V253115.R01.S.doc Version 5.0 Page 17 deliver the care to the individuals who would reside on the unit. It was agreed that the application to vary the registration would be discussed again when the home has made progress towards completion of the requirements outlined. Inspectors observed that one bedroom on this unit was currently being used as a staff smoking area. The smell of smoke could be detected strongly when entering the unit . This practice must cease immediately. Plans for an outside smoking area for staff were shared with the inspectors. Also the provision of suitable facilities for those service users who smoke is currently in the main reception area which has been recognised as not ideal for those non-smoking service users who enjoy sitting in the reception area. Plans to re-design this area were also shared with the inspectors. The home tour found the standard of cleanliness to be good. Two handrails in bathroom 1 and the toilet in the new extension area were seen to have worked loose and were in need of tightening to make them secure for use. Discussion with the homes laundress outlined the laundering procedures and return of service users personal laundry. It was identified by the manager that the laundry is to be completely refurbished as part of the homes development plan. Feed back from service users was sought as part of the pre inspection research. The request for a safe pathway for the new extension to the car park was raised along with making safe the earth at the front of the home that gets washed away onto the car park during rainfall. Inspectors saw for themselves the slip hazard this poses to car park users/service users in this area as recent wet weather had left this area very slippery under foot. Hatton Court DS0000064716.V253115.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 & 30 The homes recruitment processes are robust and all necessary recruitment checks are carried out before staff commence working at the home. The homes induction programme places staff and service users at risk by the speed in which it is carried out. Further training to equip staff to look after the service users within their care must be completed. (See standard 9 & 30) EVIDENCE: A sample of the newest recruits employed at the home were examined to monitor compliance with this standard and were found to contain all the necessary pre-employment checks required. Files were well organised. All staff undertake induction training. However, three files examined raised concerns with the inspector. The first file indicated that the employee commenced work on 10/08/05 but did not commence induction until 13/09/05 furthermore the file stated that induction training was started and completed on the same day. The second file indicated that the employee commenced employment on 08/06/05 but did not start induction until the day before the inspection and again completed training in one day. Hatton Court DS0000064716.V253115.R01.S.doc Version 5.0 Page 19 The third file stated the employee commenced employment on 12/08/05 but began induction the day before her employment commenced. The manager must ensure that all staff receive appropriate induction training within the appropriate timescale. Planned training completed by a selection of staff since the last inspection includes infection control, adult protection, first aid, moving and handling, pressure sore prevention and continence training, care planning, drug administration, use of the standex system, awareness training for wound care and introduction to palliative care. As stated in standard 19 the home has submitted an application to CSCI to vary their registration to cater for service users assessed as having E.M.I residential and nursing needs. Approval of this variation would only be authorised when evidence can be provided to CSCI that staff caring for those individuals have completed appropriate training. Hatton Court DS0000064716.V253115.R01.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35, 36, 37 & 38 Service users finances are handled appropriately. A programme of supervision is in place, however this is not up to date. Records relating to the management of the home were up to date and available for inspection. The servicing of hoist equipment was seen to fully comply with the requirement made at the last inspection visit of 7th April 2005. EVIDENCE: Standard 35 was assessed as part of the assessment of standard 18 ‘protection’ and found to be satisfactory. Hatton Court DS0000064716.V253115.R01.S.doc Version 5.0 Page 21 The manager explained that she has developed a wall planner to address staff supervision. The inspector saw that this consisted of a list of names with 5 supervision sessions having taken place for July. It was acknowledged by the area manager and homes manager that supervision training for the manager and senior nurses has not yet taken place which has subsequently impacted on the progress of the overall supervision programme. Not all aspects of standard 38 were inspected, however the requirement made at the last inspection relating to servicing records of hoist equipment within the home being available for inspection were seen to be in order on this occasion. Hatton Court DS0000064716.V253115.R01.S.doc Version 5.0 Page 22 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 3 3 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 2 x x 3 x 3 STAFFING Standard No Score 27 x 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x 3 2 3 3 Hatton Court DS0000064716.V253115.R01.S.doc Version 5.0 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Timescale for action The home must ensure that a full 10/12/05 assessment of need is made for every service user which then informs a comprehensive plan of care The home must ensure that the staff group individually and collectively have the skills and experience to deliver the services and care which the home offers to provide The home must ensure that care plans are sufficiently comprehensive, and reviewed as events require, to meet service users’ needs 10/02/06 Requirement 2 OP4 12 3 OP7 15 10/01/06 4 OP8 12 5 OP9 13 The home must ensure that 10/02/06 assessment and care planning systems, training and skills are in place so that service users’ health needs are met Medication protocols must be 10/12/05 followed at all times. The home must review its medication round arrangements to ensure that DS0000064716.V253115.R01.S.doc Version 5.0 Page 24 Hatton Court service users’ needs are paramount 6 OP19 12 The home must provide a nurse call system which minimises disruption to other service users when staff are being alerted (Previous timescale of 19th October 2004 not met) A safe pathway is laid from the new extension to the car park The handrail in bathroom 1 must be secure and safe for use at all times The handrail in the toilet of the new extension must be secure and safe for use at all times Induction training must include sufficient time for orientation and training specific to the work the individual is to perform The manager and qualified nurses must complete training in staff supervision (previous timescale of 19th October 2004 not met) Nursing and care staff must receive formal supervision at least 6 times per year 10/02/06 7 8 9 10 OP20 OP21 OP21 OP30 23(2)(o) 23(2)(c) 23(2)(c) 18(1)(a) 10/02/06 10/01/06 10/12/05 10/02/06 11 OP30 18 10/01/06 12 OP36 19 10/12/05 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 Refer to Standard OP30 OP31 Good Practice Recommendations 50 of care staff should be NVQ qualified by the end of 2005 The manager submits an application for registration to the Commission for Social Care Inspection Hatton Court DS0000064716.V253115.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hatton Court DS0000064716.V253115.R01.S.doc Version 5.0 Page 26 - 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!