Inspection on 24/10/05 for Hatzfeld House Care Home.

This inspection was carried out on 24th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Hatzfeld House Care Home. 03/12/08

Hatzfeld House Care Home. 11/09/07

Hatzfeld House Care Home. 04/04/07

Hatzfeld House Care Home. 04/04/06

Hatzfeld House Care Home. 04/01/06

Hatzfeld House Care Home. 07/12/05

Hatzfeld House Care Home. 09/03/05

Hatzfeld House Care Home. 16/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hatzfeld House Care Home 10b Mansfield Road Blidworth Nottinghamshire NG21 0PN Lead Inspector Jayne Hilton Unannounced Inspection 24th October 2005 03:00 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 Hatzfeld House Care Home DS0000028615.V253765.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. Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hatzfeld House Care Home Address 10b Mansfield Road Blidworth Nottinghamshire NG21 0PN 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) 01623 464541 01623 465508 Mr Roger Willis Mr Roger Willis Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users shall be within category OP Date of last inspection 9th March 2005 Brief Description of the Service: Hatzfield House is a converted property, set in its own grounds in the centre of Blidworth. It is within walking distance of all the local amenities and on a public bus route. Service users are accommodated in one double and twenty-one single bedrooms with a communal lounge, dining room and conservatory. Disability equipment in the home includes a passenger lift, ramped access to the building, grab rails in bathrooms/toilets, handrails in corridors, mobile/bath hoists and raised toilet seats. A call system is available in all the rooms, including communal living spaces. The level of adaptation is sufficient for meeting the needs of current service users. Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out by, Jayne Hilton on Monday 24th October 2005 at 3pm. The unannounced visit, which was completed at 6.30pm, mainly focused on the requirements and recommendations set at the previous inspection in March 2005. Several key standards were assessed also. The methodology used included speaking with four staff, indirect and direct observation of practice and interaction, a tour of the building, speaking with service users, the examination of care plans and other associated documentation and records. The management of medication was assessed and the systems in place for health and safety, food and nutrition and a comprehensive assessment of the statement of purpose and service user guide, was carried out. The acting manager had submitted a pre-inspection questionnaire and although this had not been completed fully, the inspector has included some of the information as methodology for the inspection. There were no relatives visiting at the time of the inspection and only one service user was willing to speak to the inspector. The registered manager/provider has recently employed a new acting manager and an application, has been received by the Commission for Tracey Graham, which will undergo assessment in the near future. The acting manager was on leave on the day of the inspection and therefore some standards could not be assessed in detail or some at all. The staff team who were on duty were very co-operative and tried their best to assist the inspector with finding or confirming information within their capacity to do so. Many of the previous requirements set were found, not to have been met, which is not satisfactory. Four of these pose a serious risk for service users, therefore an immediate requirement notice was served for these issues to be dealt with at once. Failure to comply with the notice may result in enforcement action being taken. What the service does well: The overall care provided for service users is satisfactory and comments from service users were that staff treat them with kindness and respect their privacy Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 6 and dignity. A service user reported that their healthcare needs are well met by the staff team and that the food provided was ok. Continence appeared to be well managed. Service users presented well cared for and appropriately dressed. The inspector observed staff using hoists to assist service users with mobility, and turn charts were evident for a service user who remains in bed. Service users benefit from a comfortable, appropriately furnished and well decorated environment, which provides specialist equipment, suitable lavatories and washing facilities and bedroom space to suit their needs and maximise their independence. Rooms viewed by the inspector were comfortable, clean and maintained and noted, to be very personalised. What has improved since the last inspection? What they could do better: There was clearly some areas that require improvement regarding the overall management of the home, staff knowledge, direction for staff and supportive policies and procedures and an improved ethos towards the expectations of the Care Standards Act 2000, associated Regulations and National Minimum Standards, care planning and evaluation. There are several outstanding requirements and some new ones set, many of which put service users health and safety at risk. Prospective service users and existing service users do not have up to date information they need to make an informed choice about where they live and not all service users have a contract or confirmation that the home can meet their assessed needs. The process for assessment, review and evaluation of changing needs of service users needs to be improved to ensure all service users needs are fully met and that they are only admitted where they fit the criteria of the registration category for the home. Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 7 Service users health, personal and social needs are not fully set out in the present system and much work is required to improve care alongside a system for monitoring and evaluating the healthcare needs of service users which also need to be improved to ensure that risks are appropriately assessed and minimised. The current system for the management of medication is unsafe and presents a risk to service users. The provision of social, cultural, religious and recreational interests and needs could be improved and service users helped to exercise more choice and control over their lives, particularly in relation to meal options. Evidence was not available to assess whether the service users receive a wholesome appealing balanced diet. There are outstanding requirements in relation to surface temperatures of radiators, the provision of window restrictors, door locks to bedrooms, and other issues are identified for infection control, the safety and security of service users in relation to the drive and night lighting of this and the grounds. Staffing levels need to be reviewed to ensure that the changed dependency needs of all service users are met with continuity and takes into account the need to escort service users off the premises should they choose to smoke. The training provision needs to be improved to ensure the mandatory topics are covered sufficiently and for other assessed needs of service users. There are no quality monitoring systems in place and there is non compliance of requirements set at the previous inspection, therefore this indicates the home is not being run in the best interests of service users and the lack of policies and procedures and indicate that service users rights and best interests are not being safeguarded. Not all records that are required to be available for inspection were available. Service users health and safety may be compromised by, several issues in relation to safe practice and breach of regulation. 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. Hatzfeld House Care Home DS0000028615.V253765.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 Hatzfeld House Care Home DS0000028615.V253765.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 Prospective service users and existing service users do not have up to date information they need to make an informed choice about where they live and not all service users have a contract or confirmation that the home can meet their assessed needs. The process for assessment, review and evaluation of changing needs of service users needs to be improved to ensure all service users needs are fully met and that they are only admitted where they fit the criteria of the registration category for the home. EVIDENCE: Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 10 A statement of purpose displayed in the home did not meet the requirements of standard 1 and regulation 4. The information regarding complaints needs to be updated to CSCI [Commission for Social care Inspection] from NCSC. There is an outstanding requirement regarding other information not included in the document and needs to state the experience and qualifications of the Registered Provider / Registered Manager, to reflect the number of rooms provided and also to reflect the room sizes. There did not appear to be a service user guide available and if this document is to be combined with the statement of purpose, the relevant information as specified by standard 1, regulation 5, also needs to be included in the statement of purpose document. There was no evidence of copies in service users rooms and a service user spoken with could not recall being issued with a copy. The inspector has requested that an up to date copy of the documents be submitted to CSCI within 14 days, as the previous timescale for action [31st July 2005] was not met. As part of the admission process, it is good practice to include the issue of a service user guide with the terms and conditions or contract and for the service user or relative to sign that they have received a copy, which then can be kept in the service users personal information. The registration certificates were displayed, however, a plant obscured these. It is recommended that they be sited in a more prominent position. There was not a copy of the last inspection report on view, neither was any information viewed regarding how this could be accessed by service users or relatives. [A requisite of the service user guide regulation] The inspector viewed service users Terms and Conditions evidenced in one service user’s files. A newly admitted service users file did not contain this document. To ensure the standard is fully addressed the room number is to be included (Standard 2.1). Terms and conditions should be available for inspection for all service users residing in the home. The regulation also requires that the registered provider inform the service user in writing that the home can meet their needs. [Regulation 14[1][d] Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 11 Four service users care plans were examined and extended community care assessments were seen. Staff reported that the acting manager or the deputy visit prospective service users to carry out an assessment. There was also an application for placement at the home, which the inspector was informed by the deputy manager, [by telephone], that this was the document used to initially assess service users who are admitted to the home. Whilst there is some useful information, particularly regarding service users preferences, the document does not meet with the criteria for Standard 3 of the NMS. [Assessment and Care plans should reflect the topics listed i.e., foot care, mental health state and condition etc] plus any individual specific healthcare needs/conditions. The assessment and care plan format and process appears somewhat disjointed and staff did not appear to use these as working documents. A review of the system is highly recommended to improve both the documentation and practice and ensure that service users needs are met. Recorded evidence must be maintained by the home to support how the service users needs are assessed and to demonstrate the homes abilities to meet the needs of the service user (Standard 3.1, 3.2 and 3.3). The inspector discussed an incident whereby a respite service user had gone temporarily missing from the home. Staff felt that information about the needs of the service user had not been fully communicated to them by the service users family at the time. This event reinforces the need for an improvement in the assessment process. There was no evidence of a missing person policy available or any risk assessments in service users personal information should they wander or go missing. One of the service users case tracked appeared to have been admitted with a primary need of Dementia, for which the home is not registered to take people with these types of illness. [A registered person is in breach of the law if they admit service users with needs that the home is not registered to provide a service for.] The service user is reported to be requiring intensive staff input and a staffing review is needed whilst the service user is to remain at the home. [See standard 27] The registered person must obtain a clear definition of the service users primary need and if this is Dementia, appropriate action taken to find a more suitable placement. Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Service users health, personal and social needs are not fully set out in the present system and needs to be improved. A service user reports that their healthcare needs are well met by the staff team, however, the system in place for monitoring and evaluating the healthcare needs of service users need to be improved to ensure that risks are appropriately assessed and minimised. The current system for the management of medication is unsafe and presents a risk to service users. Overall service users feel they are treated with respect and their right to privacy respected. EVIDENCE: The inspector randomly sampled two care plans in detail and viewed two others for specific information. Care plans viewed provided a brief overview of individual service users needs however the content does not specify actions to be taken by staff to meet individual service users needs (Standard 7.2). Review dates were recorded monthly but there was no evidence of evaluation and review of service users changing needs or reassessment of needs. Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 13 These issues were identified at the previous inspection and the provider action plan stated that this would be met by 31st July 2005 The inspector was unable to evidence service users involvement with the care planning process. In addition service users spoken with were unable to confirm knowledge of a care planning record (Standard 7.6). These issues were identified at the previous inspection and the provider action plan stated that this would be met by 30th September 2005. A service user spoken with by the inspector reported the staff to be very helpful and ensured on request that suitable arrangements were made to receive other health care professional visits. A service user reported that staff responded to call alarms promptly. The inspector viewed recorded evidence of service users receiving health care assessments from the auditory, opticians, dentist and follow up appointments with the hospitals. Weight records were in place and staff reported how they dealt with concerns about service users nutritional needs, however there was no evidence of nutritional assessments in service users care plans. General risk assessments were present in one file only apart from mobility information. There was no information in care plans to detail any history of falls and on examination of accident records the inspector found that one service user had 11events recorded within 14 weeks. Although daily progress sheets contained reference to events there is a need to log and evaluate the event of falls and document what action is being taken to prevent further occurrence. It was reported that there were no service users with pressure sores on the day of the inspection. Specialist equipment was observed, to be provided for those, requiring pressure area prevention. There were no assessments in place for tissue viability. Continence appeared to be well managed. Service users presented well cared for and appropriately dressed. The inspector observed staff using hoists to assist service users with mobility. Turn charts were evident for a service user who remains in bed. Two service users were reported to smoke and as the registered provider prohibits smoking in the home/on the premises. Staff reported that service users have been told that they have to walk to the end of the driveway, which is some distance from the home itself and on a steep incline. There is no reference to this in the individuals care plan, neither were there any risk Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 14 assessments in place to demonstrate how the safety of the individual is protected under these circumstances. [See Standard 19-21]. A local community pharmacist provides a blister pack system for medication. The inspector directly observed a care worker dispensing and administering medication. The practice adopted was pre-potting. Pre-potting medication is not an acceptable practice and contravenes Royal Pharmaceutical guidelines for safe administration of medication (page 18) (Standard 9.1). At the previous inspection the inspector issued an immediate requirement to which the provider made a written response to confirm pre-potting had been ceased. However this practice was observed once again and an immediate requirement made once again. Failure to comply with safe practice may result in enforcement action being taken. The staff member was observed to sign for the administration prior to visibly observing the medication being taken and to leave the open carrying storage boxes unattended to answer the telephone. The staff member was able to explain what to do should an error with medication occur regarding the service users health and safety, however staff were not aware of the need to report medication errors under regulation 37 to CSCI. The staff member informed the inspector that medication was returned immediately after a death of a service user and was unaware of the need to keep this for seven days in case of a Coroner enquiry. Staff reported that they had received training in medication management via the community pharmacist and by distance learning training but were not assessed for competency by the registered manager. The inspector was able to ascertain that the ordering, receipt and return of medication was the responsibility of the night staff, however no documentation or records was located to be able to assess this practice. The medication administration records [Mars] were completed satisfactorily but there was outdated information stored with the Mars, which need removing. It was reported by staff that there are no service users currently selfadministering medication. Photographs are used but there was no evidence of sample signatures at the front of the mars for those responsible for administering medication. The storage of medication was assessed at the previous inspection and very limited and an alternative source was recommended to be considered (Standard 9.4). Due to time constraints the inspector did not assess the storage facilities of medication at this visit as staff confirmed no alternative had yet been found. The inspector recommends that a suitable medication trolley be used for storing and dispensing from. There were no policies and procedures evident for the management of medicines in the home. Staff suggested that these possibly might be kept in the office in the porta-cabin in the grounds. The assessment of medicine management in the home is that unsafe and unsatisfactory practice is taking place. Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 15 Urgent action is required by the registered person to ensure that the Royal Pharmaceutical guidelines for safe administration of medication (page 18) (Standard 9.1) are in place and followed by staff. A service user spoken with was able to confirm that staff, respect the privacy and dignity of service users and that they knock before entering bedrooms etc. A service users requested assistance to use the telephone in the home during the inspection. A service user interviewed, has her own, telephone. Care plans identified service users preferred term of address and staff, were aware of these. (Standard 10.1). To ensure service users privacy in bedrooms, nets or blinds are to be offered and evidence should be recorded within the care plan. A service user stated that staff treated all service users with kindness. Indirect observations evidenced that staff were interacting appropriately with service users. Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 16 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): 12, 14, 15 The provision of social, cultural, religious and recreational interests and needs could be improved and service users helped to exercise more choice and control over their lives, particularly in relation to meal options. Evidence was not available to assess whether the service users receive a wholesome appealing balanced diet. EVIDENCE: The inspector examined recorded evidence of documentation of individual service users personal and social history. A folder provided information of entertainers and local events, which staff can book. The information regarding the provision of activities was minimal and staff reported that although they endeavour to organise dominoes and bingo etc, the service users in the home were not very motivated to participate. The responsibility of activities was of day staff before lunch usually. Staff need to provide a record of the activity provided and who participated. The service users and staff would benefit from the provision of an activities co-ordinator and some innovative and creative ideas should be introduced and based on the assessed social needs of service users. A service user was able to confirm that she could get up and go to bed when she wanted and that her independence, choice and autonomy were respected Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 17 by staff working in the home. Bedrooms were observed, to be, personalised. The service users spoken with was not aware of being able to access her personal records in accordance with the data protection Act 1998. A monitor alarm was observed to be in use for one service user, and although the explanation for its use by staff appears to be in the best interests of the service user, there was no authorisation for its use from the relatives, neither was there any reference of its use in the service users care plan. Regulation 17 schedule 4 [3][q] states that a record must be kept of any limitations agreed with the service user as to the service users freedom of choice, liberty of movement and power to make decisions.” There was no prepared menu available in the home and the inspector was unable to ascertain how meals were planned. A staff member employed for catering at teatime was not able to provide the inspector with information regarding the breakfast and lunchtime arrangements. The teatime meal served on the day of the inspection was cheese on toast and soup. A list, had been made by staff of choice options on the day of the inspection, but this was in a note pad and there appeared to be no consistency of this practice. Where other entries had been made in the note pad, there was no date to identify when the choice had been recorded. There were no records available of other meal options for lunchtime and service users reported that they ate what was put in front of them. Staff stated that they know the service users likes and dislikes. A breakfast list is posted inside one of the kitchen cabinets, however there was no evidence that service users were given a choice of meal options and no evidence that service users were offered a balanced and nutritional diet/menu. Regulation 17, schedule 4 [13] states that “records must be kept of the food provided for service users in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and of any special diets prepared for individual service user”. The inspector recommends a simple and practical way of achieving this along side a planned written menu with at least two options is to supply a page a day diary and to list the meal options chosen and taken by each service user, with the probed temperature record with the food item listed. This provides an instant daily record, which can be evaluated easily. Fridge and freezer temperatures can be recorded on the page also, which reduces several pieces of paperwork. There is a menu board displayed outside of the kitchen, this was blank on the day of the inspection. The inspector has therefore recommended individual menu be to be displayed on the dining room tables. In addition consideration is to be made on how service users can maximise their independence for example use of individual tureens / gravy boats and the Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 18 option to have tea and coffee making facilities in service users individual rooms following a risk assessment. A service user did comment that the food provided was ok. Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 19 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 Service users feel confident to make complaints and feel safe in the home. Staff although aware of how to report poor practice need to have policies and training available to ensure service users are protected from abuse. EVIDENCE: The complaints records were not available for inspection, however the pre inspection questionnaire received by CSCI on 9th August 2005, reports no complaints had been received by the home in the last twelve months. A complaint procedure was displayed and is contained within the statement of purpose document, although both require updating to CSCI from NSCS. A service user confirmed that she felt able to complain and thought that any complaint would be listened to and dealt with appropriately. Staff reported that they if a complaint was reported to them, they would record this in the staff communication book for the manager or deputy manager to deal with. Staff would benefit from a clear protocol for documenting concerns and complaints. Staff was able to explain that they would report any bad practice observed in relation to the protection of vulnerable adults. As there were no policies available this standard could not be fully assessed. Staff reported that there had been no training provided for adult protection, but some staff have covered the topic briefly in NVQ’s [National Vocational Qualifications]. The PIQ submitted by the manager reports no Adult Protection investigations for the home in the past twelve months. A service user reported that she felt safe in the home. Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 20 Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 21 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, 22, 24, 25, 26 Service users benefit from a comfortable, appropriately furnished and well decorated environment, which provides specialist equipment, suitable lavatories and washing facilities and bedroom space to suit their needs and maximise their independence, however there are outstanding requirements in relation to surface temperatures of radiators, the provision of window restrictors, door locks to bedrooms, and other issues identified for infection control, the safety and security of service users in relation to the drive and night lighting of this and the grounds. EVIDENCE: The home benefits from a recent extension providing four en-suite rooms, an assisted bathing facility and a lounge. The extension has been completed to a high specification. With the additional lounge, which has been included within the new extension the communal space meets the requirements set out within this standard. The home has three lounge areas and a designated dining area. In general, furnishings in communal areas are of a homely appearance and the decoration Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 22 of a high standard. There is an enclosed garden accessible to service users that is safe and well maintained. There is however no security systems or night lighting for the exterior of the home and this is highly recommended. The entrance driveway was noted to have some pot - holes which result in an unlevel and therefore unsafe pathway for service users, staff and visitors. As the home is now a ‘no smoking’ home, service users who smoke are expected to walk to the bottom of the drive for this purpose, which the inspector views as unsatisfactory. As it appears that two service users were in residence when the home changed its policy on smoking, it seems reasonable for the registered provider to allow smoking in the grounds nearer to the home, and/or provide shelter and appropriate outside lighting. A Parker bath has been fitted within the new extension, offering an additional and valuable assisted bathing facility. In addition other toilet and washing facilities have been upgraded to meet the needs of the service users. Hoists call alarms and grab rails were observed in the home and a passenger lift provides access to the first floor. Rooms viewed by the inspector were comfortable, clean and maintained. [Two rooms were noted to have some mal odour]. Observation of high number of rooms noted, to be very personalised. Locks on doors have been fitted to most service users rooms but on discussion with staff it was reported that service users do have the opportunity to have a key, but there was no evidence within care plans of risk assessments where service users are not able or do not wish to have a bedroom door key. (Standard 24.6). The service user spoken with did not have a door lock and was not aware she could have this facility provided. Ideally a signed declaration could be included in the terms and conditions document or in a care plan. One service user was noted to have special flooring in the bedroom; staff reported that this was provided prior to the service user moving in. There was no evidence in the care plan that the service user had agreed to the flooring or whether a carpet option had been offered on admission. During the tour of the accommodation the inspector evidenced a warm and comfortable environment. Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 23 However several rooms were found to have radiators that were exceedingly hot to the touch and not adequately guarded. An immediate requirement was issued by the inspector for a risk assessment to be completed to establish service users at risk of being burnt. Areas identified must be fitted with a suitable guard (Standard 25.5). This is an outstanding requirement from the previous inspection and where failure to comply may result in enforcement action being taken. In addition the inspector observed windows on the ground floor were not fitted with a suitable retainer. An immediate requirement was issued for these windows to be fitted with a retainer (Standard 25.1). On the day of inspection there was no malodour [other than in two service user bedrooms]. The home was observed to be well maintained and kept clean. The laundry room viewed by the inspector was organised to ensure clean linen is kept separate from soiled linen. Ample gloves and protective clothing are provided. Towels were however stored openly in a bathroom as were continence aids, which is not good practice and is a risk factor for cross contamination and infection control. A whicker/ratten seated, chair was observed in a bathroom and again this type of chair should not be in use as poses a risk as above. Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 24 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): 27, 28,30 staffing levels meet requirements regarding numbers of service users, however staffing levels need to be reviewed to ensure that the changed dependency needs of all service users are met with continuity and takes into account the need to escort service users off the premises should they choose to smoke. The training provision needs to be improved to ensure the mandatory topics are covered sufficiently and for other assessed needs of service users. EVIDENCE: Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 25 The duty rota examined by the inspector recorded evidence of three care staff on duty throughout the day and two care staff during the night. It is recommended the duty rota reflect the shift to be worked as well as the hours. In addition clarification is required of the person on duty and not just a record of the Christian name (Standard 27.2). The levels of staff provided do meet with the staffing guidance minimum staffing levels, regarding numbers of service users, however as there was clearly much demand on staff time by a service user [possibly admitted outside of the registration category], this depletes staff availability to attend to the other service users and as the design of the building, provides many communal areas and walkways, a staffing review is recommended to ensure that all service users needs are met. If a service user wishes to smoke, to ensure safety of the service user, they have to be escorted to the bottom of the drive, which obviously further depletes staff for this duration of time, as with, when staff are attending to personal care needs of service users. Night staffing again should be reviewed. The identified service users needs mean that staff are providing 1:1 care throughout most nights and which again, within the limitations of the building, means that staffing levels may not be sufficient to ensure the health and safety of all service users. Staff reported that many of the team were currently undertaking NVQ’s. Information in the PIQ completed by the manager informs the inspector that 1 member has achieved NVQ2 and 1 is currently studying this. One is working toward level 4 and that staff undergo Skills for care 3 day induction training. A new staff member confirmed that she had completed her induction and that experienced staff were supporting her learning and getting used to the service users needs etc. There was training information available for staff on the notice board but no records available of what training staff have achieved, neither was there a training programme available to outline training needs of staff for the following twelve month period. Staff informed the inspector that on site training is provided in the porta cabin and that some staff have attended training for dementia care in the past. There was no evidence of training for staff in mental health, or dealing with challenging behaviour despite these needs being identified by the inspector from the case tracking of service users needs. Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 26 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): 33,37,38 There are no quality monitoring systems in place and there is non compliance of requirements set at the previous inspection, therefore this indicates the home is not being run in the best interests of service users and the lack of policies and procedures and indicate that service users rights and best interests are not being safeguarded. Not all records that are required to be available for inspection were available. Service users health and safety may be compromised by several issues in relation to safe practice and breach of regulation. EVIDENCE: The newly employed acting manage is in the process of completing her Registered Managers Award with a view to take on the Registered Manager’s post. An application has been submitted for assessment of the fit person process. Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 27 Staff spoken with reported the new acting manager to be very approachable and supportive. There was clearly some areas that require improvement regarding the overall management of the home, staff knowledge, direction for staff and supportive policies and procedures and an improved ethos towards the expectations of the Care Standards Act 2000, associated Regulations and National Minimum Standards, care planning and evaluation. There is a small office area in the conservatory, however staff, were not able to locate the necessary paperwork, and documentation required both for the day-to-day running and for inspection. Some of this information may have been stored in the ‘porta cabin office’, however it is recommended that the situation be addressed and that any documentation required for the day to day running of the home be stored actually on site in the home. [This does not apply to staff personal files, however, which do need to be stored securely] There was no evidence of quality monitoring systems in effect at the home. Neither, staff or service users were aware of any service user survey being carried out. This has been outstanding from the previous two inspections. The inspector was unable to access records in respect of service users finances, staff personal records and training, maintenance and service records, complaints etc. Persons that have access to the records were not available on the day of inspection. A visitor’s book was not obviously available and staff did not request the inspector to sign in or out. A requirement is therefore set in relation to this breach of regulation. As there was no policy manual available for staff in the home and records were not available for inspection in view that most of the requirements set at the previous inspection had not been addressed both standards 33 and 37 are assessed as having major shortfalls. Care plans were stored in a drawer in the conservatory, but the drawer was not locked. The fire alarm and emergency lighting check records were not available and this is an outstanding issue as they were not available at the previous inspection. Staff reported that the caretaker keeps these records locked in his room. These must be left accessible and available for inspection at all times. Fire doors were observed to be propped open-again this is an outstanding requirement. Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 28 The inspector was unable to evidence a risk assessment to support this practice. The inspector has therefore issued an immediate requirement for the Registered Provider to submit a risk assessment in respect of arrangements in the event of a fire (Standard 38.2). [Fire Precautions [Workplace] Regulations. This is outstanding from the previous inspection and must be complied with to avoid enforcement action. In addition the inspector has recommended the fire door situated on the first floor to be fitted with an alarm (Standard 38.2). Staff reported that they all have regular training in manual handling and most have first aid and health and safety training. Only the catering staff were reported to hold food hygiene certificates. As food handlers the care staff are required to hold food hygiene as mandatory training. Staff did not report training for fire safety but stated that they had undertaken training in infection control. As there were no records available there was no evidence other than staff comments and the PIQ to support this. Cleaning agents and toiletries were observed left in bathrooms and toilets, which contravenes COSHH regulations. [Control Of Substances Hazardous to Health]. The health and safety poster requires some updating of information, regarding responsible staff. The storage of food in the fridge was disorganised and raw foodstuffs observed to be stored with other food items, which contravene food safety, practices. There was only one first aid box noted in the home, this was in the kitchen, the box, which was soiled with food, contained only blue plasters and burn- ease. The kitchen door was left open when unattended, leaving service users who wander at risk. Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 29 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 1 2 2 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 3 3 X 2 1 2 STAFFING Standard No Score 27 2 28 2 29 X 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 1 X X X 1 1 Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 30 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 Requirement To ensure the homes Statement of Purpose includes: State the experience and qualifications of the Registered Provider / Registered Manager • To reflect the number of rooms provided To reflect the room sizes 2 OP1 5 Ensure there is a service user guide available for all service users, that contains the specified information as required by regulation and which informs the reader how to access a copy of the last inspection report for the home All service users are to be fully assessed prior to admission and as on ongoing evaluation process to ensure the home is able to meet the needs of the service user and that they meet the criteria of the registration category and ensure service users are provided with written confirmation that the home can meet their needs within the limit of the homes registration categories. Ensure that service users are not admitted who do not meet the criteria Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 31 Timescale for action 07/11/05 • 24/12/05 3 OP3OP2 14[1][b] 24/12/05 of the registration category. [i.e. with a primary need of dementia or mental health difficulties] 4 OP4 Care Standards Act 12, 13, 14, 15,17,24 24/12/05 Provide evidence to the inspector of a clear definition of the identified service users needs from a social worker or health professional review Develop the care plans to: • Ensure service users who are at risk of wandering have the risk to their safety adequately assessed and documented in a care plan. Ensure care plans clearly define actions to be taken by staff to address individual service users needs To include service users and or their representatives signature with the written plan of care Ensure evidence is provided of appropriate evaluation and review of care plans and consultation with service user in this process. Ensure all specific needs and identified risks are documented as part of the individuals care plan, in relation to smoking, walking to end of the driveway, use of monitor alarms, Ensure evidence is documented regarding assessment of the nutritional needs of service users, tissue viability and history and risk of falls. Ensure any limitations of freedom imposed on service users are justified/agreed to be in the best interests of the service user and documented in the individuals care plan. 5 OP14OP8O P7OP4 24/12/05 • • • • • • Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 32 [This applies to any use of restraint also such as bedrails. 6 OP9 12,13, Ensure safe systems are in place for medication management. Pre – potting must cease immediately Medication must not be left unattended. Policies and procedures for the safe receipt, recording, storage, handling, administration and disposal of medicines must be available for staff. Immediate 7 8 9 OP9 OP14 OP15 18 24 17 Ensure staff are assessed as competent to administer medication. Service users must be consulted regarding their choice of meals. Ensure evidence is provided that the food provided meets with regulatory requirements: Records must be kept of the food provided for service users in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and of any special diets prepared for individual service user”. 10 OP19 12, 13,16, 23[2][o] Ensure the home the external grounds are safe for use by service users and appropriately maintained. • Ensure adequate night lighting is provided to the outdoor environment and driveway. Ensure the driveway is repaired and made safe for service users and visitors to walk on. 24/12/05 24/12/05 24/12/05 24/12/05 24/12/05 24/10/05 • 11 OP24 12[4][a] To ensure evidence that service users are provided with the option to have a key to their room unless their risk assessment suggests otherwise Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 33 12 OP25 13, 16, 23 To risk assess service users at risk of being burnt from the radiators exceedingly hot to the touch Radiators identified must be fitted with a suitable guard Immediate 24/10/05 13 OP25 13, 16, 23 To fit window retainers to all windows Immediate 12, 13, 16, 23 24/10/05 24/12/05 14 OP26 Ensure appropriate policies and practices are in place for infection control. Storage of towels. Storage of continence aids Use of appropriate seating in bathroom and toilets. 15 OP27 12, 13, 16, 18 Review staffing levels to take into account, service users dependency levels, smoking arrangements, and design of the building. 24/12/05 16 OP30 18 Ensure all staff undertakes mandatory 24/12/05 training and that evidence of this is available for inspection. Provide training for all care staff in Food hygiene, fire safety, dementia care and challenging behaviour. 17 18 OP33 OP37 24 17 To implement a system to monitor the quality of care provided Ensure that a record is kept of all visitors to the home. [And that staff are aware of the legal requirement for this.] Ensure individual records / care plans are kept secure [Data Protection Act 1998] Ensure records required by regulation [including policies and procedures] are available for inspection at all times. To submit a Fire risk assessment for DS0000028615.V253765.R01.S.doc 24/12/05 24/12/05 19 OP37 16, 24/12/05 20 OP37 17 24/12/05 21 OP38 17 Hatzfeld House Care Home Version 5.0 Page 34 23 the home (Immediate Requirement issued for second time) To ensure fire doors are not wedged open To ensure Fire Log book is available for inspection Immediate 24/10/05 22 OP38 12, 13, 16, 23 Ensure service users health and safety is maintained in relation to: • food safety practices and storage in fridges and security of kitchen when unattended by staff. cleaning materials are stored securely as required by regulation [COSHH] Control of substances Hazardous to Health. ensure adequate first aid supplies in first aid boxes. 24/11/05 • • 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 3 4 5 6 7 Refer to Standard OP1 OP1 OP2 OP3 OP4 OP8 OP8 Good Practice Recommendations Obtain a signature from service users or their representative for receipt of service user guide Re site the registration certificate or plant that is obscuring this. To include the room number recorded in the homes Terms and Conditions Review the assessment and care plan format to meet the standard topics in standard 3.3 Provide an accessible missing person protocol for staff. Use assessment tools for assessment of risk of pressure areas, nutritional screening. Include a running record of history of falls and incidents/events within the care plan. DS0000028615.V253765.R01.S.doc Version 5.0 Page 35 Hatzfeld House Care Home 8 9 10 11 12 13 14 OP9 OP9 OP9 OP9 OP10 OP12 OP12 15 16 17 18 19 20 21 22 OP15 OP15 OP15 OP16 OP18 OP19 OP26 OP27 Include a protocol for drug errors in the medication record file, which also prompts staff to report drug errors to CSCI Provide a sample signature sheet of those staff authorised to administer medication. Remove out of date information from the medication folder. To consider an alternative area for storage of medication and consider the use of an appropriate medicines trolley. To afford privacy provide service users with a choice to have nets or blinds fitted to their personal rooms Document the activities provided on a daily basis and who participated Consider providing an activities co-ordinator and reviewing the activities provided to meet the identified social needs of service users. To provide up to date information about the activities provided by the home and to circulate to all service users in formats suited to their capacity Use a page a day diary to keep a record of food provided, options taken and other kitchen records. To ensure service users are aware of the daily menu To consider alternative methods of promoting / maximising service users independence at meal times Devise a protocol for staff to follow to record and report complaints and ensure that the complaints procedure on display is up to date with CSCI [not NCSC]. Provide training for staff for adult protection. Consider the provision of a gazebo or shelter for service users who smoke Provide storage trolleys for towels etc in bathrooms and lockable facilities for toiletries/cleaning items if these are to be stored in bathrooms and toilets. Ensure the duty rota reflects: Shift to be worked Staff members full name 23 24 25 OP30 OP30 OP33 Provide an annual training programme for staff. Provide training for staff in older persons complex needs and specific needs of service users Improve the overall management and administration in the home and increase staff knowledge and skills in conjunction with the ethos of the Care Standards Act 2000, The Care Home Regulations 2001 and the associated National Minimum Standards Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 36 26 27 OP37OP33 OP38 Provide a policy manual for staff use on site in the home. Delegate the responsibility for first aid supplies and stocks to specific staff members. Hatzfeld House Care Home DS0000028615.V253765.R01.S.doc Version 5.0 Page 37 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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. 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