Inspection on 16/11/05 for Haughgate House Nursing Home

This inspection was carried out on 16th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Haughgate House Nursing Home 18/08/08

Haughgate House Nursing Home 14/08/06

Haughgate House Nursing Home 15/08/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Haughgate House Medical Nursing Home Haugh Lane Woodbridge Suffolk IP12 1JG Lead Inspector Kevin Dally Unannounced Inspection 16th November 2005 4:30 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 Haughgate House Medical Nursing Home DS0000063952.V267852.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. Haughgate House Medical Nursing Home DS0000063952.V267852.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Haughgate House Medical Nursing Home Address Haugh Lane Woodbridge Suffolk IP12 1JG 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) 01394 386249 01394 386249 Haughcare Limited Penelope Hull Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Haughgate House Medical Nursing Home DS0000063952.V267852.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th August 2005 Brief Description of the Service: Haughgate house is a converted home, with a modern extension, and extensive gardens. There is accommodation for seventeen service users with medical nursing needs but currently there is a building programme underway to add an additional 14 beds to the home. The Home is located on the outskirts of Woodbridge, close to the A12. All services can be located in the centre of Woodbridge, which is approximately 2.5 miles away. All bedrooms in the extension are single rooms and an assisted bathroom and separate laundry are available in this part of the Home. One double room is available in the main house along with a large dining room, sun lounge, treatment room, kitchen and a further two bathrooms, one of which is assisted. All bedrooms and communal areas for service users are on the ground floor with level access to all areas. Since the recent sale of the home, the first floor accommodation has been converted into office space for the owners, the manager, and for use as a training room. Haughgate House Medical Nursing Home DS0000063952.V267852.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report followed an unannounced inspection of Haughgate House a care home offering nursing care, and was carried out over a 5-hour period during a weekday evening between 4.30pm and 9.30pm. Ms Barbara Marr, the nurse in charge of the duty, and Mr Carter, one of the owners, were available to answer any questions. 3 residents, 1 relative and 1 support worker were spoken with and who shared their views on the service provided. Residents, staff and administration records were checked and a brief tour of the premises was completed. This inspection revealed that of the 27 standards inspected, 23 were assessed as fully met with 4 standards as almost met. Further, that the home continued with the positive provision of a nursing care service to residents with medical problems. What the service does well: What has improved since the last inspection? What they could do better: This unannounced inspection found many improvements evident since the last inspection and revealed only a small number of requirements to be addressed. These included the need to complete the provision of staff training for all staff, Haughgate House Medical Nursing Home DS0000063952.V267852.R01.S.doc Version 5.0 Page 6 including moving and handling updates, adult protection training, infection control and food hygiene training. New carpet was required by the kitchen area and room 5, and proof of identity for one staff member, was needed. It was recommended that the home should consider undertaking baseline pressure area, nutritional and falls risk assessments for all residents, to positively record that there were no risks. 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. Haughgate House Medical Nursing Home DS0000063952.V267852.R01.S.doc Version 5.0 Page 7 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 Haughgate House Medical Nursing Home DS0000063952.V267852.R01.S.doc Version 5.0 Page 8 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): 3,4 People can expect to have their care needs assessed prior to admission, and will know whether or not the home is able to meet their needs. EVIDENCE: During the inspection two resident’s records were checked and these contained detailed Stars Assessments, which assessed 30 areas of personal need. Using the nursing process, significant needs identified from the Stars assessment would be used to construct the care plan. Records also contained a Social Services Compass report. Three service users spoken with confirmed that the care they received was good, and that the home met their personal care needs. Service users also thought that there were “plenty of staff” to call and that they “do everything for us”. One service user stated that they were “washed and assisted to dress every day”. One relative spoken with confirmed that they thought that the care received by their relative was very good and that this included attention to details like fingernail and feet care, and visits from the hairdresser. Haughgate House Medical Nursing Home DS0000063952.V267852.R01.S.doc Version 5.0 Page 9 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 People can expect to receive good quality planned nursing care, with adequate risk assessment of this care. Based on service users comments, people can expect to be treated with respect and be encouraged to maintain their independence. EVIDENCE: At the previous inspection, two residents with complex care needs had been identified, and their care was tracked. One resident experienced frequent minor falls, whilst another resident had nutritional and weight issues. Concerns had been raised around the lack of detail provided within their plans of care and risk assessments. Therefore these resident’s records were rechecked. The resident who experienced a high number of falls, their records were clear and had been fully updated, and their plan of care reflected the strategies undertaken to reduce these. This included the use of protector aids, reminders to the resident to call for assistance, wearing a wrist pendent to call staff, physiotherapy exercises, use of a high chair and walking frame, to prevent falling. Further, a detailed record of their falls was kept, and management was closely monitoring these. It was also revealed that the resident had moved rooms to be closer to staff, and so could be more easily monitored. The family Haughgate House Medical Nursing Home DS0000063952.V267852.R01.S.doc Version 5.0 Page 10 had been consulted about the changes, and who revealed that they were satisfied with the current care. Although the resident continued to experience minor falls, the situation appeared more controlled, within an agreed risk assessment strategy. The residents moving and handling risk assessment was also checked and found to provide more detail around the risk of falls and how these should be monitored. The second resident, with more complex care needs around nutritional and weight problems was also reviewed, and improved records were found in place. Very positively, the residents weight had been regularly monitored and recorded on the MUST nutritional monitoring assessment chart, and this revealed that the resident was gaining weight. A separate nutritional risk assessment was found in place, and provided a record of the strategies to be followed by staff including diet supplements, monthly weighs, monitoring by the Dietician, and a record of food. Pressure area risk assessments were also found in place for this resident. This inspection recommended that the home undertake baseline pressure area and nutritional risk assessments for all residents, to positively record that there were no risks. The home continued to use a sheet called an ‘Accountability sheet’, which identified the accountable nurse for each shift, and once signed by the nurse, meant that all identified care had been given to residents, as per their care plan. If there had been no significant changes or observations for that service user, then no other recording was made. Any significant changes would be recorded on the evaluation section of the care plan. Although care plans were updated when required, daily records of care were maintained, and the accountability sheet signed for. However records confirming monthly care plan reviews were difficult to track via this method of recording. From residents, relatives and staff spoken with during the inspection, it was confirmed that the home continued to provide good quality care and support for residents. The inspector joined the nurse for the medication round and confirmed that the home’s medication continued to be stored in either the medication cupboard or mobile trolley. Registered nurses would administer medication directly from resident’s prescribed packets or bottles to the resident. Medication records were examined and these were found to be well maintained with no gaps in administration records, and staff were observed administering medication in a safe manner. The home’s medication policy was checked and this had recently been updated, and new guidance provided for staff including the details of what arrangements are in place around the recording, handling, safekeeping, safe administration, self administration, and disposal of medicines received into the home. Haughgate House Medical Nursing Home DS0000063952.V267852.R01.S.doc Version 5.0 Page 11 Residents and relatives spoken with, and observations at the time of the inspection confirmed that staff respected residents privacy, and provided care in a supportive and dignified manner. On arrival at the home at 4.30pm, it was then dark outside, but residents were found fully dressed and undertaking various activities. Service users spoken with confirmed that staff were polite and respected their privacy. They also confirmed that staff knocked on their doors before entering. A relative who frequently visited the home confirmed that staff treated residents with dignity. Haughgate House Medical Nursing Home DS0000063952.V267852.R01.S.doc Version 5.0 Page 12 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): 12,13,14,15 People can expect a lifestyle that enables residents to participate in personal, social and leisure activities within the home, should they choose to do so. Relatives and friends can expect to be made welcome when visiting the home. Residents can expect to receive meals that are nutritious, well balanced and which meet their needs. EVIDENCE: Discussion with three service users, a relative and the staff confirmed that service users are able to follow their own routines, and a variety of leisure and personal pursuits. On arrival at the home, some residents were observed enjoying a game of cards, and they confirmed that there was usually an event every afternoon. Residents also confirmed that they could retire to bed when they wanted and would ask a staff member to help them. Meal times are as flexible as possible and shortly after the inspection began, the evening meal was observed being served to residents. The menu was checked and residents were enjoying soup of the day, assorted sandwiches, scrambled eggs or macaroni cheese. Residents and a relative spoken with confirmed that the portions and quantities were quite adequate for the evening meal, and that there was a good variety of options offered. Families, friends and representatives are welcomed at the home, and residents were observed receiving visitors during the evening. One relative confirmed that there had Haughgate House Medical Nursing Home DS0000063952.V267852.R01.S.doc Version 5.0 Page 13 been significant improvements at the home since the new owners had started and they were “very satisfied” with the way the home was being managed. Haughgate House Medical Nursing Home DS0000063952.V267852.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): 16,17,18 People can expect to have their complaints taken seriously and acted upon. Resident’s personal safety, including by appropriate staff training and recruitment checking, can be expected. EVIDENCE: The home had a complaints policy, which included appropriate details about how a complaint can be made to the home or the CSCI. The home had a complaints book in operation, and there had not been any complaints received by the home or the CSCI, since the last inspection. One relative confirmed that they “felt that any issues would be dealt with quickly and would be addressed”. The home understood its responsibility to report any allegations of abuse to Social Services, and care staff would receive training around abuse awareness. One staff members records checked revealed that they required Protection of Vulnerable adults training. One staff member’s records were examined, and this included a Criminal Bureau Record checks (CRB), and 2 written references. One resident’s personal financial records were checked and the owners had maintained an appropriate record. When monies become depleted, the owners would request more finance from the family, and a copy of the recent expenses would be forwarded to the family, who would then top up the existing account. Haughgate House Medical Nursing Home DS0000063952.V267852.R01.S.doc Version 5.0 Page 15 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): 19,20,21,24,25,26 People can expect a safe, warm, well maintained environment, which would be properly decorated, clean, hygienic, and odour free. EVIDENCE: Haughgate house is a converted home, with a modern extension, and extensive gardens. There is currently accommodation for seventeen service users with medical nursing needs. All bedrooms and communal areas for service users are on the ground floor with level access to all areas. The first floor area now provided office space for the owners and the manager, and a training room for the staff group. All bedrooms in the extension are single rooms, and an assisted bathroom and separate laundry are available in this part of the home. One double room is available in the main house along with a large dining room, sun lounge, treatment room, kitchen and a further two bathrooms, one of which is assisted. Currently there is an extensive building programme underway to add an additional 14 bedrooms to the home, and which should be completed around March 2006 Haughgate House Medical Nursing Home DS0000063952.V267852.R01.S.doc Version 5.0 Page 16 A brief environmental tour of the premises concluded that resident’s personal rooms were well decorated, comfortable, and well maintained. Corridor areas had been repainted in modern and refreshing colours, as had been the dining room. On the day of the inspection, new lighting had been installed in the main entrance area, and which made this a very bright and attractive area. The carpet outside the kitchen area, and room 5 was noted to be quite marked, and in discussion with the owner, it was agreed that this would be replaced. The home, including resident’s rooms, was found to be warm and radiators had protector covers in place. Hot water tap temperatures were not checked on this occasion. On the day of the inspection the home was found to be very clean, hygienic and odour free. The bathrooms, toilets and bedrooms seen were provided with liquid hand wash and paper hand towels. Residents and staff confirmed that the home was very well maintained in a clean and hygienic state. Haughgate House Medical Nursing Home DS0000063952.V267852.R01.S.doc Version 5.0 Page 17 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): 27,29,30 People can expect that the home will be appropriately staffed, and can expect effective staff recruitment and supervision procedures. People can expect a staff training programme in place, but some staff may require further training. EVIDENCE: The home endeavours to ensure that there was one nurse on duty each shift, with 3 care staff on an early, 2 on a late, and 1 at night. On the day of the inspection sufficient numbers of staff were found in place for the evening and night shifts. The rota was checked and confirmed that appropriate numbers of staff were in place for the week commencing the 13th November 2005. Discussion with residents, relatives and staff confirmed that there were adequate numbers of staff to meet resident’s needs. Residents stated that “there were plenty of staff to help” and that “staff do everything for us”. One staff member’s recruitment records were examined and suitable recruitment and employment procedures were found to be in place. Since the previous inspection, staff records had been improved to include the relevant documentation. These records included appropriate Criminal Record Bureau (CRB) checks, 2 references, an application form and their photo. One staff member’s records did not have a copy of their identity check, and which was required. Care staff spoken with and training records checked confirmed that they received ongoing training relevant to the care needs of the service user group. One staff members training records included a record of moving and handling, Haughgate House Medical Nursing Home DS0000063952.V267852.R01.S.doc Version 5.0 Page 18 first aid, adult protection training, fire, diabetes care, infection control, and NVQ 2 training. One staff member required a moving and handling and food hygiene update, and Protection of Vulnerable adults training, and which must be provided. In discussion with the owner, a full training programme was now in place with a plan to ensure full compliance of meeting all staff’s training needs. Haughgate House Medical Nursing Home DS0000063952.V267852.R01.S.doc Version 5.0 Page 19 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): 31,32,35,36,38 People can expect a well managed home that has an open and welcoming atmosphere. They can also expect a safe environment. EVIDENCE: In May 2005 the home was sold to and purchased by Haughgate Care Ltd, and their application to register with the CSCI, was successful. This, the second inspection since the new owners had been in place, concluded that positive changes continue to improve both the environment and the service provision. This included the new building programme to add an additional 14 beds to the home. The owners continued to have positive dialog with residents, relatives and the staff group, and those spoken with during the inspection confirmed this. Administration and recruitment practices were notably improved. Of previous concern was the number of hours that the manager worked within the home. The owner confirmed that the manager now had more dedicated Haughgate House Medical Nursing Home DS0000063952.V267852.R01.S.doc Version 5.0 Page 20 time for the management of the home, and this was evidenced in the improved care records checked. Residents, relatives, and staff spoken with confirmed that the management continued to be very approachable, and were keeping them informed about all new developments, including the new extension. Staff confirmed that positive changes continued and that they felt supported by the management. One resident’s personal financial records were checked and the owners had maintained an appropriate record. When monies become depleted, the owners would request more finance from the family, and a copy of the recent expenses would be forwarded to the family, who would then top up the existing account. Staff spoken with and records checked revealed that supervision continued to be undertaken for care staff. Records confirmed that staff had received moving and handling training, and manual handling risk assessments had been undertaken for residents. Records revealed that fire alarm checks had been maintained, and that water temperatures had been routinely checked. Haughgate House Medical Nursing Home DS0000063952.V267852.R01.S.doc Version 5.0 Page 21 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 x x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 3 18 2 2 3 3 x x 3 3 3 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 x x 3 3 x 3 Haughgate House Medical Nursing Home DS0000063952.V267852.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? No 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 2 Standard OP19 OP29 Regulation 16(2)(c) 19(1)(b)(i ) Sch 2(1) 18(1)(c)(i ) Requirement The carpet by the kitchen and room 5 must be replaced. Proof of identity was required for one staff member. Staff must receive training including training in protection of vulnerable adults, infection control, food hygiene, and moving and handling updates. Timescale for action 01/03/05 01/01/05 01/03/05 3 OP30 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 OP7 OP7 Good Practice Recommendations The manager should consider alternative ways of recording monthly care plan reviews, and not just via the accountability sheet. The home should consider undertaking baseline pressure area, nutritional and falls risk assessments for all residents, to positively record that there were no risks. Haughgate House Medical Nursing Home DS0000063952.V267852.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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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