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Inspection on 10/03/08 for Hawkesgarth Lodge Nursing & Residential Home

Also see our care home review for Hawkesgarth Lodge Nursing & Residential Home for more information

This inspection was carried out on 10th March 2008.

CSCI found this care home to be providing an Poor service.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People have their finances dealt with effectively, a robust system is in place for keeping and recording money that people keep in the home. People feel confident that they can make complaints and appropriate action will be taken. Visitors are welcomed into the home, one person was observed being offered tea/coffee or lunch.

What has improved since the last inspection?

Overall the attitude and manner of staff has improved, this means people are treated in a suitable and dignified manner. This was especially evident at mealtimes where the atmosphere in both areas was calm and relaxing with an improved dining experience for people. People now live in a cleaner and fresher smelling home, though there are currently insufficient domestic staff, plans are in place to resolve this. The majority of people have their essential care needs met, the care plans include more detailed risk assessments and more frequent reviews and evaluations of care. A full time deputy now supports the manager, this allows the manager to put systems in place to develop and improve the service. Staff are aware of different types of abuse, this is following recent training. This helps to protect people from harm. Some of the communal areas have been refurbished with new flooring and chairs; this makes the home more welcoming for people and their relatives. The home is providing more activities for people to participate in; this enhances the quality of life for people.

What the care home could do better:

People are being put at risk of harm because staff do not know what action to take in the event of a fire. Some training has taken place, but the manager has not taken any action to ensure staff (day and night) that remain outstanding complete the fire training. A letter of serious concern was issued.Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V360538.R01.S.doc Version 5.2 Page 8Currently the home does not have a permanent cook and staff in the home are taking on this role. However, whilst the food looks appetising with plenty of choice, staff have not completed food hygiene or infection control training. This would be beneficial to ensure all the correct hygiene procedures are followed. The home needs to ensure there is a qualified first aider on duty on each shift, the manager needs to organise this which will help to ensure people get the correct treatment if an emergency arises. The manager needs to be more pro-active and prioritise her responsibilities, this will ensure health and safety needs are met, and help the service move forward. For example, some staff are using moving and handling equipment without having been trained in this area, this puts people at risk. Staff have not consistently completed infection control training again this may put people at risk of cross contamination. The manager needs to maintain people`s safety on a daily basis. The manager needs to action information obtained whilst auditing care plans. Currently when gaps in care plans have been identified i.e. with risk assessments, advocacy forms, plans of care there is no record of what action has been taken to complete this. This was also highlighted at the previous visit as part of the quality assurance process. This needs to be addressed to ensure people have the care they need on a consistent basis. The manager needs to be aware of the checks people have undertaken when coming from an agency to work at the home (references/police check) this will help protect people from harm. The manager needs to encourage staff to complete their NVQ Level 2. A robust induction procedure needs to be implemented and completed so staff are trained to meet individual needs. People in the home will benefit from having regular and permanent staff working in the home. The manager must also be registered with the CSCI to ensure she is fit to carry on in her management role. Part of this is to carry out detailed assessments of people when they are admitted to the home. The manager also needs to ensure issues re: health and personal care are continually monitored to ensure good practice is sustained.

CARE HOMES FOR OLDER PEOPLE Hawkesgarth Lodge Nursing & Residential Home Station Road Hawsker Whitby North Yorkshire YO22 4LB Lead Inspector Jo Bell Key Unannounced Inspection 10th March 2008 10:00a 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 Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V360538.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V360538.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hawkesgarth Lodge Nursing & Residential Home Address Station Road Hawsker Whitby North Yorkshire YO22 4LB 01947 605628 01947 605772 hawksgarth@zoom.co.uk www.europeancare.net European Care (UK) Limited 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) vacant post Care Home 40 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (40), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (40) Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V360538.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. We propose under Section 17(4)(c) of the Care Standards Act 2000 to impose the following additional condition on your registration: “There shall be no further admissions of service users to Hawkesgarth Lodge Nursing and Residential Care Home without the prior written agreement of the Commission for Social Care Inspection.” 2. 3. Date of last inspection 27th February 2008 Brief Description of the Service: Hawkesgarth Lodge provides nursing care and accommodation for up to 40 people who have mental health needs and/or a dementia type condition. The home, set in its own grounds, consists of a two storey older building and a more recently built single story unit. The premises are located in the village of Hawsker approximately 3 miles south of Whitby and can be reached by a limited bus service or private transport. The service provides 32 single and 4 shared bedrooms. 10 of the single rooms have en suite facilities. There is a passenger lift within the older part of the building where the accommodation is situated over 2 floors. The rest of the building is single storey. There are three distinct areas, though people are currently able to live in any one of the three areas Each ‘unit’ has separate sitting and dining areas. Care staff are usually delegated to work in specific units. Qualified nurses work across all units. The property has an enclosed garden area and ample car parking for visitors and staff. Current fees are £460.00 to £662.00 a week. This was correct as of 10th March 2008. Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V360538.R01.S.doc Version 5.2 Page 5 Additional charges are made for hairdressing, chiropody, toiletries, papers, magazines and dry cleaning. Information about the services provided are made available in the home’s Statement of Purpose, Service Users Guide and through published inspection reports available from the home. Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V360538.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. • Due to concerns raised at the previous visit the CSCI have imposed a condition whereby no further admissions can take place until the service shows sustained improvement. This is what was used to write this report. • Information about the home kept by the Commission for Social Care Inspection. Since the last key inspection in October 2007, the home have had three additional visits where different outcome groups have been focussed on. These relate to mealtimes, staffing, and the management of the home. Information from the Annual Quality Assurance Assessment (AQAA) from 2007 and details of people currently using the service. The updated AQAA has not been returned. Details from the improvement plan was also considered. Information from surveys, which were sent to people who live at Hawkesgarth Lodge, their relatives, and other professional people who visit the home. 10 were sent to people at the home and 6 were returned. 10 were sent to peoples’ relatives, 0 returned 5 were sent to staff, 1 was returned 5 to visiting healthcare professionals, 0 returned A visit to the home by two inspectors, one inspector spent nine hours at the service, another inspector spent two hours carrying out observations on people with dementia which looked at engagement with staff, interactions and the well being of people using the service. This visit included talking to people who live there and their visitors, and to staff and the manager about their work and training they had completed. It also included checking some of the records, policies and procedures that the home has to keep. • • • Information about what was found during the inspection was given to the home manager at the end of the visit, and separate feedback was given to the staff on duty (at their request). It was evident from the information gathered and the discussions which took place that the home has made a range of improvements since the last visit, this has helped to improve outcomes for people in the majority of areas. Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V360538.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: People are being put at risk of harm because staff do not know what action to take in the event of a fire. Some training has taken place, but the manager has not taken any action to ensure staff (day and night) that remain outstanding complete the fire training. A letter of serious concern was issued. Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V360538.R01.S.doc Version 5.2 Page 8 Currently the home does not have a permanent cook and staff in the home are taking on this role. However, whilst the food looks appetising with plenty of choice, staff have not completed food hygiene or infection control training. This would be beneficial to ensure all the correct hygiene procedures are followed. The home needs to ensure there is a qualified first aider on duty on each shift, the manager needs to organise this which will help to ensure people get the correct treatment if an emergency arises. The manager needs to be more pro-active and prioritise her responsibilities, this will ensure health and safety needs are met, and help the service move forward. For example, some staff are using moving and handling equipment without having been trained in this area, this puts people at risk. Staff have not consistently completed infection control training again this may put people at risk of cross contamination. The manager needs to maintain people’s safety on a daily basis. The manager needs to action information obtained whilst auditing care plans. Currently when gaps in care plans have been identified i.e. with risk assessments, advocacy forms, plans of care there is no record of what action has been taken to complete this. This was also highlighted at the previous visit as part of the quality assurance process. This needs to be addressed to ensure people have the care they need on a consistent basis. The manager needs to be aware of the checks people have undertaken when coming from an agency to work at the home (references/police check) this will help protect people from harm. The manager needs to encourage staff to complete their NVQ Level 2. A robust induction procedure needs to be implemented and completed so staff are trained to meet individual needs. People in the home will benefit from having regular and permanent staff working in the home. The manager must also be registered with the CSCI to ensure she is fit to carry on in her management role. Part of this is to carry out detailed assessments of people when they are admitted to the home. The manager also needs to ensure issues re: health and personal care are continually monitored to ensure good practice is sustained. Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V360538.R01.S.doc Version 5.2 Page 9 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V360538.R01.S.doc Version 5.2 Page 10 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 Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V360538.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 is not applicable) People who use this service experience adequate quality outcomes in this area. People have their needs fully assessed prior to admission though this does not mean that individual needs are being met. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home have not had any recent admissions. The documentation used was inspected and this covers all aspects of personal and health care. The manager always carries out an assessment prior to accepting a new person, and the care manager may be involved. Evidence of reviews from social services confirmed that this takes place. The manager is aware of the different registration categories and which people are suitable for admission. Some surveys returned from people using the service stated that people do not receive enough information about the service prior to admission. This needs to be reviewed. Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V360538.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 People who use the service experience adequate quality outcomes in this area. Essential health and personal care needs are met, with improvements being made in privacy and dignity. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: The care that people receive has improved during the past six months, essential care needs are met and staff have a clearer understanding of how to care for older people with dementia. New documentation is being introduced which uses ‘activities of daily living’ as a basis for each care plan. A total of six care plans were inspected. Generally risk assessments were in place for moving and handling, prevention of falls and for nutrition. Some plans had been reviewed and evaluated on a monthly basis. Surveys returned confirmed that generally people receive the medical care they need, healthcare professionals are contacted when needed and each visit is recorded. Staff in the home are aware that there is still work to do to ensure the care plans clearly reflect people’s needs and for them to become user friendly. Gaps in care plans were evident and some care was described in so much detail it was Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V360538.R01.S.doc Version 5.2 Page 13 difficult to follow, for example one person had four care plans relating to catheter care. The plan did not always follow the care that was given. One person needed a pressure-relieving cushion on her chair, but staff had left this in her bedroom, staff discussed a person with reduced mobility, though the records were unclear as to whether a multi-disciplinary meeting had taken place to decide what was in the best interests of the person. Input from the key worker was varied; the manager felt a record should be made on a daily basis though this did not happen. One inspector spent two hours in the small lounge/dining area observing interactions with staff and people using the service, the engagement between these parties and the well being of people. The majority of these observations were positive, with staff understanding how to interact effectively with people with communication problems. On two occasions the interactions were ‘neutral’, though this did not have a negative effect on the individual. Staff showed a greater awareness regarding privacy and dignity and the use of appropriate language between staff and people using the service has improved. The manager needs to ensure this is sustained, as this has been an issue between staff and people using the service in the past. The medication system was inspected; recently the home has started using a monitored dosage system to dispense medication. Three charts were viewed which had accurate recordings of medication being administered. New drugs trolleys have been obtained and staff are aware of how to store and dispose of medication. A robust system is in place to record controlled drugs, and staff check the temperature of the fridge to ensure eye drops/insulin/antibiotics are stored correctly. Staff are more aware of the need to keep the drug trolley in view when administering medication to ensure people are not put at risk. No concerns were raised in this area. Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V360538.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 People who use the service experience adequate quality outcomes in this area. The level of activities offered has improved, visitors are welcomed and the dining experience is more enjoyable for people now. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: During the past six months the range of activities offered has improved. A designated organiser has planned activities that are clearly displayed in the home, some one to one sessions were observed which were positive for the people using the service. A mini bus has been obtained which will ensure people can be offered trips out into Whitby and Scarborough. This needs to be regularly reviewed to ensure the different client groups are having activities offered which suit their needs. This will be enhanced when more staff complete the dementia course. Visitors are welcomed into the home a visitors book confirmed the range of times and days that people had visited. One visitor was clearly comfortable in the home talking to a range of people about daily life. Surveys received showed a mix response to the activities offered, one person stated ‘there are no activities for me’, though another said ‘every activity I need is here’. Staff have undertaken training on how to improve their communication skills, the atmosphere was professional and friendly and people looked happy and relaxed at the site visit. Staff have a clearer understanding of how to promote autonomy, and an advocacy service is available, this is Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V360538.R01.S.doc Version 5.2 Page 15 discussed in each care plan though this information was not consistently completed. The manager needs to review how autonomy is encouraged and the choices people are offered on daily basis. The dining experience in both the small lounge and large lounge/dining area was observed. A previous visit (27th February) showed that improvements were needed in the small lounge/dining area. This included the choice people have regarding the food that is served, which condiments are available and the environment whilst people are eating. However, the experience had improved at this visit. Tablecloths, salt and pepper, napkins and suitable furniture were all in place. There were enough staff to help assist people, and choices were offered regarding the location in which to have a meal. Some people ate at the table, or in a comfortable Chair. People could eat in their own rooms if they preferred and people were treated in a dignified manner. Both areas smelt pleasant and staff knew how to meet individual needs. A range of diets can be catered for e.g. diabetic, vegetarian, soft or pureed diet and religious needs are taken into account. Currently there is no permanent cook so current staff are having to work in the kitchen on a rota basis. Whilst this has not had a negative outcome for people using the service it has led to staff shortages (See staffing outcome). Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V360538.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience adequate quality outcomes in this area. People are confident that their complaints will be actioned effectively, though there is not enough evidence to confirm people are protected from harm. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: The home have a complaints procedure in place. No formal complaints have been received and the surveys completed generally confirmed that people know what action to take if they need to raise a concern or a complaint. The manager has not dealt with any complaints in the past six months. During the past six months most staff have attended an abuse awareness course, a range of staff were spoken to and all were aware of what action to take if an allegation of abuse is made, and the different types of abuse which a person may be subjected to. Staff were aware of the procedures in place and the use of the term ‘whistle blowing’. This will all help to protect people from harm. Staff also have protection of vulnerable adults checks prior to commencing employment in the home. Two incidents have occurred and whilst people were protected from further harm, the manager and senior management did not follow the correct procedure on one occasion. This has since been discussed and the manager is clear what action to take if an allegation of abuse is made in the future. Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V360538.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use the service experience adequate quality outcomes in this area. People live in a home, which is clean, though staff need to complete infection control training to ensure a good standard of hygiene is maintained. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: The home was clean and fresh smelling, no unpleasant odours were evident. The garden has improved during the past six months and this is accessible to people using the service and their visitors. Areas of the home inspected were well maintained, and some of the communal areas have been refurbished. There is new furniture in place in the lounge/dining areas. A new flooring is evident in the small lounge/dining area, which is easy to clean, and pleasant smelling. People had clean clothes on. Key workers take responsibility for ensuring there are clothes in cupboards and wardrobes belonging to the correct person following washing and ironing. Though some records showed that two people Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V360538.R01.S.doc Version 5.2 Page 18 had been wearing another person’s clothes, and one person had worn incorrect underwear. There is a designated housekeeper who ensures all areas of the home are kept clean. Currently the home does not have enough domestic staff, as they are helping in the kitchen. On occasions there have been no domestic cover, which is not acceptable, and could put people at risk of cross contamination. Staff need to undertake infection control training this will ensure laundry is dealt with appropriately. For example one member of staff carried some soiled linen in a red plastic bag through the dining area. This should have been put in the red skip and then removed when full. Three rooms were inspected and these were clean and tidy, surveys reported that the home is kept clean. The current style of push down taps which was highlighted at the last visit do not promote good hygiene practices, and make having a wash difficult as the water does not continuously run into the sink. Whilst no action has been taken the improvement plan confirmed that this would be considered in the future. Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V360538.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 People who use the service experience adequate quality outcomes in this area. People have some of their needs met, though staff are not consistently trained to provide a good and safe service. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: During the past six months the staffing levels have fluctuated, which has led to inconsistency in care. There are a range of staff with differing abilities and skills; both male and female staff work in the home with a wide age range. The home employs staff from different cultural and religious backgrounds. At the site visit there were enough nursing/care staff to meet individual needs. This was during the day, though at times there have been insufficient numbers of staff on duty, the duty rota and staff confirmed this. The manager now has a deputy and in the future there will be distinct teams with a team leader responsible for day-to-day responsibilities. However, staff discussed the big changes to rotas they have encountered in the past two months. Staff morale was poor and staff felt the lack of communication from the management regarding changes contributed to this. Staff were unclear as to the role of the deputy and the days she should be working on the floor. Currently there are twenty-six people using the service, there are normally two registered nurses and five care staff on duty. The shift pattern has changed so people do not need to work long hours. Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V360538.R01.S.doc Version 5.2 Page 20 People looked well cared for the majority of staff confirmed they have completed NVQ level 2. This training is not consistently offered, though training in dementia care is being offered. It would benefit people to have staff who are working at the same level with a common philosophy of care working in the home. Discussions took place regarding the induction training for staff and recruitment (at a previous visit-27th February). Currently the induction is on an ad hoc basis, records inspected confirmed that this is incomplete. The manager is aware that it needs to be equivalent to Skills for Care, and is hoping to put all staff through the induction programme in the future. This will help ensure that staff are all working in a consistent way. The home have a recruitment procedure in place, and the manager is aware that two references are needed, a police check (CRB) and a protection of vulnerable adults check. However, due to staff shortages some people are started without a police check but with a POVA check. The police check may come through 3-4 weeks later. This is not good practice and should only happen in exceptional circumstances. At the visit a discussion took place with the manager regarding the checks on agency staff. Whilst it is the agency’s responsibility to carry out the necessary checks prior to sending a new person to work at the home, the manager should be aware of their suitability. This was not the case. This may put people at risk. Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V360538.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 People who use the service experience poor quality outcomes in this area. The home is not run in the best interests of people because their health and safety is put at risk through lack of staff training, though some improvements have been made. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: The manager is a registered nurse who has applied to the CSCI to become the registered manager. A deputy who started two months ago supports her. The manager during the past six months has received more supported from European Care, which has assisted her in progressing the service forward. Staff had mixed views regarding the management of the home, partly because they were unsure as to the role of both the manager and the deputy. This was discussed with the manager, and would be on the agenda for the next team meeting in a few days time. The improvement plan was detailed and clearly Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V360538.R01.S.doc Version 5.2 Page 22 identified the action needed to meet all the previous requirements. However, not all the areas identified have been actioned yet. The quality assurance system is in place and a brief statement sets out the homes philosophy. An audit system is in place for the medication system and the care plans. There is no system for auditing accidents or pressure sores. Whilst the care plan audit was completed there was no record of the follow up action taken. For example it was identified that elements of care plans were not completed, and on occasions this was discussed in supervision but no clear follow up was in place. This was highlighted at the previous visit, the manager needs to be more proactive rather than reactive to improvements that are needed. The home have a robust system in place for dealing with people’s finances. Three records and monies were inspected and all found to tally. The administrator is fully aware of how to deal with hairdressing, chiropody, toiletries, and newspapers and how these need to be documented. Health and safety was discussed and aspects were inspected. Currently there is some staff that have not received elements of mandatory training, the most serious of these is the fire training. A training matrix is in place as previously records kept were incomplete and poorly recorded. This issue was highlighted six months ago. Some people attended training in November some staff (including night staff) remain outstanding. The manager has taken no action to resolve this. This puts people at risk in the vent of a fire. Staff spoken to confirmed which training they had attended. New staff stated that they are given a mentor when they start working in the home, though on occasions it was evident that the mentors are not up to date with training themselves. An immediate requirement was issued to ensure training is planned within 48 hours. The home currently do not have a system for carrying out regular fire drills, though testing of the equipment takes place weekly. Some moving and handling training is not up to date, though this is planned for the end of March/beginning of April. A system needs to be in place to make sure those staff that do not attend are given another training course as soon as possible. One member of staff said she uses moving and handling equipment though she has not received any training herself. This makes the procedure unsafe for the person using the service and needs to be addressed. People were observed moving and handling people in the large lounge area (nursing staff) and this was done in a gentle and confident manner. It was evident that some risk assessments for moving and handling need updating to ensure staff know what they are doing. The manager needs to ensure there is a qualified first aider on duty at all times. Some staff have completed emergency training though an accredited first aid course would be beneficial. Staff also need to complete food hygiene training. Currently there is no permanent cook and one of the domestic staff are carrying out this role though Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V360538.R01.S.doc Version 5.2 Page 23 they have received no food hygiene training, this is really important to ensure people are not put at risk through cross-contamination. The manager needs to prioritise her responsibilities to ensure people’s health and safety are not put at risk. Though this was very evident, during the day people looked comfortable Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V360538.R01.S.doc Version 5.2 Page 24 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 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x x 1 STAFFING Standard No Score 27 2 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x 3 x x 1 Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V360538.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action 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. Refer to Standard OP3 OP12 OP14 OP15 Good Practice Recommendations The manager needs to ensure she has the skills to assess people correctly when new admissions are presented. The activities offered need to be continually reviewed to ensure they continue to meet individual needs Staff need to continue to encourage autonomy and offer choices to people regarding their daily routines. The manager needs to make sure the dining experience for people remains positive. DS0000028005.V360538.R01.S.doc Version 5.2 Page 26 Hawkesgarth Lodge Nursing & Residential Home 5. 6. OP18 OP26 The manager needs to be pro-active in preventing incidents of abuse occurring, and be confident what action needs to be taken. The current style of taps needs to be reviewed as they are not suitable for people using them, and staff are not able to wash their hands effectively. Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V360538.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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