CARE HOMES FOR OLDER PEOPLE
Hawkesgarth Lodge Nursing and Residential Home Station Road Hawsker Whitby YO22 4LB Lead Inspector
Mary Slattery Unannounced 13 July 2005_09:30 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 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 and Residential Home J53_J04_S28005_Hawkesgarth Lodge_V231396_130705_stage4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Hawkesgarth Lodge Nursing and Residential Home Station Road Hawsker Whitby North Yorkshire YO22 4LB 01947 605628 01947 605772 Address Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) European Care (UK) Ltd Post Vacant Care Home 40 Category(ies) of Dementia 40, Mental Disorder, excluding registration, with number learning disability or dementia - over 65 years of of places age 40 Hawkesgarth Lodge Nursing and Residential Home J53_J04_S28005_Hawkesgarth Lodge_V231396_130705_stage4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Service users from 60 years of age. Service users to include 40 (DE(E) and up to 40 (MD(E) up to a maximum of 40. Date of last inspection 5th October 2004. Brief Description of the Service: Hawkesgarth Lodge provides nursing care and accomodation for up to 40 service users who have mental health needs and/or dementia. Hawkesgarth lodge is located in Hawsker a hamlet south of Whitby and is situated in its own grounds. The accommodation provided is in single and double rooms over two floors and there is a passenger lift giving access to the first floor. There is an enclosed garden area and ample private parking for visitors and staff. The home is owned by European Care (UK) Limited and was registered in 2002. Hawkesgarth Lodge Nursing and Residential Home J53_J04_S28005_Hawkesgarth Lodge_V231396_130705_stage4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report relates to an unannounced inspection of the home carried out on the 13th July 2005. The inspection took six hours plus 2 hours preparation time. A tour of the premises was carried out which included service users private accommodation. A selection of the homes’ records were looked at and time was spent observing the activity in the home, talking and listening to service users staff and visitors. The focus of the inspection was on a number of key standards, inspecting the case records of a number of the service users to see if they corresponded with their experience of life in the home. The appointed manager was available throughout the inspection and the findings were discussed with him at the close of the inspection. What the service does well:
The staff at Hawkesgarth Lodge provide an environment in which service users have access to communal areas with out restrictions and they are assisted by the staff to make choices about their daily lives. The home was clean and there was a good provision of equipment to assist service users who have limited mobility and for the prevention of pressure sores. Good information had been collected about the service users and the care plans provided staff with clear guidance about all aspects of their personal and nursing care needs. A full review of the care plans has been carried out and the companies care plan documentation has been implemented. The staff provide a wide range of activities both in the home and in the community ranging from board games to visits to the swimming baths and the cinema. The staff welcomes visitors and relatives meetings take place on a regular basis. This arrangement enables people to discuss any concerns they may have about the services provided to their relative. The appointed manager has created an environment that encourages staff to develop their skills and team working. The service users currently living in the home were not able to give an account of their life and experience but through observation of the interaction between
Hawkesgarth Lodge Nursing and Residential Home J53_J04_S28005_Hawkesgarth Lodge_V231396_130705_stage4.doc Version 1.30 Page 6 service users and the staff, the observation of staff practice and the inspection of the records it was evident that the service users personal and nursing care need were addressed and that they were well cared for by the staff. The staff said that a number of improvements had been made to the service and that they were supported by the manager. The relatives met with were very complimentary about the staff and said that the standard of care their relative received met their high expectations. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Hawkesgarth Lodge Nursing and Residential Home J53_J04_S28005_Hawkesgarth Lodge_V231396_130705_stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Hawkesgarth Lodge Nursing and Residential Home J53_J04_S28005_Hawkesgarth Lodge_V231396_130705_stage4.doc Version 1.30 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 standard(s) 1 and 3. People are provided with considered information about what the home provides. Information is gathered about people moving in to ensure that their needs can be met is a safe manner. EVIDENCE: The statement of purpose and the service users guide gives information about the care provided, the services and the facilities and the arrangements for admission to the home. Copies of the documents are available on request and are to be found in the entrance hall in the home. The qualified nursing staff arrange to meet prospective service users before they move into the home to assess their needs and to establish that their needs can be met. Hawkesgarth Lodge provides nursing care to service users with mental health and/or dementia. The majority of the service users are not always able to make an informed decision about the type of care they need or the home they wish to live in.
Hawkesgarth Lodge Nursing and Residential Home J53_J04_S28005_Hawkesgarth Lodge_V231396_130705_stage4.doc Version 1.30 Page 9 The policy of the home is to invite prospective service users and their family or representative to visit and discuss the services and facilities to assist the service user in making a decision to move in or to make that decision on their behalf. The assessment records we looked at gave clear information about the service users personal, nursing, social and mental health care needs. Initial risk assessments were carried out and recorded and actions plans were in place to minimise risk. Hawkesgarth Lodge Nursing and Residential Home J53_J04_S28005_Hawkesgarth Lodge_V231396_130705_stage4.doc Version 1.30 Page 10 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 standard(s) 7, 8 and 9. There are good systems in place to assist the staff in meeting the service users health care needs. EVIDENCE: All of the care plans are under review and work is progressing to ensure that the company’s care planning documentation is fully implemented. The care plans we looked at gave clear information about the service users personal, nursing, social and mental health needs. Their was clear guidance in place to assist staff in meeting individual needs, information about contact with external health care professionals and the outcomes of any treatments and interventions. All staff are informed about forthcoming admissions so that bedrooms are prepared, any specialised equipment needed is in place and that they are provided with the diet they need and like. A number of risk assessments records had not been completed. It is necessary to record the findings of all risk assessments that have been undertaken to ensure that all staff are aware of the actions necessary to minimise risk to service users. Where no risk has been identified this should also be recorded. The qualified nursing staff are responsible for the administration of medication and the appointed manager has implemented a monitoring system to ensure
Hawkesgarth Lodge Nursing and Residential Home J53_J04_S28005_Hawkesgarth Lodge_V231396_130705_stage4.doc Version 1.30 Page 11 compliance with the policy. There was a good provision of equipment for pressure relief and all bed safety rails were fitted with safety bumpers. There are no service users living in the home that administer their own medication. The qualified nursing staff are responsible for the administration of medication. Changes need to be made to ensure that where service users refuse medication the appropriate code is entered on the record. The controlled medication recording book should have clear page references and clear information about medication discontinued. Hawkesgarth Lodge Nursing and Residential Home J53_J04_S28005_Hawkesgarth Lodge_V231396_130705_stage4.doc Version 1.30 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 standard(s) 13, 14 and 15. The visiting arrangements are flexible enabling service users to keep contact with family and friends. Service users are helped to exercise choice about their daily lives and the food they eat. EVIDENCE: The care plan records gave information about the service users family and friends and the details for the arrangements for visitors is available in the statement of purpose and displayed in the home. Visitors in the home at the time of the inspection told us that thy are made welcome and kept informed about any changes in the condition of their relative. They said they could be if they so wish be involved in caring for their relative, that the staff are always kind and helpful. The appointed manager has set up relatives meting and we were told that the relatives found these useful and informative. The majority of the service users are not able to make an informed decision about daily living. The information gathered about them enables staff to provide social activities in line with past and present interests and abilities. Service users were taking part in a number of activities during the inspection, some were enjoying the good weather in the enclosed garden, and others were participating in board games, general conversation with staff and the afternoon session of bingo. Other activities include swimming, the cinema and the theatre. The service users who are able access all communal parts of the home and they are monitored by the staff to ensure their safety.
Hawkesgarth Lodge Nursing and Residential Home J53_J04_S28005_Hawkesgarth Lodge_V231396_130705_stage4.doc Version 1.30 Page 13 Lunchtime was observed and this was conducted in a sensitive way, there were sufficient staff available to assist service users and plenty of drinks were provided. There are no arrangements in place for service users to be offered a cooked breakfast. One of the service users was asleep at lunchtime and the meal was left uncovered. Some of the staff employed to undertake catering duties had not had the appropriate food handling training. Hawkesgarth Lodge Nursing and Residential Home J53_J04_S28005_Hawkesgarth Lodge_V231396_130705_stage4.doc Version 1.30 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 standard(s) 16 and 18. The home has a relevant complaints procedure and staffs’ awareness of abuse ensures service users are safe. EVIDENCE: The details of how to make a complaint about the service provided are made available in the statement of purpose and displayed in the home. The appointed manager has made arrangements for regular relatives meetings to take place, these give them the opportunity to discuss any concerns they may have and for the staff to keep them updated regarding any changes to the service, the facilities and the environment. Private meetings are also arranged to discuss issues relating to the care of individual service users. There have been no recent complaints made about the service provided by Hawkesgarth Lodge. Staff were clear about their responsibility to reports any suspicion of abuse and poor care practices. Hawkesgarth Lodge Nursing and Residential Home J53_J04_S28005_Hawkesgarth Lodge_V231396_130705_stage4.doc Version 1.30 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 standard(s) 19, 20, 21, 22 and 26. The standard of the environment needs to improve to provide service users with a homely place in which to live. EVIDENCE: The service users bedrooms were personalised with items that reflected their past and present lives and some had family photographs and chosen personal possessions. Some of the bedrooms are shared and there was appropriate screening in place to ensure privacy when personal or nursing care was being delivered. The service users are not always able, by nature of their condition to make an informed choice about sharing private accommodation. The manager was fully aware of the need for full consultation with service users and/or their representative before arrangements are made for service users to share private accommodation. A number of areas in the home have been refurbished and redecorated and further plans are in place for a number of bedrooms and corridors to be redecorated and new flooring laid.
Hawkesgarth Lodge Nursing and Residential Home J53_J04_S28005_Hawkesgarth Lodge_V231396_130705_stage4.doc Version 1.30 Page 16 The home was clean, hygienic and free from offensive odours and the time of the inspection. Staff are employed to undertake domestic and laundry duties and there were systems in place for the control of the spread of infection. There was good provision of equipment to assist people with their mobility including hoists and turntables. Service users have access to an enclosed garden area with seating and shade; this is a pleasant facility and is well used. The front garden looked untidy and required attention. The following issues regarding the premises and facilities were identified and need to be addressed. Wheel chairs that were in use were not fitted with footplates; this practice places service users at risk from injury. Two fire doors were held in the open position by the use of wedges, this practice is not safe. To consult with the fire safety office and seek advice about fitting the appropriate hold open devices. Two of the bathing facilities were not operative, this needs to be addressed to ensure there are sufficient numbers of appropriate bathing facilities for the number of service users accommodated. The windows in the lodge need to be replaced as the double-glazing seals are shot and the glass is no longer clear. Attention needs to be given to the cracks in the walls in bedrooms 34 and 35 and the beam on the corridor outside both rooms. The extractor fans in the laundry were not in working order. To put up a curtain or blind in the bathroom located on the ground floor in the lodge. Following the last inspection of the home an action plan was required to address the following. An action plan was not produced and the following remains outstanding. To replace the floor covering in the separate toilet and the dining room in the lodge. To provide an appropriate smoking facility for service users other than the entrance hallway. Hawkesgarth Lodge Nursing and Residential Home J53_J04_S28005_Hawkesgarth Lodge_V231396_130705_stage4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30. The service users receive a good standard of care from the staff. Failure to carryout the required checks on staff places service users at risk. EVIDENCE: The home employs nursing staff with the relevant nursing qualifications to meet their mental health and physical nursing needs. A number of the care staff have achieved NVQ Level 2 and arrangements are in place for others to commence their training. Further training is planned to ensure that all staff have undertaken statutory training to include fire safety, food handling, health and safety, infection control. All new staff are subject to induction and records were in place to evidence this and confirmed by new members of staff. The staff rotas showed that there were sufficient staff on duty with the skills to meet the needs of the service users. Staff meetings are held on a regular basis and arrangements are in place for staff supervision. New staff have been employed prior to the required checks with the Criminal Records Bureau being carried out. Hawkesgarth Lodge Nursing and Residential Home J53_J04_S28005_Hawkesgarth Lodge_V231396_130705_stage4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 35 and 38. The appointed manager has an understanding of the areas in which the home needs to improve. EVIDENCE: The appointed manager is a qualified first level nurse and has a number of years of experience in caring for people with mental health needs. He has carried out a full review of the service and has implemented plans in order of priority to improve the overall service. An application for registration has been submitted to the Commission and is currently being processed. Arrangements are to be made for the manager to undertake the Registered Managers Award. The staff said that the focus is on the service users and that the manager has through support and guidance enabled them to make positive changes to the lives of the services users. Hawkesgarth Lodge Nursing and Residential Home J53_J04_S28005_Hawkesgarth Lodge_V231396_130705_stage4.doc Version 1.30 Page 19 A number of the service users are supported by the staff with the management of their personal finances and the arrangements in place for this were appropriate. There is a health and safety policy and procedure in place and staff are subject to health and safety training. The required checks on equipment are carried out and the required certificates in place. The following areas need to be addressed under health and safety: Footplates to be fitted to wheelchairs to reduce the risk of injury to service users. To provide appropriate smoking facilities for service users to reduce the risk of fire and to improve the environment for people living, working and visiting the home. Hawkesgarth Lodge Nursing and Residential Home J53_J04_S28005_Hawkesgarth Lodge_V231396_130705_stage4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 1
COMPLAINTS AND PROTECTION 1 3 1 3 x x x 3 STAFFING Standard No Score 27 3 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 3 x x 3 x x 1 Hawkesgarth Lodge Nursing and Residential Home J53_J04_S28005_Hawkesgarth Lodge_V231396_130705_stage4.doc Version 1.30 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 9 15 Regulation 13(2) 13(c ) Requirement The registered person is required to keep accurate medication records. The registered person is required to make arrangements to ensure that all food to be served is kept covered. The registered person is required to submit a plan with timescales to the Commision detailing the arrangements to address the issues regarding the premises as detiled in the report. The registered person is required to undertake the rquired checks on staff prior to their employment in the home. The registered person is required to ensure that all wheelchairs are fitted with foot plates. All fire doors are held in the closed position or that appropriate hole open devices are fitted. Appropriate smoking facilities are provided for service users. Timescale for action 15th August 2005. 15th August 2005. 30th August 2005. 3. 19 16 and 23 4. 29 17 Schedule 4 13 (4) 30th August 2005. 30th August 2005. 5. 38 Hawkesgarth Lodge Nursing and Residential Home J53_J04_S28005_Hawkesgarth Lodge_V231396_130705_stage4.doc Version 1.30 Page 22 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. Refer to Standard 7 15 31 Good Practice Recommendations It is recommended that the findings of all risk assessments are recorded to clarify if a service user is at risk. It is recommended that service users are offered a cooked breakfast at least once each week. It is recommended that arrangements be made for the appointed manager to undertake the registered managers award. Hawkesgarth Lodge Nursing and Residential Home J53_J04_S28005_Hawkesgarth Lodge_V231396_130705_stage4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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