Inspection on 09/09/08 for Hawkesgarth Lodge Nursing & Residential Home

This inspection was carried out on 9th September 2008.

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

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

Hawkesgarth Lodge Nursing &... 10/03/08

Hawkesgarth Lodge Nursing &... 15/10/07

Hawkesgarth Lodge Nursing &... 26/04/07

Hawkesgarth Lodge Nursing &... 18/08/06

Hawkesgarth Lodge Nursing &... 04/01/06

Hawkesgarth Lodge Nursing &... 13/07/05

Hawkesgarth Lodge Nursing &... 05/10/04

Hawkesgarth Lodge Nursing &... 29/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 20/03/2009.

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 9th September 2008 08:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V371664.R02.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.V371664.R02.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) Angela Champness-Smith Care Home 40 Category(ies) of Dementia - over 65 years of age (40), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (40) Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V371664.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia, over 65 years of age - Code DE (E), maximum number of places: 40 Mental Disorder, excluding learning disability or dementia, over 65 years of age - Code MD (E), maximum number of places: 40 The maximum number of service users who can be accommodated is: 40 There shall be no further admissions of service users to Hawkesgarth Lodge Nursing & Residential Home without prior written agreement of the Commission for Social Care Inspection. (this will be removed shortly) 10th March 2008 2. 3. Date of last inspection 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 Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V371664.R02.S.doc Version 5.2 Page 5 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 9th September 2008. 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.V371664.R02.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 1 star. This means the people who use this service experience adequate quality outcomes. “We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken.” The key inspection took place on Tuesday 9th September 2008. Prior to the visit the information from the following sources was obtained and considered: The annual quality assurance assessment. This is information, which details what has happened during the past 12 months. Four surveys from people using the service, one survey from a healthcare professional and two from staff. Notifications (Regulation 37) relating to incidents in the home affecting people using the service. Details of complaints and allegations raised by people connected to the service. Progress of the previous requirements and recommendations made at the last site visit. At the site visit one inspector spent five hours at the home. During this time observations of care practices took place. People using the service were spoken with. Discussions with the manager regarding meeting needs, mealtimes, protecting people and the environment took place. The breakfast meal was observed and time was spent inspecting care plans, looking at individual rooms and reviewing a selection of health and safety information. Staffing and management issues were discussed and feedback was given to the manager at the end of the inspection. What the service does well: Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V371664.R02.S.doc Version 5.2 Page 7 The home is set in a quiet location close to Whitby Abbey and the town of Whitby; people in the home can access these areas with assistance from staff and the minibus. People have a pleasant dining experience where choice and appealing meals are offered and staff interact well with people. What has improved since the last inspection? What they could do better: The environment could be improved. This will enhance the quality of life for people and assist with maintaining the home’s cleanliness. More domestic staff will also help this and an improvement in the style of taps used. The way in which controlled drugs are disposed of could be improved; this would ensure they are dealt with effectively. Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V371664.R02.S.doc Version 5.2 Page 8 How complaints are investigated could be improved, this would give people a clear outcome which would explain the investigation carried out and the action taken. This would help to resolve the issues. The manager needs to continually monitor care practices to ensure a good standard of care is maintained. The equipment in the kitchen could be improved. This would help catering staff do their job more effectively which would mean people get their food in a timely manner. 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.V371664.R02.S.doc Version 5.2 Page 9 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.V371664.R02.S.doc Version 5.2 Page 10 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 good outcomes in this area. People are effectively assessed prior to admission, which helps to ensure individual needs can be met. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The three pre-admission assessments looked at confirmed that a senior person completes an assessment before an individual moves to the home. This is to check what type of care and support the person needs and whether the staff have the skills and knowledge to provide that care if the individual chooses to move there. The process also reassures the individual and their family that they will receive the right support. The manager has a greater understanding of the importance of obtaining the right information before someone moves Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V371664.R02.S.doc Version 5.2 Page 11 into the home. The type of client is taken into account, for example whether they have dementia or nursing needs and how they will fit into the home. Assessments are completed if the person has a care manager or is privately funded. These detail health, personal, nursing, social and mental health needs. The surveys completed by people living their report that people are given enough information about the service and what it provides. This means they can make an informed choice about whether to move there or not. In the future the registered nurses in the home will undertake assessments with the Key Worker, this will mean that the person has met the staff member before they come into the home on a permanent basis. Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V371664.R02.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 and 10 People who use this service experience adequate quality outcomes in this area. People generally have their health and personal care needs met in a dignified manner. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Three care plans were looked at during this visit. These describe the care and support people need to stay in charge of their own lives as much as possible. The plans looked at contained a lot of information, so that an unfamiliar carer could look at them and would be able to work out how much support they needed. There were written assessments as to whether people were at risk of developing pressure sores, of losing weight because of poor appetite or a health problem or needing help with moving and handling. Those identified as ‘at risk’ had a care plan in place describing how that risk was to be managed. Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V371664.R02.S.doc Version 5.2 Page 13 The care plans have improved and are now updated on a monthly basis. This was evident in all plans inspected. Plans are also audited to identify where improvements can be made. Key workers have started to record information on a more regular basis, and details regarding use of an advocate are starting to be seen. Information relating to activities and social history needs to be more detailed (see Daily life outcome group), though the manager is aware of this. People generally look clean and well cared for, though staff need to monitor this regularly, two issues have been raised regarding poor care practices, which the manager is aware of. Surveys received from people indicate that sometimes people receive the medical attention they need, though this could be improved. Some people also felt that communication between the home and healthcare professionals could be improved. The home have contact with local doctors, tissue viability nurses, continence advisors and the community mental health team. The home complete notifications regarding any incidents that have occurred, and undertake accident audits and pressure sore audits to identify if there are specific reasons why these issues occur. The medication system was inspected and medication was observed being given to different people. Charts with details of medication were well maintained; stock balances take place when the medication first arrives then this is completed as part of the audit process (though kept separately). Staff would benefit from more medication training and this is hoping to be arranged by the manager. Daily fridge temperatures are taken though the temperature of the room should be taken to identify if the none fridge items are stored at the correct temperature (the room is small and warm). Staff discussed controlled drugs; there is a suitable place to store these, and these are disposed of through the local pharmacy. People have their privacy and dignity maintained, this has improved and staff have a greater understanding of how to treat people with dignity and respect. Staff carry ‘dignity at work’ cards which acts as a prompt and reminder. Some staff have received training in caring for people at the end of their life and this enhances the experience for people using the service. Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V371664.R02.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 and 15 People who use this service experience good quality outcomes in this area. People participate in a range of activities and visitors are welcomed. Staff encourage autonomy and choice, and people enjoy dining in pleasant surrounding with appealing food. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home have an activities organiser who plans weekly activities and records these in the care plans. A plan is available on the notice board with details of each morning and afternoon event. Some days people do arts and crafts, baking, gardening, trips into Whitby and there is a library service and music to listen to. People were observed enjoying arts and crafts, the home have regular entertainers and staff try to have one to one sessions with people. There is a minibus available to take people out, and staff have undertaken specialised dementia training called ‘yesterday, today, tomorrow’ this helps staff understand social history of people with dementia. The activities organiser has not completed any specific training and does need to ensure people are Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V371664.R02.S.doc Version 5.2 Page 15 given the opportunity to participate in all activities. This needs to be in line with the person’s risk assessment. For example people may like to have a greenhouse in the garden, this could be easily actioned for people to enjoy. Visitors are welcomed into the home and are now offered a drink when they arrive. Some people like to have a meal with their relative, which staff can easily accommodate. Staff have a greater understanding of the need to encourage choice and autonomy, for example at bedtime and in the morning regarding the time people get up and go to bed. Staff were observed asking people their preference instead of giving them instructions. This was more pleasant for people and received a positive response. The home have an advocacy service and details of this are readily available and this issue is discussed in individual care plans. The breakfast time meal was observed; the experience for people was calm and relaxing with staff asking people if they would like ‘cornflakes, weetabix or porridge’. Staff then asked if ‘orange, or cranberry juice was preferred’. Some people had completed their menus the day before, but staff were aware that people needed a gentle reminder again. People were sat in the large lounge/dining area and also people could have breakfast in their rooms or in the small dining area. Tables were laid with napkins, cutlery, salt and pepper and flowers. This looked appealing and staff greeted people in a pleasant and caring manner. The kitchen area was generally clean though more equipment would help. For example a larger toaster and a grill. The manager discussed refurbishment plans for the kitchen to address these issues. The toaster would save time, and people could have the choice of grilled food instead of fried food. The catering person was knowledgeable about people using the service and discussed how some people have soft and pureed diets. People are asked if they have enjoyed their meal and the cook is passionate about providing the best food and drink possible for people. Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V371664.R02.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 and 18 People who use this service experience adequate quality outcomes in this area. People are generally confident that they will be listened to and staff are more alert to the need to keep people safe. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home have a complaints procedure in place, which is easily accessible. One complaint has been received in the past 12 months, this related to care practices and was partly substantiated. Mixed responses were received in the surveys regarding people’s understanding of how to complain. A complaint investigation was inspected. This had some detailed information though it was unclear what the issues raised were and whether these had all been investigated. The overall outcome was unclear and partly as a result of this the complainant remains unsatisfied. The home are doing audits of comments, compliments and complaints. Currently details of how many complaints have been received are displayed in the entrance area. However, it is unclear what benefit this has because people are left wondering what the outcome was or what action has been taken. It may be useful having an accessible compliments book, which people can complete anonymously without having to go to a member of staff. Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V371664.R02.S.doc Version 5.2 Page 17 The manager has a greater awareness of abuse issues and one referral has been made to social services and a referral to the Protection of Vulnerable Adults List. A procedure is in place for staff to refer to and staff spoken with were aware of different types of abuse. Staff carry a small card in their pocket with details of the action to take if they suspect abuse, this acts as a prompt and reminder. People looked safe in their environment and staff have protection of vulnerable adults checks prior to starting employment in the home. This helps to protect people from harm. Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V371664.R02.S.doc Version 5.2 Page 18 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 this service experience adequate quality outcomes in this area. People live in a generally comfortable and environment, though infection control procedures are compromised due to aspects of the home needing to be updated. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home is located outside Whitby and is set in its own grounds. Currently the maintenance person is unavailable for two weeks, though the manager uses contractors if any maintenance needs undertaking. The home is generally clean and well maintained. However, the home would benefit from a full refurbishment and this is in the planning stage at present. This will enhance the environment and help with keeping areas clean. Currently there are two Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V371664.R02.S.doc Version 5.2 Page 19 domestic staff which is not sufficient as the home has many different communal areas, bedrooms, corridors and rooms. However, the manager is in the process of recruiting more staff. Mixed information was received in the surveys regarding cleanliness of the home. Staff have undertaken infection control training and people using the service have their washing and ironing done by staff. As previously discussed the taps that are used by people are not suitable to meet their needs. Though these are part of the refurbishment plans. These needs to be addressed in order to maintain hygiene prevent cross-contamination and make it easier for people using the service to obtain water. Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V371664.R02.S.doc Version 5.2 Page 20 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 and 30 People who use this service experience adequate quality outcomes in this area. People are cared for by staff who are generally competent, and recruited in sufficient numbers to meet individual needs. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home currently has twenty-five people using the service. The top floor is not been used. There are enough staff to meet individual needs. There are generally two registered nurses on duty with four or five care staff. Throughout the visit people were given assistance in a timely fashion, staff approached people in a kind and caring way and people responded to this positively. Since the last visit staff have undertaken a range of training in dementia care. Some staff are attending a course looking at an observational tool to identify people’s well-being and the outcome of positive interaction with people. More staff need to complete an NVQ Level 2 in care. The annual quality assurance assessment stated that 48 of care staff have completed this. This helps to achieve consistency of care amongst staff and improve outcomes for people. The manager needs to regularly monitor the culture of the home and the attitude and manner of staff to ensure it is of a high standard. The attitude of some Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V371664.R02.S.doc Version 5.2 Page 21 staff was part of a previous complaint, which was partly substantiated, and the manager is aware that monitoring of staff is essential. A new induction pack is in place, which some staff are working their way through. This covers a range of care practices, health and safety and training information. All staff need to complete this and currently it is an ongoing process. As new staff start work they will automatically complete this. There are elements, which are completed the first day staff start work then over 6-12 weeks areas are covered. The home have a robust recruitment procedure in place. Two written references are obtained along with a police check to ensure people are suitable to work with this client group. Staff files confirmed that the correct checks are in place. This helps to protect people. Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V371664.R02.S.doc Version 5.2 Page 22 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 and 38 People who use this service experience adequate quality outcomes in this area. The home is starting to be run in the best interests of the people using the service. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The manager of the home is registered with the Commission; she has run the home for over twelve months and has developed her own management style. People feel they can go to the manager if they have any concerns and this includes people using the service and staff. The manager has grown in confidence and is aware of the roles and responsibilities of being an effective Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V371664.R02.S.doc Version 5.2 Page 23 manager. The home is now starting to be run in the best interests of people using the service, this needs to be monitored and sustained in order to progress further. The quality assurance system has been developed, though people using the service have not had the opportunity to complete surveys or questionnaires regarding their opinion on the service. Regular meetings are in place for people using the service and staff, and more audits are now in place. The care plan audit has been reviewed and the manager regularly monitors the outcome of the audits for care plan, medication, audits and complaints. This helps to identify where improvements need to be made, and also where staff have provided good care. The home have introduced an ‘employee’ of the month system. Staff, people using the service and relatives decide who deserves this accolade and this is discussed at the team meeting. This helps improve morale and staff are keen to improve their care practices. The manager is supported by a deputy manager who staff feel more confident about. She has a clear role and remit which staff understand. She has supernumerary time and works as part of the care team, this helps maintain standards. People’s personal monies are dealt with effectively by the home and this is discussed with people when they are first admitted to the home. This was inspected six months ago and no concerns were raised. An advocacy service is also available when people need assistance with finances. Health and safety was discussed and details regarding policies were available in the annual quality assurance assessment. The home have an up to date fire risk assessment and weekly fire testing takes place. Staff have a greater awareness of the action to take in the event of a fire, one person spoke in detail about what to do if a person was in their room when a fire started. Staff also carry prompt card with bullet points on to remind staff. There is emergency lighting in the home and health and safety checks take place routinely. People are cared for by staff that have now received a range of essential training. This includes fire safety, moving and handling, infection control and protection of vulnerable adults. It was evident that some staff need to undertake food hygiene training, this is especially important for catering staff. A further course is planned for January 2009. People using the service have access to a qualified first aider at all times. Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V371664.R02.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 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 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 2 17 x 18 3 2 x x x x x x 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x x 2 Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V371664.R02.S.doc Version 5.2 Page 25 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. Standard OP19 Regulation 23 Requirement A plan of refurbishment for the home must be forwarded to the CSCI. This will help identify how the home can enhance the quality of life for people. A qualified first aider must be on duty at all times, this will ensure the correct action is taken when an emergency occurs. All staff involved in food and drink must complete food hygiene training. This will help to prevent cross-contamination. Timescale for action 09/10/08 2. OP38 13 09/11/08 3. OP38 16 09/11/08 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 OP8 OP16 Good Practice Recommendations People need to receive medical help when needed and staff need to communicate effectively with healthcare professionals. The information that people who have made a complaint receive could be easier to understand with clear reference DS0000028005.V371664.R02.S.doc Version 5.2 Page 26 Hawkesgarth Lodge Nursing & Residential Home 3. 4. 5. 6. OP26 OP28 OP30 OP33 to each issue raised, the outcome and the action 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. Staff should continue to work towards completing NVQ Level 2 in care training; this will help people to have their needs met consistently. Staff should continue to complete induction training; this will help improve care practices. Views and opinions about the service should be sought from people using the service and their relatives; this is in line with the home’s quality assurance policy. Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V371664.R02.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. Extracts may not be used or reproduced without the express permission of CSCI Hawkesgarth Lodge Nursing & Residential Home DS0000028005.V371664.R02.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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