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Inspection on 05/08/08 for Hawksyard Priory Care Home

Also see our care home review for Hawksyard Priory Care Home for more information

This inspection was carried out on 5th August 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 told us that they were happy living at the service. They said "am happy here", and "feel safe here." People receive good standards of care and support meeting their individual needs and choices. Healthcare needs are met by the service. Peoples` needs are assessed before they come to live at the service. Assessment of peoples` needs, gives confidence that staff are aware of their needs are and will be able to meet them. People are encouraged to visit the home prior to them deciding to come and live there. The service has two activity leaders and a range of activities take place most days. Food is described as "very good" and there is always a choice available. The service has an experienced Manager who provides appropriate and effective leadership. Knowledgeable, friendly and sufficient staff provide care at the service.

What has improved since the last inspection?

The three requirements made at the previous inspection we were found have been met. We made a requirement at the previous inspection that risk assessments be in place for the use of bedrails and when needed lap belts this has been addressed, although as identified below there is a need to ensure that bedrails are safely fitted. We asked that there should be better information in care plans for staff to manage and evaluate the healing of wounds. It was positive that a severe pressure sore that had been acquired whilst the person had been in hospital had almost healed due to the care and attention given by the home.

What the care home could do better:

There are five requirements and eleven good practice recommendations made as a result of this inspection. We found that better and more robust systems for the recruitment of new staff should be in place. The lack of a criminal records check or a protection of vulnerable adults check that is undertaken before staff start work puts people at risk from peoples who may be unsuitable to work with vulnerable people. Bedrails need to be fitted appropriately and staff must protect the Bed rail risk assessments are available but need to more fully identify any risks to the person concerned. Bedrails can pose a serious risk if required checks are not undertaken. There is a need to improve some medication practices so that there is greater assurance that people receive the medicines as they are prescribed. When the issues of practice are addressed this will give greater assurance that the risk and potential harm of medication error will be minimised. There needs to improved arrangements in place for the safekeeping of people`s money when it is undertaken by the home. Requirements highlighted at the back of this report when addressed will give greater assurance that people living at the home will be protected from the risk of financial abuse.There needs to be sufficient privacy curtains to fully enclose peoples beds and give people privacy.

CARE HOMES FOR OLDER PEOPLE Hawksyard Priory Care Home Armitage Lane Armitage Rugeley Staffordshire WS15 1PT Lead Inspector Amanda Hennessy Unannounced Inspection 5th August 2008 09:00 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 Hawksyard Priory Care Home DS0000022334.V370071.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. Hawksyard Priory Care Home DS0000022334.V370071.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hawksyard Priory Care Home Address Armitage Lane Armitage Rugeley Staffordshire WS15 1PT 01543 490112 01543 492546 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) Hawksyard Priory Nursing Home Limited Mrs Susan Haskett Care Home 76 Category(ies) of Dementia - over 65 years of age (27), Learning registration, with number disability (1), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (27), Physical disability (6), Physical disability over 65 years of age (49), Terminally ill (4) Hawksyard Priory Care Home DS0000022334.V370071.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. PD(E) Minimum age 60 years DE(E) - MD(E) Minimum age 60 years Conditions for Palliative Care 1. That at least one of the Nursing Staff have the recognised Qualification ENB931 or K260 within 9 months. 5th September 2006 Date of last inspection Brief Description of the Service: Hawksyard Priory is a privately owned care home situated on the outskirts of the Staffordshire village of Armitage. The home is a former Dominican Priory and is set in extensive and pleasant grounds. The home provides both nursing and personal care, including mental health care, for up to a total of 76 elderly people. Access to the home is via a long driveway. A regular bus service stops at the end of the drive and all shops and community facilities are available in the village. Bedrooms are on all three floors. The ground floor (22 bedrooms) and first floor (26 bedrooms) offer accommodation for people with general personal care and nursing care needs. The top floor (26 bedrooms) offers accommodation for people with mental healthcare needs. Separate lounge and dining facilities are provided on each floor. Hairdressing and smoking facilities are also provided. A large church is also part of the buildings. Laundry and kitchen facilities are provided on site. We did not see any information about fees charged in the service user guide seen during the inspection. Readers of this report are asked to contact the service directly for information on fees that are charged. Hawksyard Priory Care Home DS0000022334.V370071.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. The means the people who use this service experience adequate quality outcomes. This unannounced inspection was carried out in one day by two Inspectors and an ‘Expert by Experience’. An ‘expert by experience’ is a person who, because of their shared experience of using services, and or ways of communicating, visits a service with us to help us get a picture of what it is like to live in or use the service. Our inspection commenced at 09:00 hours and finished at 17.30 hours. As it was unannounced neither the home nor the provider knew we were going. The manager was present throughout the inspection. Information for the report was gathered from a number of sources: We looked at different parts of the building, records and documents. We had discussions with the manager and care staff plus visitors and people who live at the service to gain their views on what it is like to live in and receive care from this service. Some people were unable to communicate their views verbally to us so we used direct and indirect observation to inform the inspection process. Ten people who use the service were ‘case tracked’, this process involves establishing people’s experiences of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes of the care that they receive. Tracking peoples’ care helps us understand the experience of people who use the service What the service does well: People told us that they were happy living at the service. They said “am happy here”, and “feel safe here.” People receive good standards of care and support meeting their individual needs and choices. Healthcare needs are met by the service. Peoples’ needs are assessed before they come to live at the service. Assessment of peoples’ needs, gives confidence that staff are aware of their needs are and will be able to meet them. People are encouraged to visit the home prior to them deciding to come and live there. The service has two activity leaders and a range of activities take place most days. Food is described as “very good” and there is always a choice available. Hawksyard Priory Care Home DS0000022334.V370071.R01.S.doc Version 5.2 Page 6 The service has an experienced Manager who provides appropriate and effective leadership. Knowledgeable, friendly and sufficient staff provide care at the service. What has improved since the last inspection? What they could do better: There are five requirements and eleven good practice recommendations made as a result of this inspection. We found that better and more robust systems for the recruitment of new staff should be in place. The lack of a criminal records check or a protection of vulnerable adults check that is undertaken before staff start work puts people at risk from peoples who may be unsuitable to work with vulnerable people. Bedrails need to be fitted appropriately and staff must protect the Bed rail risk assessments are available but need to more fully identify any risks to the person concerned. Bedrails can pose a serious risk if required checks are not undertaken. There is a need to improve some medication practices so that there is greater assurance that people receive the medicines as they are prescribed. When the issues of practice are addressed this will give greater assurance that the risk and potential harm of medication error will be minimised. There needs to improved arrangements in place for the safekeeping of people’s money when it is undertaken by the home. Requirements highlighted at the back of this report when addressed will give greater assurance that people living at the home will be protected from the risk of financial abuse. Hawksyard Priory Care Home DS0000022334.V370071.R01.S.doc Version 5.2 Page 7 There needs to be sufficient privacy curtains to fully enclose peoples beds and give people privacy. 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. Hawksyard Priory Care Home DS0000022334.V370071.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hawksyard Priory Care Home DS0000022334.V370071.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6. Quality in this outcome area is good. People have required information about the service and their needs assessed before coming to live at the service enabling them to make an informed decision that the service is suitable to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provides required information to people about the care and support they offer. The service has a statement of purpose and service user guide available. Both documents give an accurate picture of what people can expect from the service should they choose to live here. The service user guide seen did not include information about fees charged. People coming to live at the service for long term care have an assessment of their needs undertaken by the manager before they come to live at the service. We looked at these assessments and found them to be Hawksyard Priory Care Home DS0000022334.V370071.R01.S.doc Version 5.2 Page 10 comprehensively completed. A copy of the Social Workers assessment was also included in peoples care records to assist staff in planning peoples’ care. We found that the assessment of need for people staying at the home on a short term were not always comprehensive and relied on information provided by the Social Worker and contained some confusing information. One identified “ does not require sedation” but we found that this person came into the service with temazepam, which is a medicine to help people sleep. Another person’s assessment we were told was admitted as an emergency but we found there was confusing information about their poor eyesight and which eye was affected. The assessment of needs forms the basis of the person’s plan of care so it is important that accurate information is available or has been clarified. The home does not have people requiring intermediate care. Hawksyard Priory Care Home DS0000022334.V370071.R01.S.doc Version 5.2 Page 11 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. Quality in this outcome area is adequate. Care planning needs to be developed to more fully include peoples needs, choices and capabilities to give confidence that their needs will be known and therefore met. Medication is safely administered and stored but there is a need for improvement to give greater assurance that people are protected from potential medication errors. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We found that people have a plan of care that gives staff information on how people’s needs should be met. We did discuss a need to further develop plans to more fully highlight people’s individual needs and choices. Some care plans seen identified: Hawksyard Priory Care Home DS0000022334.V370071.R01.S.doc Version 5.2 Page 12 “needs the care of two for all aspects of washing and dressing and bathing”, there was no record of which toiletries people liked or whether they preferred a bath or shower and how frequently. We looked at for people with challenging behaviour but they did not always say what the challenging behaviour was and what staff should do. It was positive that all care plans are regularly reviewed. We found that people are weighed regularly and soon after coming to stay at the home. One person cared for had lost some weight but there was no record of any referral to their Doctor for advice or a need for dietary supplements. Since our previous inspection risk assessments are in place for the use of bedrails. We found the risk assessments to be basic and did not detail all risks. In addition when we looked at four beds and found that there was an excessive gap that would place people at risk from serious injury. People have access to other healthcare professionals according to their needs Records seen show that people are regularly seen by their doctors, chiropodist and opticians. Relatives told us “ we are always kept informed of how they are and if they have been seen by a Doctor”. We found that the majority of medicines are administered and stored safely but some improvements are needed to protect against the risk of medication error. Staff hand write some of the medication records. The risk of error would be minimised if two people confirm the accuracy of each entry. Staff do sign to confirm that the majority of medicines are given but this is not the situation for creams and lotions. We saw gaps on the treatment making it uncertain whether creams and lotions have been applied. In addition to gaps on the treatment sheet some medicines had been prescribed in a variable dose “take one or two tablets” but there was no record of how much of the medicine had been given. The absence of the exact amount of medicines given may mean that people are given too much medicine or that they could have more medicines but staff are hesitant to do so as it may be that they have already had the maximum dose. There was also correction fluid on medication records and “stick-on labels” this is not good practice as it can cover up essential instructions and we advised it should stop immediately. Some people are prescribed some medicines “as required” although there were no instructions in place to identify when medicines are required. There are appropriate and safe systems in place for the administration and storage of controlled medications and also medicines that need to be stored between 2 and 8oC. It is positive that the service has recently had an inspection by their new Pharmacist and has already started to address requirements highlighted. We saw that people were treated respectfully and spoken to politely throughout the inspection. Staff were courteous and knocked on doors before Hawksyard Priory Care Home DS0000022334.V370071.R01.S.doc Version 5.2 Page 13 they entered taking care to maintain peoples’ dignity. The home has a number of double rooms but we found that privacy curtains in the majority of these rooms do not fully occlude the bed and offer people sufficient privacy. Hawksyard Priory Care Home DS0000022334.V370071.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 and 15. Quality in this outcome area is good. People who live at the service have the opportunity to take part in a range of activities, maintain relationships with friends and relatives and are provided with a choice of tasty and generously portioned meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has three members of staff who organise and plans activities. Activities are arranged for both individuals and small groups. We were told about activities which include karaoke, shopping, painting nails and bingo. We were also told that trips out are also arranged with regular visits to ‘Spode Cottage’ and the theatre. An entertainer comes to the service once a month and leads a sing-along. People living at the service are assisted in keeping up to date with current affairs. Newspapers are delivered the cost of which is met by the service. Lichfield library calls regularly to enable people living at the service to choose and exchange books, “talking” books are also available if requested. The Hawksyard Priory Care Home DS0000022334.V370071.R01.S.doc Version 5.2 Page 15 service has a well-stocked case of books and stocks of videos and DVDs are available for people to watch as they choose. People are able to attend the church service held at the church that is part of the service. Other religious dominations can and do visit when requested for individuals. People are able to choose where or how they spend their day. People told us that they spend their time either in one of the three lounges or their bedroom. People can choose whether to join in with activities or not. Discussions with people that live within the service showed that they could choose when to go to bed and that staff always ask them when they wanted to get up. One person said that they have their own car at the service and come and go as they please. Visitors are made welcome at anytime and visitors that we spoke said that they visit every day. The service has a four-week menu, which identified that a varied well-balanced diet is provided. A choice of main meal is always available. People living at the service can choose where they prefer to have their meals. It was nice to see that all dining tables had tablecloths, flowers, cruets and appropriate cutlery. Staff support people to be as independent. We saw staff supporting people to have their meal and this was done in a relaxed and sensitive manner. Hot drinks are provided several times throughout the day and evening. We were told that a hot drink and a biscuits were available after seven in the evening. Hawksyard Priory Care Home DS0000022334.V370071.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 and 18. Quality in this outcome area is adequate. People can feel confident that their concerns will be listened and will be acted upon. Arrangements at the service do not adequately protect people from the risk of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has a complaints policy and procedure. People can find the complaint procedure in the Service User Guide and also displayed in the service. We have had one complaint about the service since our previous inspection. We asked the Manager to investigate the complaint. The service has a log of all complaints that are received. It is positive that all concerns are comprehensively investigated and there is a record of the conclusion of the complaint and any actions that need to take place as a result of concerns raised. Staff also discussed how concerns raised had resulted in a change of practice. People told us that staff listened to. Staff we spoke to said that they would highlight any concerns made to them to the Matron or the Nurse. Hawksyard Priory Care Home DS0000022334.V370071.R01.S.doc Version 5.2 Page 17 There have been two safeguarding adult referrals (one of these was an incident where the service was not involved. It occurred before the person was admitted to the service for a short stay). The service worked with other agencies to investigate the concern that involved them. The outcome was that there was no evidence that abuse had occurred although the service did implement actions such as improved record keeping. We discussed abuse and safeguarding with staff. Some staff were able to give details of the different types of abuse, all said they would report straight away. We found that this was not undertaken in the case of two of the people we case tracked. There was an incident when one person hit another with a walking stick apparently rendering them unconscious, although this was not reported as a safeguarding incident. This was discussed with the unit manager who said it was decided it was self-defence and therefore it was considered a referral was needed. This incident had not been reported to us either as it should have been. The majority of staff told us that they had not had Safeguarding training. Some of the staff said they understood what whistle blowing policy was after prompting, but none were really clear about it. The Manager told us that Safeguarding training is being arranged with the Local council. We have highlighted in other sections of this report where there are risks to people of harm and potential abuse. Improvements needed to more fully safeguard people include a criminal records check or protection of vulnerable adults check before people start working at the home (section 6 staffing), staff, bedrails that prevent a significant risk of harm (section 2 health and personal care) and improved arrangements for the safekeeping of people’s money (section 7 management and administration). Hawksyard Priory Care Home DS0000022334.V370071.R01.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 and 26. Quality in this outcome area is adequate. The service is clean, comfortable and is maintained to a good standard for people living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The building is a former Dominican Priory and is set in extensive and pleasant grounds. It is well maintained and the manager and staff feel that facilities will be further improved by the addition of the new extension, which is currently being built. There is a lounge and dining room on each floor all are suitably furnished and decorated. Bedrooms are on all floors with a passenger lifts accessing all three floors. There are currently twenty-four two double rooms, although the new extensive will give the home more single bedrooms which have ensuite Hawksyard Priory Care Home DS0000022334.V370071.R01.S.doc Version 5.2 Page 19 facilities. As previously identified there is a need for adequate screening to fully occlude beds in double rooms to afford people with privacy. Bedrooms have been personalised with ornaments, small items of furniture and family photographs. The third floor is where people with dementia lives and although is dated was clean. We saw lots of people wandering around the corridors from one end to the other and it’s a shame that as this unit is on the third floor they do not have direct access to the garden. We asked staff if they thought people with dementia would be able to find their way around the home, they agreed it would be difficult as there were no directional arrows sign for example in use. We asked the Matron to consider their use and how this problem could be addressed. The service provides people with a range of equipment to support them to be as independent as possible. The baths are fitted with hoists and there is a range of grab and hand rails around the building. Hoists are available for moving people safely. When we last visited the home it was highlighted that a person living at the service had managed to come downstairs and negotiate the “baffle locks” that limit access to the stairs which put them at risk of falling on the stone stairs. The Manager has since spoken to the fire service about a need to address this and will be addressed as part of the current extension and refurbishment of the service. The service is clean throughout and there are appropriate arrangements in place such as liquid soap, gloves and aprons to minimise the risk of cross infection. Hawksyard Priory Care Home DS0000022334.V370071.R01.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. Quality in this outcome area is adequate. Failures in recruiting new staff may put people at risk. Sufficient, knowledgeable and well-trained staff are provided to meet peoples needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service is staffed with appropriate numbers and skill mix to meet people’s needs. Staff we met spoke positively about support and training they receive and were knowledgeable about peoples’ needs. We also observed good interaction between staff and people living at the service. People were very complementary about the staff and told us: “They are very good”. The Manager told us that staff are supported to undertake a care qualification (minimum of National Vocational Qualification level two) all people we spoke to have either already a care qualification or are undertaking one. This gives confidence that staff are knowledgeable and understand peoples’ care needs. Hawksyard Priory Care Home DS0000022334.V370071.R01.S.doc Version 5.2 Page 21 There is a need for improvement to take place in relation to the recruitment of staff. We found that staff start work without either a criminal records check or a protection of vulnerable adults check. We discussed this at length with the Manager and Administrator who said that this was information previously given to them. We advised that they look at guidance available on our web site, but said they said that they would immediately address it. We also found that application forms did not always provide dates of previous employment. Other checks such as references and nurse’s personal identification number that details their qualifications are undertaken before new staff start work. We advised that they ensure that they have evidence that the personal identification number is checked for future reference. We were told that new staff have, induction training with an external training provider that meets the “Skills for Care” standards. No records of the completion of staff induction were available in any files seen. We advised the manager that she needed to do this. Hawksyard Priory Care Home DS0000022334.V370071.R01.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, 36 and 38. Quality in this outcome area is adequate. Management and administration at the service is based on openness and respect. There is a need for the improvement and development of service systems to give greater assurance that people’s welfare is protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is a qualified nurse and has managed the service for several years. She undertakes regular training to ensure her nursing knowledge and skills are kept up to date. She was fully aware of the needs of the people that lived there and provides good support to the staff. People told us that they found the Manager approachable: Hawksyard Priory Care Home DS0000022334.V370071.R01.S.doc Version 5.2 Page 23 “ Matron is approachable and you can always go down to her office and she will listen to your opinion.” There are good systems in place to support the staff. Regular staff meetings take place and staff supervision is also undertaken regularly. The service has systems in place to monitor quality and improve the service provided to the people that live there. We were told that surveys are sent to people living at the home and their relatives and health professionals. The Manager did send us the homes Annual Quality Assessment (AQAA) when we asked for it earlier this year. We have discussed a need for additional information to be made available and the manager has already started to do this when we ask for this next. We found several issues with in systems that are place to look after people’s money. The service is not keeping receipts for all transactions and those receipts available are all kept together in a blue tub making any audit of peoples money very difficult. We also found that there are no checks of money that is being kept. Two members of staff have the access to four peoples accounts (with their personal identification numbers) and collect their money, we do not feel that these arrangements are sufficiently safeguarding people. We were told that once this pension money has been collected the home stores it in the safe until the amount reaches three hundred pounds. The administrator told us that any money then is then transferred into Hawksyard Priory Patients fund and these arrangements are in place for five people. We were told that there no people are receiving interest on this money. The home needs to sort this out because people have different amounts of money invested in the account and would need interest payments in line with their balances. We found that one person had had fifty pounds withdrawn, a receipt for clothing amounting to £38.96 was available but their change had not been returned. We were told that the carer who must still have this money but they were on two weeks annual leave. This is not acceptable practice and all monies must be returned to people promptly. We looked at staff training in health and safety and other required areas. The home ensures that all staff receive training as and when they need it. It is positive that the home has its own moving and handling trainer and a new member of staff whose first day was the day of the inspection had her moving and handling training. All maintenance contracts seen were up to date. We randomly checked hot water temperature records; fire alarm checks and emergency lighting checks are satisfied they are being maintained to protect the people living at the home. As previously highlighted within this report there is a need to ensure that bedrails are safely fitted to protect people who need them, required checks are Hawksyard Priory Care Home DS0000022334.V370071.R01.S.doc Version 5.2 Page 24 undertaken before people start working at the home and medicines practices minimise the risk of medication error. Hawksyard Priory Care Home DS0000022334.V370071.R01.S.doc Version 5.2 Page 25 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 3 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 1 3 x 2 Hawksyard Priory Care Home DS0000022334.V370071.R01.S.doc Version 5.2 Page 26 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 OP8 Regulation 13(4)(c ) Requirement There must be appropriate risk assessments in place when people need bedrails to highlight and address the potential risk of harm to residents. There should be appropriate records to demonstrate that medicines have been given and when medicines are not given the required code should be entered. This will show that medicines (including creams and lotions) have been given as prescribed. Incidents that affect people health and wellbeing should be reported to the required agencies. The service must have appropriate systems in place to protect people from financial abuse. People must have required interest paid back to in relation to money that is stored within Hawksyard Priory Patients fund. Timescale for action 05/09/08 2 OP9 13(2) 05/09/08 3 OP18 13(6), 37 05/09/08 4 OP35 13(6) 05/09/08 5 OP35 13(6), 20(1) 05/09/08 Hawksyard Priory Care Home DS0000022334.V370071.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3 4 5 6 7 8. Refer to Standard OP7 OP9 OP9 OP9 OP9 OP10 OP18 OP19 Good Practice Recommendations Care plans should be developed to more fully identify the person’s individual needs, choices and capabilities. Two members of staff should confirm the accuracy of the entry for handwritten entries on the medication administration record. The amount of medicine given when a variable dose (one or two tablets) is prescribed should be recorded. Care records should detail that when medicines are prescribed on an “as required” basis there are directions for their use and whether the medicine was effective. The practice of using use of correction fluid and “stick on labels” should stop as it can cover un essential and required information. Privacy curtains should fully occlude beds in double bedrooms to provide people with adequate privacy. Staff should all have training in safeguarding of vulnerable adults and procedures that should be undertaken to safeguard people living at the home Keypads should be in place on staircases to stop residents getting onto the stairs and putting them at risk from accident. Arrangements should be made to ensure that staff do not manage peoples money Receipts must be available to confirm all financial transactions. There should an audit of peoples’ money that is being kept by the home undertaken by an external organisation. 9 10 11 OP35 OP35 OP35 Hawksyard Priory Care Home DS0000022334.V370071.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Hawksyard Priory Care Home DS0000022334.V370071.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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