Inspection on 01/07/08 for Hawthorn Green Nursing Home

This inspection was carried out on 1st July 2008.

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

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

Other inspections for this house

Hawthorn Green Nursing Home 18/05/09

Hawthorn Green Nursing Home 04/09/07

Hawthorn Green Nursing Home 19/06/06

Hawthorn Green Nursing Home 27/01/06

Hawthorn Green Nursing Home 11/08/05

Hawthorn Green Nursing Home 17/03/05

Hawthorn Green Nursing Home 25/10/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 17/12/2008.

CARE HOMES FOR OLDER PEOPLE Hawthorn Green Care Home 82 Redmans Road Stepney Green London E1 3AG Lead Inspector Sarah Greaves Unannounced Inspection 13:00 1 and 2nd July 2008 st 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 Hawthorne Green Care Home DS0000007357.V365849.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. Hawthorne Green Care Home DS0000007357.V365849.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hawthorn Green Care Home Address 82 Redmans Road Stepney Green London E1 3AG 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) 020 7702 7788 020 7702 8045 zelina.ramdhan@sanctuary-housing.co.uk Sanctuary Care Ltd Manager post vacant Care Home 90 Category(ies) of Dementia - over 65 years of age (45), Old age, registration, with number not falling within any other category (45) of places Hawthorne Green Care Home DS0000007357.V365849.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. MINIMUM STAFFING NOTICE Date of last inspection 4th September 2007 Brief Description of the Service: Hawthorn Green Care Home is a ninety bedded nursing home situated in Stepney Green, close to Stepney Green and Whitechapel underground stations and accessible by local bus routes. This purpose built care home has a ground, first and second floors, with lifts. The home is divided into six separate units, each with up to fifteen service users. Three of the units provide nursing care for people with dementia and the other three units provide general nursing care. A limited number of the beds have been purchased by the Tower Hamlets Primary Care Trust for the provision of Continuing Care. Hawthorne Green Care Home DS0000007357.V365849.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 2 stars. This means that people that use the service experience good quality outcomes. This unannounced key inspection was conducted over two days. Information was gathered through speaking to and observing residents, and speaking to visitors and staff. We read eight care plans, checked the management of medication on one unit, toured the premises, observed an activity session and looked at a selection of relevant documents and records. We checked staff records (for recruitment, training and supervision), health and safety records and residents’ financial records. The service was sent an Annual Quality Assurance Assessment (AQAA), which is a self –audit tool for registered care services. Information from the AQAA has been used for this report. Although the last key inspection of this service was commenced on the 4th September 2007, an unannounced random inspection was conducted on the 18th January 2008. What the service does well: What has improved since the last inspection? Hawthorne Green Care Home DS0000007357.V365849.R01.S.doc Version 5.2 Page 6 Eight requirements and two recommendations were issued in the previous key inspection report; seven of the requirements and both recommendations have been achieved. One requirement could not be effectively tested at this inspection. Requirements: 1. The service evidenced that it is working with the Primary Care Trust regarding the provision of pressure relieving equipment. 2. Adult Protection training had been provided. 3. The garden area had been significantly improved. 4. The requirement for a review of staffing levels on the afternoon shifts has been temporarily suspended until there is an increased occupancy level. Staffing levels will then be reviewed with the manager and service manager. 5. The service was offering a comprehensive training programme for staff. 6. The service was seeking and acting upon the views of the residents and their representatives. 7. Staff were receiving regular formal supervision of a recognisable quality. Recommendations: 1. There was some evidence of nursing and care staff engaging in activities with residents, although this could be improved upon. 2. The service had achieved a new weekly link with a local school to promote community involvement. The service had made environmental improvements, including the creation of a bar in the activities room and new shower rooms (wet rooms). What they could do better: Two requirements and three recommendations have been issued in this report. The service needs to ensure that the clinical assessments within the care plans are accurately maintained. We have also identified specific issues with care planning, such as inappropriate language and abbreviations. The service has demonstrated that it is taking measures to address some of the shortfalls commented upon in this report, such as a better quality of dementia care. Recommendations have been issued for the care home to complete the allergies section on the medication administration records to identify when a person has no known allergy, develop its existing night- time food choices and to replace the original sun protecting garden equipment. Hawthorne Green Care Home DS0000007357.V365849.R01.S.doc Version 5.2 Page 7 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. Hawthorne Green Care Home DS0000007357.V365849.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 Hawthorne Green Care Home DS0000007357.V365849.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are assured that their needs will be properly assessed before moving into Hawthorn Green. EVIDENCE: There were 68 people residing at the care home at the time of this inspection; therefore we read 12 of the available care plans. It was noted that the needs of the residents had been fully assessed prior to admission by the placing authorities and the care home. The key National Minimum Standard 6 was not applicable for assessment, as the service does not offer intermediate care. Hawthorne Green Care Home DS0000007357.V365849.R01.S.doc Version 5.2 Page 10 Hawthorne Green Care Home DS0000007357.V365849.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 good. This judgement has been made using available evidence including a visit to this service. Although the care plans evidenced some positive progress with the identification and delivery of health, personal and social care needs, better scrutiny needs to be applied in order to ensure that the holistic needs of individuals are fully addressed. Residents receive a service that promotes their dignity. EVIDENCE: Through reading eight randomly selected care plans, we identified some strengths with the service’s care planning. The care plans contained detailed information to address identified health and social care needs; there was also good evidence that an individualised approach was employed to recognise and understand the daily routines and preferences of the residents. It was Hawthorne Green Care Home DS0000007357.V365849.R01.S.doc Version 5.2 Page 12 acknowledged at the last inspection that the care plans would need to contain some clinical terminology (for example, admission notes recorded the current and relevant past medical history of a person); however, the service was advised to ensure that a more straightforward style of language was used in the acute and core care plan sections so that care workers could fully understand identified issues relating to mobility, continence, skin care and other activities of daily living. It was noted that the service had made a very noticeable attempt to address this, although we found some areas for improvement. Care Plan 1: The urinary continence assessment contained a clinical abbreviation that a care worker on duty at the time could not explain. A pain assessment had not been completed. There was an excellent ‘Life History’, which had been written by a relative. Care Plan 2: We found two separate and conflicting pieces of information regarding the background of the individual. The Life History (written by staff) stated that the resident was a Londoner and there was no reference to associations with other towns or countries; however, another document (also written by staff) stated that this person was born in a different country. The review chaired by the placing authority (the local Primary Care Trust) had identified the need for this resident to be referred to the dietician; the service had achieved this. Care Plan 3: The bowel care assessment and falls risk assessment had been conducted for June 2008 but were not signed by the responsible registered nurse. There was contradictory information within the nutritional risk assessment and the Waterlow (pressure sore prevention) assessment; the nutritional risk assessment should have identified skin care issues months earlier, in accordance to the information on the Waterlow assessment. Care Plan 4: The core care plan for colostomy care was good. It did not evidence that a monthly evaluation for June 2008 had occurred, although this did appear to be an administrative error, as the care plan was established in May 2008 and had a subsequent monthly evaluation also dated May 2008. Care Plan 5: The care plan, written by a staff nurse, stated that ‘the family is happy that X is in care’ and ‘X is a CVA patient’. We discussed the inappropriate use of specific words and abbreviations with the manager. Care Plan 6: This was a well-written care plan for a person with complex health care needs, including the delivery of nutrition through a percutaneous endoscopic gastrostomy (PEG) tube. Care Plan 7: There was conflicting information in the nutritional risk assessment and the Waterlow assessment. The resident was noted to have a pressure sore, which was seen by the community tissue viability nurse two days later. The Waterlow Hawthorne Green Care Home DS0000007357.V365849.R01.S.doc Version 5.2 Page 13 assessment had been changed to reflect the presence of the pressure sore and a care plan was in place. However, the specific care plan for the pressure sore had not been updated with the guidance received from the tissue viability nurse. Care Plan 8: This was a care plan for a resident on one of the units for people with dementia. We observed that the resident displayed specific behaviour (due to the losses caused by dementia) in the communal lounge and checked the care plan to find out how staff supported this person. There was no care plan to identify that the behaviour was recognised as an emerging problem. We were aware that the service provider had active links with a dementia care resource; however, the service did not yet demonstrate the full achievement of a holistic (care planning, activities and environment) approach to dementia care. It is acknowledged that staff training will be provided and the service stated its own plans for improvement (for example, a focus upon recruiting registered mental nurses when staff nurse posts become available). Through discussions with the manager and the service manager, we were advised that the service had informed the Primary Care Trust of some concerns regarding the provision of medical care for residents. We checked the management of medication on Maple Unit. It was noted that the allergies section of the medication administration record sheets had not been completed when a resident was not known to have an allergy; a recommendation has been issued in this report for the service to complete this section as good practice so that it is clear that a gap does not indicate that the section has been neglected. We found that the temperature for the medication refrigerator had exceeded the licensed level on one day in June 2008; there was no evidence of the service taking any actions such as repeating the temperature later in the day. An administrative omission was found in the index section of the record book for controlled drugs. A valid copy of the British National Formulary was located on the unit and there were no issues of concern regarding the storage of medication or the auditing system used by the staff. All of the bedrooms were now equipped with a lockable cabinet for the secure storage of topically applied creams and lotions. Through speaking to residents and visitors, and through observing interactions between residents and staff, we found that the residents were spoken to in a respectful manner. Staff were observed to discreetly support people that needed to be taken from the lounge to their rooms for continence care. Confidential information regarding residents was securely stored. Hawthorne Green Care Home DS0000007357.V365849.R01.S.doc Version 5.2 Page 14 Hawthorne Green Care Home DS0000007357.V365849.R01.S.doc Version 5.2 Page 15 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. This judgement has been made using available evidence including a visit to this service. Although residents received well organised and enjoyable activities, including opportunities to meet people from the local community, the scope of the service was limited due to a lack of staff. The food service was good but would benefit from on-going development. EVIDENCE: We met with the full-time activities organiser and directly observed an activities session. We were concerned to find out that the part-time activities post (to assist the activities organiser) had been vacant since November 2007, although a new person had been recruited but had not commenced employment at the time of this inspection. We found that the activities organiser had achieved good outcomes for residents but was limited by the absence of a second activities colleague. The activities records demonstrated that residents participated in activities such as movie afternoons with popcorn, Hawthorne Green Care Home DS0000007357.V365849.R01.S.doc Version 5.2 Page 16 bingo, gentle exercise, reminiscence, darts and board games. The service had established a regular link with a local primary school; children visited once a week and the residents had been invited to a school play. A hairdressing service from a visiting hairdresser was offered. Although there had been events at the care home since the last inspection (such as a barbeque and a jumble sale) we noted that there was an evident lack of outings. We were informed that there had been a problem with accessing community transport but this was in the process of being resolved. The activities organiser recognised the need to respond to residents that did not wish to participate in group activities and time was allocated for individual chats. We observed a lively activities afternoon in the garden, which involved singing, a quiz and refreshments; some visitors also participated. The activities organiser had completed Adult Protection training and a three day dementia course; however, we felt that the lack of a second person impacted upon the service’s capacity to develop a dedicated activities programme for people with dementia. The activities organiser also informed us that she had applied for an activities course offered by a national association for activities staff, which would be delivered over a nine-month period. A recommendation was issued in the previous inspection report for the service to demonstrate that nursing and care staff took an active role with involving residents in activities. The activities records did not demonstrate a structured approach to the provision of activities when the activities organiser was not present, although via reading care plans and discussions with relatives we were informed that staff chatted to residents, encouraged newspaper reading and listening to music, and used activities equipment for games. We observed on one unit that the radio was tuned into a station that does not cater for the interests of older people. We met a number of visitors during the course of this inspection. Relatives and friends spoke positively about the service, which offered flexible visiting hours and light refreshments. The care home was visited twice a week by representatives of the Roman Catholic Church; however the activities organiser was unable to find representatives from other faiths. A minister and members of a Baptist church in southwest London had visited earlier this year and conducted a service, but this could not be a regular event due to the distance. We found that the service had addressed the cultural and communication needs for current and prospective residents through the appointment of new staff with knowledge of Bangladeshi traditions. We were aware from previous inspections that residents have been supported to exercise their civic rights (such as voting) and information was made available about advocacy services. We met residents that were able to express how they made their own choices; for example, a married couple had chosen their own living arrangements for their allocated rooms. Hawthorne Green Care Home DS0000007357.V365849.R01.S.doc Version 5.2 Page 17 We received positive remarks from residents regarding the quality of the food service. We met with the chef and reviewed some weekly menus. At the time of this inspection approximately fifteen residents chose to have a cooked breakfast; we also noted that there was a wide range of breakfast cereals, including cereals that were ordered for one or two residents in response to personal requests. A tour of the kitchen evidenced that fresh fruits and vegetables were available; choices were offered at each main meal. The service had guidelines for fortifying food to prevent weight loss. We noted some good practices such as the availability of two vegetables at lunchtime and the provision of home baked cakes several times a week at tea-time. However, we noted that the service did not have a specific menu plan to meet the needs of people that become hungry at night time, which could be residents with dementia that do not sleep well or possibly people with diabetes that were previously accustomed to having a late night snack to regulate their blood sugar levels. It was acknowledged that night staff could access items to make sandwiches; however, the service has been advised to research the provision of a more structured approach to meeting ‘out of hours’ nutritional needs. We also found that staff would benefit from additional guidance notes on the menu plans to explain the contents of some items (for example, some residents and staff were not clear whether to expect dumplings or potato on one savoury dish, and the provision of accurate explanations was particularly important for residents that need support due to memory loss); the service manager has confirmed that this amendment was being made. Residents were consulted as part of the menu-planning task. Hawthorne Green Care Home DS0000007357.V365849.R01.S.doc Version 5.2 Page 18 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 good. This judgement has been made using available evidence including a visit to this service. Systems were in place to gather and respond to complaints, and to protect residents from abuse. EVIDENCE: The service produced a suitably written complaints procedure, which was made available to residents and their supporters in the Service User Guide. We spoke to as many relatives as possible during the course of this inspection, who reported that they were satisfied with the service’s response to any concerns or complaints raised. The manager was conducting regular meetings for the families and friends of residents, which were described by visitors as a useful forum for discussing their own findings. At the time of this inspection there had not been any serious complaints since the previous inspection visit. The staff training records demonstrated that staff had received Adult Protection training and the service used the Tower Hamlets Adult Protection policy. At the time of this inspection there had not been any Adult Protection issues since last year. We noted from the training records that non-care staff had not been provided with Adult Protection; it was agreed with the service manager that Hawthorne Green Care Home DS0000007357.V365849.R01.S.doc Version 5.2 Page 19 this training would be made available. Staff have previously demonstrated their knowledge of how to whistle-blow. Hawthorne Green Care Home DS0000007357.V365849.R01.S.doc Version 5.2 Page 20 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): 19,20,21 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a comfortable and welcoming home. EVIDENCE: The service occupied a purpose built premises, which is close to local amenities and good transport links. Since the last inspection Camellia Unit had been closed for re-decoration and had just re-opened. There had been a major programme of environmental improvements, including the creation of six wet rooms, the purchase of some profiling beds and garden landscaping. The activities room on the first floor now offered a bar and a wide screen television. We noted that there were insufficient parasols in the garden to protect Hawthorne Green Care Home DS0000007357.V365849.R01.S.doc Version 5.2 Page 21 residents on hot days; we were informed that equipment had blown away during a storm. We have suggested an alternative option, such as a permanent awning. Each unit provided a pleasantly decorated communal lounge and a separate dining area, which was spacious enough for up to fifteen residents. We were able to freely enter a sluice room, which could present obstacles if accessed by a resident with dementia; the use of a keypad system was suggested. We would like to see more environmental aids for people with dementia, such as memory boxes outside bedrooms to assist residents to identify their own rooms. All of the bedrooms offered an en-suite toilet and other toilets were located near to the communal rooms. It was noted that these facilities quickly evidenced physical deterioration due to the use of wheelchairs and hoist. We found that a pile of (unused) incontinence pads had been inappropriately stored in one bathroom. The wet rooms appeared particularly good for residents with more complex mobility and care needs, as they comfortably accommodated a resident and a couple of members of staff. It was acknowledged that homely touches could not be added to these rooms because this would be harmful to the infrastructure. The premises were found to be clean and free from any lingering offensive odours. Hawthorne Green Care Home DS0000007357.V365849.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence including a visit to this service. Positive improvements were noted with the service’s training programme; however, the absence of sufficient senior nurses needs to be addressed in order to meet the needs of the residents. EVIDENCE: As previously stated within this report, there were 22 resident vacancies at the time of this inspection; hence, staffing numbers had been adjusted until the service filled these vacancies. The service previously had one senior staff nurse allocated to each of the three floors (each floor had two units) but at the time of this inspection there was a vacant position for a senior nurse for Camellia and Bramble units. The senior staff nurse for Juniper and Honeysuckle units was covering the vacant deputy manager’s post; therefore two floors did not have a senior staff nurse. The finding concerned us, taking into account that the care home was working towards improving the quality of its service following a series of concerns last year and this inspection has highlighted some problems with the planning and delivery of health care and personal care. The service manager stated advertisements have been placed for senior Hawthorne Green Care Home DS0000007357.V365849.R01.S.doc Version 5.2 Page 23 staff nurse posts; the care home also advertised earlier this year for a clinical nurse specialist position to support the manager but did not receive any suitable responses. We looked at the training programme for nursing and care staff, although the training grid was not fully up-to-date (but other evidence to demonstrate that training had occurred was produced). New staff were provided with induction training, which we observed to be taking place during this inspection. The service provided a range of mandatory training, such as moving and handling, health and safety, fire awareness, infection control and food hygiene. It was noted that improvements had been made to the training programme; for example, the annual moving and handling training was a full day course provided by an external trainer. We met one member of staff that had completed a ten days ‘train the trainer’ course for dementia care and a second member of staff was identified to also do this training. The plan was for the trainers to deliver a three days dementia awareness course to nursing and care staff. We looked at the training records for the infection control course (a quiz completed as part of the training); no concerns were identified with the standard of scrutiny for checking answers. We looked at a sample of the recruitment files, which were found to be satisfactory, apart from one application form that did not have sufficient details of the employee’s previous employment history. This finding was discussed afterwards with the manager, who stated that a curriculum vita had been provided. Over 50 of the care staff had attained a National Vocational Qualification at level 2 and a group of care workers were undertaking this qualification at the time of this inspection. Hawthorne Green Care Home DS0000007357.V365849.R01.S.doc Version 5.2 Page 24 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 good. This judgement has been made using available evidence including a visit to this service. The service evidenced good practices to promote the safety and welfare of the residents. EVIDENCE: At the time of this inspection the manager had been in post for a few months; there had been a lengthy period of induction whilst the service manager had continued to be based at Hawthorn Green. The manager is a qualified registered general and registered mental nurse, with a registered managers Hawthorne Green Care Home DS0000007357.V365849.R01.S.doc Version 5.2 Page 25 award qualification and ‘train the trainer’ status for dementia care. The manager had prior experience of being a registered manager in a care home for older people and was close to completing the registration process with the Commission for Social Care Inspection. We received very positive comments from visitors regarding the conduct of the manager and there was recognition of how she was attempting to enhance the service. We found that the manager demonstrated a realistic and knowledge based understanding of the issues that needed to be improved; this was clearly evidenced in the supervision records. As previously stated in this report, the service was conducting regular meetings for the families and friends of the residents. We read the minutes for one of these meetings and noted that the service has been transparent and straightforward regarding the problems that arose last year, and how it was striving to address these issues. There were systems in place to seek the views of the people that use the service such as monthly unannounced monitoring visits conducted by the service manager (which involved discussions with residents and observations of residents that were not able to verbally express their views) and residents meetings, we would like to see further progress such as the involvement of residents in staff recruitment. We met with the administrator and checked the financial records for four randomly selected residents. There were no concerns identified with the system used and the accounts held. The administrator stated that she was audited by staff from the head office and could also seek advice from a named person, which we felt was an essential quality-monitoring tool. We looked at the supervision records for four members of staff. Supervision was being provided regularly, in accordance to the stipulations of the National Minimum Standards for Care Homes for Older People. We noticed that the service was clearly addressing any issues of poor performance through the supervision process. At previous inspections we have made specific observations of staff practice that did not demonstrate an expected level of competency; discussions with the manager and the supervision records evidenced that she has also made these observations. Team meetings were also conducted. The following records were checked and were satisfactory; Landlord’s gas safety certificate, electrical installations, Legionella risk assessment, weekly emergency lighting testing, daily water temperature testing, weekly testing of fire equipment and public liability insurance. Hawthorne Green Care Home DS0000007357.V365849.R01.S.doc Version 5.2 Page 26 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 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Hawthorne Green Care Home DS0000007357.V365849.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The Registered Person must implement more rigorous methods to improve upon the quality of the care plans. The Registered Person must ensure that residents cannot access the sluice rooms. Timescale for action 30/09/08 2. OP19 13 (4) (c) 30/09/08 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. 3. Refer to Standard OP9 OP15 OP20 Good Practice Recommendations The service should complete the allergy section of the medication administration records. The service should develop a more extensive nightime menu. The service should increase upon its provision of sun protecting garden equipment. Hawthorne Green Care Home DS0000007357.V365849.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Hawthorne Green Care Home DS0000007357.V365849.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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