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Inspection on 18/05/09 for Hawthorn Green Nursing Home

Also see our care home review for Hawthorn Green Nursing Home for more information

This inspection was carried out on 18th May 2009.

CQC 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 CQC 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

We noted that the care home provided a friendly and welcoming environment for residents and visitors. The premises benefit from a pleasant location that offers a rear garden overlooking a park and is close to local amenities; these facilities are enjoyed all year by residents and particularly in good weather conditions. The service had its full activities team in place and there was clear evidence of residents being offered a social programme that catered for varying needs including people that wished to have quiet discussions rather than join group activities. Staff recruitment was safely conducted.Hawthorn Green Nursing HomeDS0000007357.V375549.R01.S.docVersion 5.2

What has improved since the last inspection?

The service has closely examined all aspects of how it functions and made a broad range of positive changes. For example, there is now an established managerial structure within the care home to both support the manager and to promote good clinical care amongst the staff nurses and care workers. The service has introduced a new system for ensuring that important information is communicated to the manager on a daily basis, which is essential for a service of this size. The requirements from the previous key inspection were promptly responded to. One requirement in regard to care planning was issued at a random inspection earlier this year. We were satisfied that the service was actively working towards an improved model of care planning, which should be achieved this autumn.

What the care home could do better:

We have issued two requirements within this report, in regard to checking for medications that need to be disposed of and a measure to prevent unnecessary odours. However, there are other areas for improvement regarding care planning and delivery of care. Requirements have not been issued on the basis that the service is presently working upon the improvement of the care plans and we anticipate that the introduction of a clinical lead nurse will enable the service to focus upon the type of issues that this report has identified (for example, how to make mealtimes more pleasurable and responsive to the wishes of individuals).

Key inspection report CARE HOMES FOR OLDER PEOPLE Hawthorn Green Nursing Home 82 Redmans Road Stepney Green London E1 3AG Lead Inspector Sarah Greaves Unannounced Inspection 18, 19 and 27 May 2009 10:00 DS0000007357.V375549.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Hawthorn Green Nursing Home DS0000007357.V375549.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Hawthorn Green Nursing Home DS0000007357.V375549.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hawthorn Green Nursing 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 No registered manager at the time of this inspection 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 Hawthorn Green Nursing Home DS0000007357.V375549.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th January 2009 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. Hawthorn Green Nursing Home DS0000007357.V375549.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 one star – adequate service. This means that people who use this service experience adequate outcomes. This key inspection was conducted over three days by two inspectors, and the first day of this inspection was unannounced. Information was gathered through speaking to residents, visitors, the manager and staff. We read a randomly selected sample of the care plans, and checked upon the storage and recording of medication. We also looked at other relevant documents such as policies and procedures and staff files (for recruitment, training and supervision details). The premises were toured and staff with specific responsibilities were interviewed (such as social activities, catering and residents’ finances). The service was sent an Annual Quality Assurance Assessment (AQAA) prior to this inspection, which is a self-audit tool. Information from the AQAA was used for the production of this report. What the service does well: We noted that the care home provided a friendly and welcoming environment for residents and visitors. The premises benefit from a pleasant location that offers a rear garden overlooking a park and is close to local amenities; these facilities are enjoyed all year by residents and particularly in good weather conditions. The service had its full activities team in place and there was clear evidence of residents being offered a social programme that catered for varying needs including people that wished to have quiet discussions rather than join group activities. Staff recruitment was safely conducted. Hawthorn Green Nursing Home DS0000007357.V375549.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Hawthorn Green Nursing Home DS0000007357.V375549.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hawthorn Green Nursing Home DS0000007357.V375549.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are offered suitable measures to promote a safe admission. EVIDENCE: We read a randomly selected sample of the care plans. It was noted that the needs of prospective residents were assessed prior to admission; this process involved assessments by the placing authority and senior staff from the care home. All residents were offered a short trial period, which was followed by a review meeting in order to establish if the placement would become permanent. Hawthorn Green Nursing Home DS0000007357.V375549.R01.S.doc Version 5.2 Page 9 The manager stated that the service was producing specific assessments within the first twenty-four hours for people that were newly admitted to the care home; these assessments included moving and handling, tissue viability, nutrition and falls risk. A more comprehensive care plan would be in place (and checked upon by the manager) within five days. We met visitors (family members and friends) that confirmed they had visited the service prior to people moving in; it was acknowledged that some prospective residents would not be able to visit Hawthorn Green due to their health problems but we would hope that pre-admission visits were encouraged whenever possible. The key standard 6 was not applicable for assessment as the service did not provide intermediate care. Hawthorn Green Nursing Home DS0000007357.V375549.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The planning of care needs to demonstrate better accuracy with the use of clinical tools so that residents’ needs are fully identified and addressed. There is a need for staff to apply greater consideration in regard to the language used in the care plans. The service needs to adhere to its own medication policy regarding how to complete medication charts and the need to safely store/dispose of prescribed medications. EVIDENCE: We read a randomly selected sample of the available care plans. The following observations were made in regard to care planning and delivery of care; Hawthorn Green Nursing Home DS0000007357.V375549.R01.S.doc Version 5.2 Page 11 Care Plan 1: Issues were identified at the inspection and discussed with the manager. We would not wish to publish information that would potentially identify the resident and compromise their confidentiality. We did have concerns in regard to the mattress smelling of urine. Care Plan 2: The resident had a good assessment with much input from their family. The falls risk assessment was incorrectly scored as it did not accurately reflect currently prescribed medications; this was pointed out to the staff nurse on duty, who agreed. The resident’s Waterlow (assessment tool to identify susceptibility to pressure sores) score identified this person to have healthy skin, despite the fact that the resident was having a prescribed cream applied twice a day to a red area of skin on their sacral region. Care Plan 3: This care plan contained awkwardly expressed views about the relatives of the resident, for example, “very demanding, unable to reason with them- their attitude appears to be borne of guilt not looking after X themselves”. There was also a subjective description applied to a close relative of the resident. The bowel assessment on the Waterlow contradicted another assessment relating to elimination. The care plan developed for the resident being ‘at risk of developing a pressure sore’ did not refer to the fact that this person is prescribed a topical cream to provide a barrier to the negative impact of the incontinence upon the skin. Care Plan 4: The spelling of the resident’s first name was noted to have changed a few times within the care plan; in fact, two different spellings occurred twice on one document. Hawthorn Green Nursing Home DS0000007357.V375549.R01.S.doc Version 5.2 Page 12 The weight recording chart identified that the resident had a Body Mass Index (BMI) of 26 (overweight) but the Waterlow was scored for a normal weight range. An entry within a ‘Communication’ assessment stated that “X is a white lady and is able to communicate her needs”. We found recorded strategies to support the resident to be orientated to time and place, such as providing a clock and a calendar in their bedroom. It was observed that there was a clock but no calendar; a discussion with their relative indicated that there had never been a 2009 calendar in place. Care Plan 5: This resident was described in their care plan to have healthy skin but they were prescribed a cream for dry skin. The falls risk assessment score was incorrect as it did not accurately score for the different medications that this person was prescribed. The Waterlow assessment provided a score for a person in the underweight category but the resident was recorded as having a BMI within a normal range on their nutritional chart. The records completed by visiting professionals identified that a dietician found that staff had incorrectly produced a nutritional score in December 2008. It was acknowledged that a plan was in place for all of the care plans to be rewritten by October 2009. We were in agreement with the views expressed by the Tower Hamlets PCT Clinical Nurse Specialist for Nursing Homes in May 2009, in regard to the need for some form of streamlining of the care plans. It was also agreed with the manager that there was additional detail within the care plans that was not needed, such as a ‘Maintaining A Safe Environment’ care plan that stated the need for toilets to be labelled and accident forms completed in the event of an accident. These kinds of actions would be regarded as part of the service’s safety policies and procedures. The service informed us that it will be launching CIRCA (a computer based system that helps residents with dementia to communicate and reminisce) soon after this inspection visit. Staff will receive training in how to use it. The system promotes connection with old memories from films, music and everyday life and has been observed to work well by its developers (a Scottish university department) in other care settings. We looked at the risk assessments during the reading of the care plans. It was felt that there could be more precise information; this was discussed with the manager in regard to the risk assessments for cot-sides. Hawthorn Green Nursing Home DS0000007357.V375549.R01.S.doc Version 5.2 Page 13 We were told by a resident that the night-time carers do not put the incontinence pads on properly and do not change the pads until 6.30am. We asked to see the records for night checks and pad changes. There were records kept for checking whether residents were asleep or awake but no record was kept for pad changing. The manager stated that she felt that the current form was inadequate and will develop a more detailed one. We have raised the issue of the need for the manager to conduct overnight spot checks. We checked the storage and recording of medication on one of the units. The following observations were made: 1) A supplement (Ensure) was signed for twice, when in fact it had not been given. 2) A designated code was entered 20 times on a medication chart to indicate that a prescribed medication had not been given. However, the code used required for staff nurses to define the reason why the medication was not given but this had not been done. There were no issues of concern with the management of controlled medications and medication that needed to be refrigerated. The temperatures for the medication refrigerator were recorded daily, apart from 3 days in April 2009. We noted a tube of Cavilon spray on top of a medication cupboard in an ensuite toilet. The cream had no prescription label and did not appear on the medication chart. Fucibet cream was found in the cabinet of another resident; this cream was no longer prescribed to this person. Some cartons of a prescribed supplement drink (Fresubin) were left in a prominent position in a communal lounge. We found a jar of ‘thick and easy’ granules for thickening fluids appropriately stored out of immediate reach in a cupboard; however, it did not have a prescription label on it, which unit staff should have questioned and addressed. We noted that a trained nurse was not clear about the types of medication that residents were receiving, which we picked up when comparing the medication section of the falls risk assessments to the medication administration charts for individuals. For one example, a staff nurse stated that it was acceptable to score a particular medication (quetiapine) as being a hypnotic on the basis that a side effect is drowsiness; we discussed this afterwards with a CQC pharmacist inspector who advised against this interpretation. We received some positive views about the care home from residents and visitors. However, we made specific observations that indicated areas for improvement. For example, one resident stated that their bottom was sore since they got a new wheelchair. In our presence the resident told a carer Hawthorn Green Nursing Home DS0000007357.V375549.R01.S.doc Version 5.2 Page 14 about having a presently sore bottom; the carer ignored the statement by not acknowledging or answering it. Hawthorn Green Nursing Home DS0000007357.V375549.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were provided with a varied and suitable programme of activities, including opportunities to maintain links with the local community. The service needs to demonstrate some improvements with providing a calming and responsive environment for dining. EVIDENCE: We met with the activities organiser on the third day of this inspection. The service employs two people to provide an activities and entertainments programme, although nurses and care workers also support residents with their social needs. The activities organiser provided documented evidence of the activities programme since the last inspection, which included visiting entertainers, outings and shopping trips, weekly bingo, arts and crafts, singing and music, reminiscence, quizzes, visits from school children, exercise and Hawthorn Green Nursing Home DS0000007357.V375549.R01.S.doc Version 5.2 Page 16 one-to-one chats with people that do not wish to or are not able to take part in group activities. We were shown the multi-sensory equipment, which residents have found relaxing and soothing. During the course of the inspection we observed staff playing games with residents (such as throwing a soft ball) and it appeared to be very enjoyable for participants. The activities organiser and the manager stated that there was a plan to meet individually with all of the nursing and care staff so that each staff member would have their own ‘mini-appraisal’ of their current knowledge and skills in the provision of activities and objectives for future development. During this inspection two residents/relatives told us that they would like to see a priest or nun, or both. One resident stated that they had expressed this wish but it had not been fulfilled. The manager agreed that the priest visits only rarely and said that she would contact another resource and request visits from a priest there. The service offered very flexible visiting hours for relatives and friends. We met some visitors who came in almost daily and had developed good relationships with other residents and staff. We joined the residents at lunchtime. The following observations were made regarding the food service: Music by the Beatles was played quite loudly at lunchtime. At the same time residents were being asked questions by staff (regarding food and drink choices) and other residents were trying to concentrate upon feeding themselves, particularly people with some degree of dexterity difficulties. We observed a resident being fed; this individual was quite unable to feed him/her. The feeding of the resident was fast with questions being fired at the resident whilst he/she had food in his/her mouth; it was also noted that there was still skin on the fish that this person was being fed. When the pudding arrived the staff member tried to prise the hand open to place a spoon in the hand. The resident stated that this hurt, but the staff member said “No, it doesn’t”. This resident is prescribed analgesia so that their hands can be opened to be washed. Pudding for the resident was sponge with no custard as the resident does not like custard. No cream, ice-cream or similar alternative was offered as a substitute. We observed that squash and water were available at lunch but tea and coffee were not offered, although we received comments from residents that such a choice would be liked. We looked around the main kitchen and checked the menus for a four week cycle. It was noted that there was a good choice of cereals, biscuits and cakes (including home baked items) and different conserves. Cooked breakfast was offered daily, which several residents on each unit elected to have. Hawthorn Green Nursing Home DS0000007357.V375549.R01.S.doc Version 5.2 Page 17 Hawthorn Green Nursing Home DS0000007357.V375549.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems were in place for the protection of the residents. EVIDENCE: The service produced a comprehensively produced complaints procedure. There were no issues of concern regarding the investigation of complaints apart from the matter previously discussed in this report, regarding a specific resident. The service was equipped with an Adult Protection procedure, inclusive of information regarding how to whistle blow. The safeguarding procedures for the local social services were used in conjunction with the service provider’s own documents. There were no Adult Protection concerns at the time of this inspection. There have been Adult Protection concerns raised since the last key inspection. We noted that the service had responded by identifying issues for improvement and demonstrated good efforts to raise the quality of care. Hawthorn Green Nursing Home DS0000007357.V375549.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some improvements to the cleanliness of the premises are required. EVIDENCE: The service occupies a purpose built premises within walking distance of a park, and local shops and amenities. There are pleasantly maintained communal areas including an activities room and a rear garden. Many of the bedrooms evidenced that people were supported to personalise their own space. The following observations were made during this visit: Hawthorn Green Nursing Home DS0000007357.V375549.R01.S.doc Version 5.2 Page 20 On Juniper Unit the kitchen doors were greasy and the refrigerator was dirty inside. On Honeysuckle Unit we observed a toilet frame over a toilet; the handles were noticeably dirty. There was no toilet seat but the rim on the toilet was not in a clean condition. We noted two bedside cabinets which needed replacing, one had a broken hinge on the door and the other had strips of veneer missing and was in a poor condition generally. We observed that there were too many incontinence pads being stored in the bedrooms; the manager explained that this was due to a change in the delivery arrangements and she was trying to resolve the issue so that people could enjoy a homely environment. As previously stated, an unacceptable odour was detected in one of the bedrooms due to inadequate cleaning of the mattress. Hawthorn Green Nursing Home DS0000007357.V375549.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Suitable arrangements were in place for residents to receive their care from safely recruited, appropriately trained and supervised staff. EVIDENCE: We found that the staffing levels were good for each unit and were pleased to note that the care home had appointed a clinical lead nurse and a deputy manager. We spoke to the manager regarding current staff vacancies, which the service was addressing. The need to have a good balance of skills was discussed; for example, staff nurses that were dual qualified in general and mental health nursing, or a balance of the two registrations, so that residents would benefit from combined knowledge and experience to address physical and dementia care needs. The service evidenced an ongoing programme of mandatory training and other training relevant to the needs of the residents. We noted that staff had been working with a visiting Primary Care Trust clinical nurse specialist nurse for Hawthorn Green Nursing Home DS0000007357.V375549.R01.S.doc Version 5.2 Page 22 nursing homes and this was described as a valuable approach to developing new knowledge and skills. Staff recruitment was checked and found to be satisfactory. Hawthorn Green Nursing Home DS0000007357.V375549.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care home demonstrated that it was striving towards continuous improvement in order to provide a responsive and safe service for residents. EVIDENCE: A new manager commenced at Hawthorn Green earlier this year. She is a registered nurse with prior managerial experience in care homes. The manager confirmed that she has applied to the CQC for registration and is also pursuing Hawthorn Green Nursing Home DS0000007357.V375549.R01.S.doc Version 5.2 Page 24 a recognised management qualification. We spoke to the manager about undertaking a dementia course as a future training objective, taking into account that forty-five of the places at the care home are for people with dementia. However, we found that the manager was knowledgeable regarding the needs of older people in care homes with nursing, and she presented good management strategies for communicating information, managing staff and achieving continuous improvement. Through speaking to residents and their visitors, and via observations, we felt that the service demonstrated a clear ethos of wishing to achieve the best outcomes for its residents. The service acknowledged that there have been some difficulties since the last key inspection, which has resulted in specific measures to promote improvements (for example, the new managerial team and actions taken to ensure that all staff perform at an expected standard). The National Minimum Standards for Care Homes for Older People require that service providers visit a service once a month (unannounced) to conduct a monitoring visit, and then produce a report regarding their findings. We were satisfied that this had been achieved and noted that there has been a detailed involvement from external senior managers in order to improve the care home. We inspected the arrangements for the safekeeping of residents’ monies. Receipts are kept and petty cash vouchers signed for cash handed over. We checked two accounts sheets and cash balances and were satisfied that these arrangements protected and safeguarded residents’ finances. The health and safety records checked at this inspection were found to be satisfactory. Hawthorn Green Nursing Home DS0000007357.V375549.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 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 Hawthorn Green Nursing Home DS0000007357.V375549.R01.S.doc Version 5.2 Page 26 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 The registered person must demonstrate improved systems to check for expired medications/medications no longer prescribed. 2. OP26 13 The registered person must implement an auditing system to check for odours in mattresses, wheelchair and/or standard cushions. 30/09/09 Requirement Timescale for action 30/09/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hawthorn Green Nursing Home DS0000007357.V375549.R01.S.doc Version 5.2 Page 27 Care Quality Commission London Regional Office Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.london@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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