Inspection on 19/06/06 for Hawthorn Green Nursing Home

This inspection was carried out on 19th June 2006.

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 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 01/07/08

Hawthorn Green Nursing Home 04/09/07

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hawthorn Green Care Home 82 Redmans Road Stepney Green London E1 3XX Lead Inspector Sarah Greaves Key Unannounced Inspection 10:30 19 and 20th June 2006 th 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 Hawthorn Green Care Home DS0000007357.V298066.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. Hawthorn Green Care Home DS0000007357.V298066.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 3XX 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 Sanctuary Care Limited *** 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 Hawthorn Green Care Home DS0000007357.V298066.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. MINIMUM STAFFING NOTICE The home can accommodate two (2) named service users under the age of 65 years. 27th January 2006 Date of last inspection 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. Six of the beds have been purchased by the Tower Hamlets Primary Care Trust for the provision of Continuing Care. A limited day care service (for three service users) is offered. Hawthorn Green Care Home DS0000007357.V298066.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors conducted an unannounced inspection visit on Monday 19th June, which was continued on Tuesday 20th June. The inspectors assessed the home’s compliance with the requirements and recommendations issued in the previous inspection report and assessed the home’s performance with the key National Minimum Standards for Care Homes for Older People. The inspectors gathered information through speaking to service users, relatives, staff and the manager. Information was also collected via the reading of care plans, policies and procedures, and via direct and indirect observations. Information relating to the management of complaints was evidenced via an Adult Protection meeting, which was scheduled in the week after the inspection. What the service does well: What has improved since the last inspection? The home demonstrated that an auditing system for care plans and a system for identifying the last wishes of service users were in place. Improvements were identified in the safe use of wheelchairs by staff and the decorative condition of the communal toilets. It was noted that staff were receiving regular supervision and the induction training of new staff was properly documented. The home also demonstrated that food temperatures were being recorded on a daily basis. Hawthorn Green Care Home DS0000007357.V298066.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hawthorn Green Care Home DS0000007357.V298066.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 Care Home DS0000007357.V298066.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users needs were identified prior to admission and they received opportunities to visit the home before moving in. EVIDENCE: A recommendation was issued in the previous inspection report for the home to ensure that the contracts for privately funded service users clearly indicated whether the service users or their representative had signed the contract; this recommendation was noted to have been met. The inspectors looked at a randomly selected sample of the pre-admission assessments for service users (assessments undertaken by the placing authority and by the home). The assessments co-ordinated by the local social services were noted to have been of a satisfactory standard. The inspectors observed that each service user also received a pre-admission assessment of their needs by the home. Hawthorn Green Care Home DS0000007357.V298066.R01.S.doc Version 5.2 Page 9 The inspectors observed that a prospective service user and their family viewed the home on the first day of the inspection. The inspectors spoke to a recently admitted service user and their representative, who confirmed that they had been offered the opportunity to visit the home prior to moving in. Standard 6 was not applicable for assessment, as the home does not provide intermediate care. Hawthorn Green Care Home DS0000007357.V298066.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11 Quality in this outcome area is adequate. This outcome has been made using available evidence including a visit to the service. Although the service demonstrated that the care plans were audited, greater attention must be focused upon examining the quality, contents and clinical judgements within the care planning documents, evaluations and risk assessments. The home needs to actively demonstrate that consultation will take place with service users representatives, as part of the care planning process for service users with dementia. The home must ensure that a more robust approach is undertaken relating to the safe management of medications. The final wishes of service users were recorded. EVIDENCE: A requirement was issued in the previous inspection report for the home to ensure that the care plans are monitored by senior staff and audited by the manager. The manager presented written evidence to demonstrate that an auditing and monitoring system had been established. Hawthorn Green Care Home DS0000007357.V298066.R01.S.doc Version 5.2 Page 11 The inspectors read seven care plans during this inspection. It was noted in two of the care plans that the families of the service users wished to be actively involved in the delivery of personal care (for bathing and hair care); however, staff had not recorded on the evaluation records whether this personal care had been provided in accordance with the care plan objectives. Two other care plans stated that service users wished to receive a bath or shower at least once per week; the evaluation records did not demonstrate that this frequency of personal care was attained. The manager stated his belief that staff may be mistakenly recording ‘general wash given’ or ‘assisted with washing’ instead of specifically verifying that a weekly (or more frequently, as required) bath or shower was provided, as clearly worded within the personal care objectives. One of the care plans did not properly document the significant change in a service user’s mobility status (from being wheelchair bound to now using a walking frame). The inspectors sought information regarding the home’s present management of service users pressure sores. The home possessed its own guidelines for pressure sore prevention and pressure sore care. The inspectors requested to view the guidelines issued by the Tower Hamlets Tissue Viability service, which were not available within the home at the time of the inspection. The manager stated that the Tissue Viability nurses had provided training to staff; the inspectors recommended that the home should store copies of the local protocols on each of the units. A requirement was issued in the previous inspection report for the home to ensure that the health care needs of service users were recorded in the care plans (for example, consistent weighing of service users with identified nutritional needs) and for appropriate action to be taken in response to any findings of concern. The inspectors found that there had been an improvement in the consistency of recording the weights of service users in accordance to their nutritional risk assessments; however, it was noted in one care plan that conflicting information relating to the nutritional needs of an individual were recorded in two different assessments on the same date. The inspectors were informed that Sanctuary Care was reviewing its care planning methodology and risk assessment tools The care plans contained a ‘Life History’ form for each service user, although some of these documents contained very brief information or had not been fully completed. It was noted that one of the care plans documented that a service user residing on one of the units for people with dementia had actively enjoyed outdoor walking when they were younger; however, nursing staff had not explored whether this impacted upon current routines and behaviour. The inspectors acknowledged that there would be occasions when a service user does not want to disclose information or there is no representative to provide a social history; however, staff did not indicate (in writing) these circumstances. Hawthorn Green Care Home DS0000007357.V298066.R01.S.doc Version 5.2 Page 12 The inspectors checked the home’s management of medication on one of the six units. A requirement was issued in the previous inspection report for the home to ensure that (1) medication administration charts are properly recorded to demonstrate whether a medication has been given or not and (2) all topically applied creams and lotions are securely stored. The inspectors observed that medication records had been completed in order to evidence whether medication had been administered; however, the inspectors found prescribed topically applied medications (conotrane and aqueous cream) in the bedroom of a service user residing on one of the units for people with dementia. It was observed that the thermometer for the medication refrigerator had not been operative since June 1st 06. The staff nurse on duty stated that she had reported the need for a new thermometer. The inspectors found a medication that had been labelled by the pharmacist for the use of an individual service user; it was observed that the service user’s name had been crossed out with a biro pen and the medication was now being used as a ‘homely remedy’. The inspectors noted that a service user was prescribed sudocrem lotion; however, there were no specific instructions for application on the pharmacy label and this information was not recorded on the service user’s medication administration chart. A prescribed topical lotion for a deceased service user (who had passed away in May 2006) was detected in the tray used for storing current prescribed topical treatments. The inspectors noted that one service user appeared to have a large supply of a prescribed medication (tablets). The inspectors noted that the General Practitioner had increased the dosage of this medication; however, it was not possible to track whether the home possessed an excessive supply of this medication, as there was an inconsistent approach to recording on the medication records when a new supply had commenced. These medication issues have been referred to a CSCI pharmacist inspector, who will conduct an unannounced pharmacy inspection. A requirement was issued in the previous inspection report for the home to ensure the dignity and choices of service users with dementia through improved liaison with their representatives. The manager stated that this process had been commenced through involving the representatives of service users at care planning reviews. The inspectors looked at the review forms for two recent reviews; it was noted that the representatives of the service users had been present but there was no clear-recorded information to demonstrate that the representatives had been asked about the individual routines and preferences of service users. This requirement has been repeated in this report. Hawthorn Green Care Home DS0000007357.V298066.R01.S.doc Version 5.2 Page 13 A requirement was issued in the previous report for the home to discuss with service users (and their representatives, as necessary) whether they wished to be resuscitated within the home, and for this information to be recorded in their care plans. The inspectors noted that this information was not recorded in the seven care plans read during this inspection; however, via discussion with the manager it was identified that the home’s policy and practice was to record in a care plan when a service user stated that they did not want to be resuscitated. This requirement has been deleted. Trained staff had received resuscitation training. Hawthorn Green Care Home DS0000007357.V298066.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users received a very good programme of activities, arranged by a committed activities team. The home needs to develop its provision of activities for people with dementia. Service users were supported to remain part of the local community and the food service was good. EVIDENCE: The inspectors spoke to the home’s full-time activities co-ordinator. The activities co-ordinator was employed for thirty-six hours per week and a parttime assistant was employed for eighteen hours per week. At the time of the inspection, the inspectors observed service users participating in an afternoon book club. Service users reported that they attended the book club every week and enjoyed this activity. The home was noted to provide a broad range of activities that included visits to the theatre, cinema, a hotel function, tea dances, pub lunches, the seaside and places of interest. Local organisations (such as schools, youth groups, choirs and a city farm) were regularly invited to the home, and an active programme of arts and crafts, bingo, hair- dressing and manicures, music sessions, jam making and other entertainments. The inspectors found the activities programme to be very well structured and Hawthorn Green Care Home DS0000007357.V298066.R01.S.doc Version 5.2 Page 15 fulfilling for service users. Via discussion with the activities co-ordinator, the inspectors noted that the service did not have a designated programme of activities specifically for the service users with dementia. The inspectors suggested the introduction of sensory equipment that could be used on the three units for people with dementia. At the time of this inspection, the inspectors were informed that there was a reminiscence box for the home but each unit for people with dementia did not offer its own separate resources. The home possessed some musical instruments that could be used for music sessions; however, this equipment was maintained in the activities room as opposed to being readily available on the units for staff to facilitate spontaneous activities. Service users were offered opportunities to retain their links within the community through the activities programme and via visits from relatives and friends. Service users and relatives stated that the home offered flexible visiting hours, and relatives were encouraged to participate in the communal life of the home (such as the forthcoming summer fete). The inspectors were shown the minutes to demonstrate that regular meetings were held for service users relatives. The inspectors observed service users receiving their lunch on the first day of this inspection visit. Service users were assisted by staff to choose their options for lunch and dinner, via menu cards that had been presented on the previous day. The inspectors observed that the menu display cards (placed on each dining table) were produced in a fine print that would not be visible to service users with restricted vision. Service users and their relatives stated that the food was satisfactory and that fresh fruit was provided daily. An inspector checked the main kitchen, which was appropriately maintained; however, there was no spare hygiene headwear (as required by health and safety legislation) to offer to the inspector. A member of the catering staff showed the inspector how the needs of service users requiring a diabetic diet would be met. The inspector was informed that the home had run out of supplies of marmalade and jams suitable for diabetics, which was due to the recent switch from an external catering supplier back to ‘in-house’ catering. This finding was discussed with the manager, who stated that none of the diabetic service users requested marmalade and/or jams. The inspectors have spoken to the dietician service at the Mile End Hospital who have recommended suitable conserves for people with diabetes, in the event of the home receiving any diabetic service users who request these products. Hawthorn Green Care Home DS0000007357.V298066.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 inspected at least once during a 12 month period. 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 the service. The home’s management of complaints was noted to have improved since the last inspection. The service needs to consistently demonstrate a full and immediate adherence to local area Adult Protection procedures and the Whistle-blowing policy needs to be made relevant to the home. EVIDENCE: The home produced a satisfactory complaints procedure, which was provided to service users and their representatives in the Service User’s Guide. The relatives spoken to during the inspection stated that they were familiar with the home’s complaints procedure; service users reported that they would initially raise any concerns with their relatives or speak to a nurse. The home possessed an appropriately written Adult Protection policy, which was used in conjunction with the Tower Hamlets Social Services Adult Protection procedure. At the time of this inspection, an Adult Protection allegation had been referred to Tower Hamlets Social Services; however, the staff had not been suspended in accordance to both the home’s own protocols and the Tower Hamlets procedure. The inspectors expressed concern at this decision; it was noted that appropriate action relating to the suspension of staff occurred soon after the inspection. The inspectors observed that the home’s Whistle-blowing policy appeared to be written primarily for Sanctuary Housing Association staff and did not inform staff of relevant organisations that Hawthorn Green Care Home DS0000007357.V298066.R01.S.doc Version 5.2 Page 17 they could whistle-blow to, such as the Commission for Social Care Inspection and the local social services. A requirement was issued in the previous inspection report for the home to ensure that complaints were robustly and effectively investigated. The investigations for the aforementioned Adult Protection allegation (which was concluded soon after this inspection) and a separate anonymous complaint were noted to have been comprehensively investigated. Hawthorn Green Care Home DS0000007357.V298066.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home was clean and free from any offensive odours. The safety of service users needs to be addressed through systems to ensure the safe storage of disposable razors and toiletries in service user’s en-suite bathrooms. The home needs to develop its physical environment for people with dementia. EVIDENCE: The home occupies a modern, purpose built premises. The inspectors noted that the home needed toensure that an on-going programme of refurbishments were being undertaken for the communal areas and bedrooms; however, the standard of the premises were satisfactory. A requirement was issued in the previous inspection report for the home to ensure that the communal toilets were maintained in a good decorative order; this requirement was met within the stipulated time-scale. The inspectors observed that two of the toilets did not have accessible call bell cords. It was acknowledged that one of these Hawthorn Green Care Home DS0000007357.V298066.R01.S.doc Version 5.2 Page 19 toilets (on the ground floor) was specifically identified as being for the use of visitors; however, the inspectors observed that some of the service users were visited by older partners, friends and relatives that might experience a potential fall or an episode of ill-health within the home’s premises. The call bell cord was not accessible in a toilet on the first floor, which was in close proximity to the activities room. The inspector was informed by the manager that this toilet was for the use of staff only; however, the toilet door was not marked as being for staff only. The inspector observed a service user being escorted by a member of staff to use the first floor toilet after the book club activity on the first day of the inspection. The home needs to either clearly identify this toilet as being for staff only or ensure that it is a safe environment for service users. A requirement was issued in the previous inspection for the home to ensure that wheelchairs were safely maintained and that staff were trained in how to safely use the wheelchairs. The inspectors observed that written guidance on wheelchair use had been displayed on the units and no inappropriate practices were observed during the inspection. It was observed that the home had commenced the process of creating appropriate environments to meet the needs of people with dementia (for example, clear pictorial signs on doors to indicate that the room was a toilet or bathroom). At the time of this inspection, the home had not progressed to providing visual stimuli that would offer reassurance and reminiscence opportunities to people with dementia (such as old style radios, small items of period furniture, and traditional board games). The inspectors observed that a disposable razor blade (with the plastic covering for the blade removed) was stored in the en-suite bathroom of a service user with dementia. It was also noted that the service users did not have a cabinet for the storage of items such as shampoo and talcum powder, which could be hazardous if inappropriately used by a non-supervised service user with dementia. A requirement for the service to ensure that the premises are free from any offensive odours was met and the home was clean. Hawthorn Green Care Home DS0000007357.V298066.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The recent documentation for the recruitment and induction of staff was satisfactory; however, the home did not demonstrate that the safety of service users would be assured through re-checking any staff references that were not correctly validated at the time of appointment. Progress had been attained with dementia training; however, the home did not evidence individual staff training profiles. EVIDENCE: The home demonstrated that staffing levels were in accordance to the Minimum Staffing Levels assigned by the Health Authority.A requirement was issued in the previous inspection report for the home to ensure that staff references were consistently checked for their validity and that all staff had received a minimum of a Protection of Vulnerable Adults First check prior to employment. Another requirement was issued for the home to demonstrate that new staff received a comprehensive programme of induction training that is properly documented. These requirements were checked by one of the inspectors and found to have been met. The inspectors noted that the service had not retrospectively taken action to rectify the discrepancies discovered in staff files at the last inspection, although the timescale applied in the last inspection report was specifically set to allow for retrospective checks. Hawthorn Green Care Home DS0000007357.V298066.R01.S.doc Version 5.2 Page 21 A requirement was issued in the previous inspection report for the home to ensure that the staff were trained to meet the needs of the service users admitted to the dementia care units. The home evidenced that many of the staff had attended relevant training and that other staff had been booked to attend this training. Another requirement was issued for the home to ensure that all staff possessed individual training profiles, which was a repeated requirement. The inspectors found that this had not been met at the time of this inspection. The manager informed the inspectors that the timescale for completion was not realistic; however, the CSCI was not advised of this when the home submitted its Action Plan following the last inspection. This requirement has been repeated again with a new timescale. Hawthorn Green Care Home DS0000007357.V298066.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Good practices for financial processes were identified, and staff were receiving a regular programme of supervision. The managerial auditing of standards within the home needed some development. The health and safety of service users must be promoted through ensuring that food has not expired and that refrigerator temperatures are monitored and recorded. EVIDENCE: At the time of this inspection, the manager had applied to the CSCI for registration for ‘registered manager’ status. It has been confirmed that this interview will be conducted in August 2006. The manager had been in post for almost five months at the time of this inspection. It was noted that some good practices were in place, such as separate meetings for service users, relatives Hawthorn Green Care Home DS0000007357.V298066.R01.S.doc Version 5.2 Page 23 and staff. The inspectors noted that some initiatives, particularly the auditing of care plans and medication practices, needed to extend beyond ensuring that documents had been completed and to exercise judgement as to whether beneficial actions were being taken to support the personal care, health care and medication needs of individuals. The inspectors found that the CSCI were not advised of when the home deemed that more time was needed to meet the timescales within inspection reports. A requirement was issued in the previous inspection report for the home to ensure that all staff received a minimum of six formal ‘one –to-one ‘ supervisions per year. A randomly selected sample of staff files were looked at by one of the inspectors, which demonstrated that supervision was being provided on a suitably regular basis. An inspector checked the home’s system for general accounting (petty cash expenses) and the management of service users finances; these systems were noted to be maintained in an orderly and transparent manner. A requirement was issued in the previous inspection report for the home to ensure that a) out of date food was not stored in the service users refrigerators b) food temperatures were recorded daily and c) refrigerator temperatures were recorded daily. As identified within Standard 9 of this report, the inspectors found that one of the medication refrigerators had a faulty thermometer for twenty days. It was also observed that the refrigerator temperatures had not been recorded for six days in June, on one of the units. The inspectors found that satisfactory records were maintained for food temperatures; however, the inspectors found yoghurt that had expired within the refrigerator in a service user’s bedroom. The care plan for this service user demonstrated that they required assistance with the monitoring of the contents of their refrigerator, due to their diagnosed care needs. The inspectors checked the home’s records for health and safety inspections and practices (for example, fire, gas, water and electrical safety), which were found to be satisfactorily adhered to. Hawthorn Green Care Home DS0000007357.V298066.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 3 2 X X X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 2 X 3 3 3 X 2 Hawthorn Green Care Home DS0000007357.V298066.R01.S.doc Version 5.2 Page 25 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 12 and 15 Requirement The Registered Person must ensure that the care plans for service users satisfactorily document the care planning needs and outcomes for individuals. The Registered Person must ensure that accurate information relating to service users weight and appetite status is maintained, which must be audited by senior staff. The Registered Person must ensure that topically applied creams and lotions are securely stored. This is a repeated requirement. The Registered Person must ensure the on going monitoring of refrigerator temperatures. This is a repeated requirement. The Registered Person must ensure that pharmacy labels are not altered by biro pen. The Registered Person must ensure that medications no longer required are disposed of DS0000007357.V298066.R01.S.doc Timescale for action 31/10/06 2. OP8 12 30/08/06 3. OP9 13 (2) 30/07/06 4. OP9 13 (2) 30/07/06 5. 6. OP9 OP9 13 (2) 13 (2) 30/07/06 30/07/06 Hawthorn Green Care Home Version 5.2 Page 26 7. OP9 13 (2) 8. OP10 12 (2) 9. OP18 13 (6) 10. OP18 21 11. OP29 19 12. OP30 18 13. OP32 12 safely in accordance to the home’s medication policy. The Registered Person must ensure that the pharmacy labels for topical medications clearly state the location and frequency of application, or that this information is recorded on the medication administration record. The Registered Person must ensure the dignity and choices of service users with dementia, through improved liaison with their representatives. A new timescale has been applied to this repeated requirement to enable the home to formally meet the representatives of service users with dementia at a six monthly care planning review meeting. The Registered Person must ensure that the homes own Adult Protection procedure and the local Social Services Adult Protection procedure is adhered to regarding suspension of staff. The Registered Person must ensure that the Whistle-blowing policy advises staff of appropriate organisations that they can whistle-blow to. The Registered Person must ensure that all staff files evidence that rigorous checks have been undertaken on all staff references. This is a repeated requirement. The Registered Person must ensure that all staff possess an individual training profile that is maintained within the home. This is a repeated requirement. The Registered Person must ensure that the needs of the DS0000007357.V298066.R01.S.doc 30/07/06 30/06/06 30/07/06 30/09/06 31/10/06 31/10/06 30/09/06 Page 27 Hawthorn Green Care Home Version 5.2 14. OP38 13 service users are promoted through rigorous auditing of the quality of their care. The registered person must ensure that out of date food is not stored in the service users refrigerators. This is a repeated requirement. 30/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP8 OP12 Good Practice Recommendations The home should ensure that a copy of the local Tissue Viability policy is maintained on each unit. The home should provide a choice of sensory equipment and musical instruments on each of the units for people with dementia, to enable staff to facilitate activity sessions in the absence of the activities staff. The home should print accessible menu cards for display on dining tables. The home should ensure that additional supplies of kitchen hygiene headwear are available on the premises. The home should make proper arrangements to display that the first floor toilet close to the manager’s office and the service users activity room is for staff only. Alternatively, the call bell cord should be accessible to service users that use this toilet. It is recommended that the call bell cord be placed in an accessible position within the visitors’ toilet. The home should provide furniture and decorations that meet the social and emotional needs of people with dementia. 3. 4. 5. OP15 OP15 OP22 6. OP22 Hawthorn Green Care Home DS0000007357.V298066.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ National Enquiry Line: 0845 015 0120 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 Hawthorn Green Care Home DS0000007357.V298066.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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