Inspection on 04/09/07 for Hawthorn Green Nursing Home

This inspection was carried out on 4th September 2007.

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 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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hawthorne Green Care Home 82 Redmans Road Stepney Green London E1 3AG Lead Inspector Sarah Greaves Unannounced Inspection 10:30 4th and 5 September 2007 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 Hawthorne Green Care Home DS0000007357.V352182.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.V352182.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hawthorne 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 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 Hawthorne Green Care Home DS0000007357.V352182.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. 17th July 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. Hawthorne Green Care Home DS0000007357.V352182.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors conducted this unannounced inspection over a period of two days. The inspectors gathered information through speaking to residents, their relatives, staff and the service manager. The inspectors read nine randomly selected care plans, and spoke to these residents (and their relatives, where possible). Information was also obtained through measures such as checking the storage and administration of medication, looking at policies and procedures, checking staff files and touring the premises. The Commission for Social Care Inspection issued the care home with an annual quality assurance assessment several weeks prior to the inspection. This assessment was completed by the home and information provided has been used for this report. At the time of this inspection the care home was being temporarily managed by the group manager for Sanctuary Care nursing homes, referred to within this report as the ‘service manager’. It was confirmed that Sanctuary Care would be seeking to appoint a new permanent manager. What the service does well: What has improved since the last inspection? Twelve requirements and three recommendations were issued in the previous inspection report; eleven of the requirements and all of the recommendations had been met at the time of this inspection. The service demonstrated that care plans now contained more detailed information relating to the health care Hawthorne Green Care Home DS0000007357.V352182.R01.S.doc Version 5.2 Page 6 and social needs of the residents, including social interests, nutritional needs and prevention of pressure sores. Residents with dementia had been offered sensory equipment to enhance their participation in social activities. Systems were in place for the improved management of residents’ topically applied prescribed medications and for the disposal of expired medication, although one expired medication was detected at this inspection. The service demonstrated that staff recruitment had improved and staff guidance regarding whistle blowing now clearly stated that staff could contact the Commission for Social Care Inspection regarding any concerns relating to the conduct of the care home. The service manager now checked all complaints. The service now produced menu cards that were easier to read and staff demonstrated that they were aware of the food that they were serving. What they could do better: Ten requirements have been issued in this report, including one repeated requirement. Although the care plans were being audited, managerial and senior staff must check that correct information is being used for individual clinical assessments. There is also a need to ensure that accurate personal hygiene records are maintained and that residents are provided with pressure relieving equipment. The service needs to improve upon its delivery of staff training (inclusive of Adult Protection training) and ensure that staff receive suitable formal supervision. The service must review its staffing levels for afternoons and evenings in order to ensure that the holistic needs of residents can be properly met. Residents must be provided with a safe and comfortable environment. The service needs to address malodours within the premises, unlocked cupboards that contain substances hazardous to health and cluttered fire corridors. The garden needs to be developed into a well-maintained and relaxing facility. The care home needs to demonstrate that the views of residents (and their representatives) are being sought as part of its measures to improve the service. Three recommendations have been included in this report. The service should clearly identify expiry dates for medications. Nursing and care staff should be supported and trained to become more involved with meeting the social needs of residents, and the service needs to develop more links with people and organisations in the local community. Hawthorne Green Care Home DS0000007357.V352182.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.V352182.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.V352182.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Standard 6 (key standard) was not assessed, as it was not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents (and their families) are provided with appropriate information and assessments prior to admission to the care home. EVIDENCE: The service produced a satisfactorily presented Statement of Purpose and Service Users Guide. Discussions with residents and relatives during the course of the inspection identified that the residents (and their families and friends) felt that the care home provided suitable pre-admission information (including a guided tour by a senior member of staff) in order to enable people to make an informed decision about whether to move into the home for a trial period. Hawthorne Green Care Home DS0000007357.V352182.R01.S.doc Version 5.2 Page 10 The service manager acknowledged that alterations to these documents would be required to record the appointment of a new manager. The inspectors were informed that the vast majority of residents were admitted to the care home via arrangements by social services departments or the local primary care trust. Through reading the assessments within the nine care plans looked at during this inspection, the inspectors found that appropriate pre-admission assessments had been undertaken by external health and social care professionals and by senior staff within the home. The inspectors did not find any evidence to suggest that any residents were inappropriately placed. Hawthorne Green Care Home DS0000007357.V352182.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, 10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements were observed in the service’s care planning; however, more detailed auditing is needed to ensure the accuracy of clinical assessments and monitoring charts. Residents and their relatives reported that they were treated in a respectful manner. The service needs to focus upon improving the quality of its care planning, delivery of care and staff training to meet the needs of residents with end of life needs. EVIDENCE: A total of nine care plans were read during this inspecting. The inspectors were informed that the care plans had been recently audited and altered, in order to demonstrate a more individualised approach to identifying and meeting each resident’s holistic needs. The inspectors observed this approach; for example, Hawthorne Green Care Home DS0000007357.V352182.R01.S.doc Version 5.2 Page 12 the planning to meet a person’s nutritional needs now stated their known preferences for meals and beverages (including any specific instructions for the preparation of drinks). The inspectors found that the care plans contained details of how the care home proposed to address the needs of the residents and there was recorded evidence to indicate that each care plan issue was reviewed on a monthly basis; however, there were a significant number of mistakes noted with the use of recognised clinical tools. For example, the nursing staff completed prevention of falls assessments, which required staff to accurately identify which types of medication residents received (such as aperients and diuretics); however, the inspectors found that these assessments did not consistently match with the information found on individual’s medication charts. The care home used a clinical guideline (Waterlow) for assessing an individual’s susceptibility to developing pressure sores. The inspectors found that although one Waterlow assessment identified that the person had healthy skin, the care plan reported that blisters had been recognised and were being treated. Another Waterlow assessment was inaccurately scored for a person known to have dry skin. It was also noted that an incorrect score had been issued in a dependency profile; this mistake was repeated for two consecutive months. The care plans had been signed by residents (or their next of kin, if applicable). The inspectors were advised that the care home was due to switch to a different system of care planning that would commence a few weeks after the inspection. A requirement was issued in the previous inspection report for the registered person to ensure that the needs of the residents were promoted through rigorous auditing of the quality of the care. The care home demonstrated that a Sanctuary Care deputy manager was brought in from another care home to specifically work on the quality of the care planning. The inspectors were shown a guidance tool that was used in order to prompt a comprehensive approach to gathering information to address aspects of residents’ activities of daily living. The inspectors observed that the physical appearance of the residents’ indicated that support was offered with personal care tasks. Residents presented as being neatly dressed and their hair was groomed. One of the care plans stated that a resident needed assistance to have a shower once a month; there was no information to indicate that this person was offered baths. The other care plans seen by the inspectors did not demonstrate that residents were able to access a bath or shower more than once a week. It was noted that the care plan for a resident that was fed via a gastrostomy tube (not allowed any oral fluids or foods) appropriately contained guidance regarding how to cleanse and freshen the person’s mouth; however, this guidance did not extend to moisturising their lips, although the inspector observed the presence of noticeably dry lips. The inspectors observed that there were gaps Hawthorne Green Care Home DS0000007357.V352182.R01.S.doc Version 5.2 Page 13 in the recording of hygiene care, for example, one care plan did not state whether a resident had received a bath, shower, bed bath, or wash for three days. A couple of visitors raised concerns regarding the standard and frequency of hygiene care, and the inspectors received a number of comments about clothes (particularly bed clothes and underwear) being inadequately cared for (lost, damaged by the washing process and not being hung up on appropriate hangers). One of the residents informed the inspectors that they felt uncomfortable sitting in their wheelchair; it was noted that this person had not been issued with a pressure-relieving cushion for the wheelchair. Another resident stated that they did not feel comfortable in their chair. The inspectors spoke to a visiting registered nurse from the local Primary Care Trust (who had conducted an assessment of this individual’s needs) and were informed that the nursing assessment had confirmed the need for a referral to an occupational therapist for a new chair. As previously stated within this report, the inspectors identified discrepancies with the use of the Waterlow assessments for the preventions of pressure sores. The inspectors noted that there was no recorded information within the care plans to indicate why particular settings were selected for the pressure relieving mattresses. The care plans were noted to contain more detailed information regarding how people’s continence needs were managed, than previously observed. The care home had adopted a new system (demispan measurements) for calculating whether residents presented with a too low, too high or healthy weight. The inspectors noted that one person had lost a significant amount of weight (13 kilograms in one month); this information had been appropriately referred to the general practitioner and a dietician, and satisfactory weight gains were noted in subsequent months. The service manager stated that the care home would be adopting a new nutritional assessment, (Malnutrition Universal Screening Tool) which was reported to have been successfully used at other Sanctuary Care establishments. A significant number of issues of concern regarding the care, safety and welfare of residents have been raised by health and social care professionals since the last inspection visit. These concerns have been investigated by the Tower Hamlets Adult Protection team and have identified poor practices within the care home. The inspectors checked the care home’s storage and recording of medication on one of the units. It was noted that prescribed medications were securely maintained, the unit possessed an up-to-date medication guidance book and the medication refrigerator daily temperatures were within acceptable ranges. Three requirements relating to medication were issued in the previous inspection report; two of these requirements were fully met and the third requirement was partially met. The inspectors found that prescribed topically Hawthorne Green Care Home DS0000007357.V352182.R01.S.doc Version 5.2 Page 14 applied lotions and creams were securely stored (this was tested through checking in a substantial number of bedrooms) and clear information regarding the location and frequency of topical applications was found on either the pharmacy label and /or the medication administration record. A requirement was issued in the last report for the care home to ensure that medications no longer required are appropriately disposed of. It was noted that there were clear systems for removing medications that were no longer required. However, the inspector found that a medication that had expired by 01/09/07 was still being used on 05/09/07. The staff nurse stated that she had given this medication on the morning of the first day of the inspection, as she had not noticed a written instruction for disposal, which was on a separate sticker, rather than on the main pharmacy label. A recommendation has been issued for the service to highlight expiry dates on medications (a system that was being used for eardrops and eye-drops. The inspectors noted that a resident that had been recently discharged from hospital had not received a newly prescribed medication for five days (the medication was being administered at the time of this inspection). The inspectors were informed that the resident had been discharged from hospital without the new medication and although the care home had promptly sought to rectify this situation, delays had occurred between the General Practitioner and the pharmacy. The inspectors were surprised that the unit had not reported this occurrence to the service manager so that steps could be taken to avoid a repeat of this problem. The inspectors spoke to residents (and their representatives, where possible) regarding their experiences of the care home. Overall, people informed the inspectors that they liked the staff and felt that they were treated in a respectful, polite and friendly manner. One of the residents stated that they thought staff had not respected their entitlement to privacy (the inspectors were not in a position to ascertain the accuracy of this statement, but have acknowledged that the care home had appeared to deal with a sensitive issue in an appropriate manner, in conjunction with health and social services personnel). The inspectors did not observe any practices during this inspection that infringed upon the rights of the residents. A requirement was issued in the previous inspection report for the care home to develop upon its ‘End of Life’ care planning. The inspectors noted that limited progress had been achieved, for example, relevant documents were not properly signed regarding peoples’ last wishes. The service manager stated that she had arranged a meeting with the care home’s General Practitioner in order to establish protocols for managing the changing needs of residents. The Commission for Social Care Inspection has been informed of concerns by local hospital doctors in regard to the care home’s failure to appropriately respond to deteriorations in residents’ health, which should ordinarily be managed within a care home, that provides nursing care. Hawthorne Green Care Home DS0000007357.V352182.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 adequate. This judgement has been made using available evidence including a visit to this service. Residents were offered opportunities to take part in activities within the home and in the community; however, the service needs to improve links with local resources and encourage nursing/care staff to participate in the social stimulation of individuals. Residents were supported to make choices, and the food service was good. EVIDENCE: The inspectors met with the care home’s activities organisers. At the time of this inspection there were two activities organisers, a full-time worker (36 hours) and a part-time worker (19 hours). The activities team had only worked together for two weeks; hence there was limited evidence of their attainments. The inspector was shown a monthly plan, which included group activities (such as reminiscence, gardening, bingo, quizzes, crafts and musical entertainments) and time spent on one-to-one discussions with people that are not able to or do not wish to engage in group sessions. The inspectors were informed that Hawthorne Green Care Home DS0000007357.V352182.R01.S.doc Version 5.2 Page 16 the care home had organised some entertainments during the summer, including trips to Brighton, Margate, Regents Park (for people too frail to travel far) Bethnal Green Museum of Childhood and pub lunches. The inspectors were informed that the care home had retained its links with ‘Magic Me’, an intergenerational arts project; however, there was otherwise a limited range of local resources offered to enable residents to benefit from the stimulation of meeting people from their communities. At the time of this inspection the care home had appointed a volunteer with experience and knowledge of Bangladeshi traditions, but this person had not yet commenced their voluntary work. The inspectors noted that the new activities team were positively responded to by residents and relatives. Residents and their visitors were observed to participate in quizzes and afternoon tea in the garden during the course of this inspection. The inspectors did not witness a planned approach to staff spending time with residents; for example, staff allocating a specific time each afternoon to interact with the residents by chatting or using sensory equipment in order to promote communication with people with dementia. The inspectors met a number of relatives during the course of the inspection. Visiting hours were flexible and residents could receive visitors in the communal rooms or in the privacy of their own rooms. Representatives of their religious faith visited some residents, although these visits appeared limited. A recommendation has been issued within this report for the registered person to assess the care home’s current arrangements for accessing religious ministers (or persons authorised to visit on their behalf), in order to determine if the needs and aspirations of residents are being met. Via the checking of the care home’s maintenance of residents’ financial records, the inspectors noted that some residents actively exercised choices regarding how they spent their personal allowances. The tour of the premises also demonstrated that many residents had personalised their bedrooms with framed photographs, ornaments, cushions and small items of furniture. The inspectors did not meet any residents at this inspection that expressed an interest in accessing advocacy services or looking at their personal files; however, visitors stated that they would raise any issues of concern with social services or the care home manager. The inspectors looked at the menus and observed the serving of meals. Recommendations were issued in the previous inspection report for the daily menu information to be produced in a larger, more accessible print and for staff to be informed of the food that they are serving; these recommendations were found to be met. Residents stated that they enjoyed their food and were offered choices; however, one resident stated that they were given mushroom soup even though they had expressed that they do not like this particular soup. The inspector found that there was a good choice of food items, for example, there was a choice of seven different breakfast cereals including Hawthorne Green Care Home DS0000007357.V352182.R01.S.doc Version 5.2 Page 17 porridge and a daily cooked breakfast was available. Residents were able to choose items (such as salads, sandwiches and omelettes) if they did not like the options on the regular menu. The inspectors noted that fresh fruit was sent to the units and homemade cakes were provided once a week; the service manager agreed with the inspector’s suggestion for an increased frequency of homemade cakes. The needs of people with diabetes were met through the provision of very low sugar and sugar free desserts, appropriate biscuits and preserves. The catering staff stated that four people were receiving fortified diets for weight gain, in accordance to the advice of dieticians. Hawthorne Green Care Home DS0000007357.V352182.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 adequate. This judgement has been made using available evidence including a visit to this service. Residents are assured that their complaints will be suitably investigated and acted upon. However, the service needs to ensure that staff are properly supported to fully understand their responsibilities regarding protecting residents from abuse. EVIDENCE: The care home produced a satisfactorily written complaints procedure, which was included within the Service Users Guide. The inspectors met a visitor that was unaware that they could make a complaint to the manager of the care home; however, some residents and all other visitors understood how to make complaints. A requirement was issued in the previous inspection report for the care home to demonstrate that there is a system to ensure that complaints are adequately investigated, via auditing of all complaints by the registered person. Following discussion with the service manager this requirement has been deleted; the manager now views every complaint. Hawthorne Green Care Home DS0000007357.V352182.R01.S.doc Version 5.2 Page 19 A requirement was issued in the previous inspection report for the care home to ensure that the whistle-blowing policy advised staff of their entitlement to contact relevant external organisations if they had concerns about the conduct of management. This requirement was met. The inspectors expressed concerns regarding the quality of training for staff (duration, frequency and actual content); these concerns included the Adult Protection training. The service manager acknowledged that training had been delivered in a manner that was not consistent with Sanctuary care’s approach. The care home used its own Adult Protection procedure, in conjunction with the local procedures issued by Tower Hamlets Social Services. The Sanctuary Care Adult Protection procedure was stated to be subject to review. The inspector spoke to two care staff regarding the Adult Protection procedure and whistle blowing, and found that staff were not clear about these issues. Hawthorne Green Care Home DS0000007357.V352182.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, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service demonstrated that some improvements had been attained since the last inspection; however, the care home must ensure the safety and comfort of residents through more rigorous measures to ensure that the environment is free from potentially dangerous items and unpleasant odours. EVIDENCE: Hawthorne Green is a purpose built care home, which is divided into six separate units. Residents’ accommodation is located on three floors and the building is served by passenger lifts. Hawthorne Green Care Home DS0000007357.V352182.R01.S.doc Version 5.2 Page 21 A requirement was issued in the previous inspection report for the care home to ensure that unsightly staining was removed from the walls. The service manager and maintenance person confirmed that a full programme to redecorate all of the bedrooms had been commenced, starting with the rooms observed to need the most immediate attention. At the time of this inspection at least thirty (out of ninety bedrooms) had been redecorated. A requirement was also issued for the care home to ensure that malodours in residents’ bedrooms were more effectively dealt with. The inspectors did note at this inspection that there were still areas within the home that presented unacceptable odours. The service manager was aware of these specific concerns and stated that actions were being taken such as the removal of carpets, more frequent cleaning of the carpets and the use of new cleaning agents. This requirement will be repeated. The inspectors toured the premises and made the following observations: 1. Cupboards containing substances hazardous to health were left unlocked on the first and second floors. 2. Discarded cupboard brackets and a hoist were found in a small passageway that was marked as a fire exit. 3. The door concealed internal piping for the heating system was left unlocked on one of the units for people with dementia. 4. Communal rooms, bathrooms and ceilings with stained and chipped paintwork. 5. Dead plant left on windowsill. 6. Rear garden neglected and overgrown. It was noted in the last inspection report that a residents’ bedroom was being used to store equipment that did not belong to the resident. At this inspection the inspectors found two walking aids in the en-suite bathroom of a resident that is immobile and not known to require this equipment. These items were removed by the second day of the inspection and the further examples were found of this unacceptable practice. The inspectors found that the standards of bedrooms varied. It was noted that a resident who did not have regular visitors had a torn duvet on top of their wardrobe and a broken picture frame on their cabinet. Other bedrooms were noted to be smartly maintained; items within the rooms suggested that the residents received regular visitors. Hawthorne Green Care Home DS0000007357.V352182.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 adequate. This judgement has been made using available evidence including a visit to this service. Although the safety and welfare needs of residents were addressed through satisfactory staff recruitment practices, the service needs to ensure that staffing levels can meet the holistic needs of individuals during afternoons and evenings. Care staff were enabled to access National Vocational Qualifications training in order to understand and meet the needs of the residents; however, the service must improve upon the quality of its mandatory and additional training. EVIDENCE: The inspectors discussed the staffing numbers with the service manager. At the time of this inspection, three members of staff (one qualified nurse and two care workers) were allocated to each fifteen-bedded unit between 8am and 8pm. A ‘floating’ member of staff was employed between 8am and 2pm to work between the two units on each floor. Four staff (one qualified nurse and three care workers) were employed to work on each floor at night time. The inspectors observed that it was difficult for three staff to manage during the Hawthorne Green Care Home DS0000007357.V352182.R01.S.doc Version 5.2 Page 23 afternoon, particularly at times that there were conflicting needs on the units (such as the staff nurse administering medication, a care worker dispensing afternoon drinks, residents needing support with toileting and generally ensuring the welfare and safety of all residents). A requirement has been issued for the care home to demonstrate robust arrangements to ensure that the needs of the residents are met through adequate staffing levels. Via discussion with the service manager, the inspectors found that 53 of care workers had attained a National Vocational Qualification (NVQ) at level 2 or 3; therefore the care home met the National Minimum Standard for achieving a qualified work force with at least 50 of care staff with a relevant NVQ. A requirement was issued in the previous inspection report for the care home to ensure that all staff possessed two rigorously checked references. The inspectors looked at six randomly chosen staff files. It was noted that the standard of recruitment for members of staff more recently appointed was in accordance to the stipulations of the National Minimum Standards and Regulations. Through checking the files of staff that had been employed at the care home for several years and via discussion with the service manager, the inspectors found that there had been a satisfactory effort to retrospectively secure absent references. This requirement has now been deleted. As previously stated within this report, the inspectors found insufficient evidence to demonstrate that staff have been receiving a comprehensive and effectively presented package of training. Staff files evidenced that numerous training sessions were delivered on one day and the evaluation forms did not demonstrate if staff had understood their training. Hawthorne Green Care Home DS0000007357.V352182.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 adequate. This judgement has been made using available evidence including a visit to this service. Although residents were benefiting from recent management changes, the service needs to demonstrate on-going work to ensure that the wishes of the residents (and their representatives) contribute towards the improvement of the service. Residents are assured that their personal finances will be safely managed; however, the service needs to ensure that residents are protected through the provision of a safe environment and effective staff supervision. EVIDENCE: Hawthorne Green Care Home DS0000007357.V352182.R01.S.doc Version 5.2 Page 25 At the time of this inspection the service manager was managing the care home, which had been a temporary arrangement for several weeks. The inspectors were informed that the registered manager was not returning to the care home. The service manager is appropriately qualified (registered nurse with a management qualification) and has extensive prior experience of managing care homes. The inspectors noted that the service manager was conducting meetings with residents and their relatives. All of the visitors spoken to at this inspection confirmed that they had met the service manager and appeared to have some understanding of why management changes had occurred. Relatives reported that they had not felt consulted and involved regarding practices at the care home until the service manager took over the daily management of the service. The financial records for five randomly chosen residents were looked at; no issues of concern were identified. The service evidenced that staff were being provided with at least six formal supervisions per year; however, these supervisions were not individualised and failed to address relevant areas of practice. The inspectors found an example of two staff possessing almost identical supervision records. The inspectors checked the health and safety records for the following practices, which were found to be satisfactory; electrical installations, fire alarm testing, weekly wheelchair checks, refrigerator temperatures, landlord’s gas safety, legionella, emergency lighting testing and the maintenance of the hoists. The inspectors were provided with evidence to demonstrate that although the portable electrical appliances’ testing was overdue, arrangements were in place to obtain new equipment to conduct these tests. As previously recorded within this report, the inspectors found that hazardous equipment was not consistently kept locked up and a corridor (a fire escape route) was cluttered. The inspector found out-of-date food in a refrigerator on one of the units. It was acknowledged that a relative had brought the food in that day and placed it in the refrigerator without notifying staff. The inspector advised that relatives should be reminded to inform a member of staff so that the food can be checked and labelled. Hawthorne Green Care Home DS0000007357.V352182.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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 X X X 2 X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Hawthorne Green Care Home DS0000007357.V352182.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 ensure that the information entered within the clinical assessments is audited to check for accuracy in order to provide residents with individualised and safe care. The Registered Person must ensure that care plan records relating to meeting the hygiene needs of individuals are kept upto-date in order for staff to effectively monitor whether personal care plans are being met in accordance to the needs and wishes of residents. The Registered Person must ensure that residents are provided with equipment to promote the prevention of pressure sores. The Registered Person must ensure that staff receive training to understand the Adult Protection procedures produced by the service provider and the local social services, so that residents can effectively be safeguarded from abuse. DS0000007357.V352182.R01.S.doc Timescale for action 31/01/08 2. OP8 16(2) (c) 31/01/08 3. OP18 18 (1) (c) 31/03/08 Hawthorne Green Care Home Version 5.2 Page 28 4. OP20 23 (2) (o) 5. OP26 16 (2) (k) 6. OP27 18 (1) (a) 7. OP30 18 (1) (c) 8. OP33 24 9. OP36 18 (2) 10. OP38 13 (4) The Registered Person must ensure that the garden area is improved in order to provide a pleasant and relaxing environment for residents and their visitors. The Registered Person must ensure that malodours within the premises are eradicated so that residents are provided with a pleasant and clean environment. This is a repeated requirement. The Registered Person must ensure that the staffing levels for the late shift are reviewed, so that residents are safely supported with their holistic needs. The Registered Person must ensure that staff receive a comprehensive training package with sufficient time for training and evaluation, in order for residents to have their needs understood and addressed by properly trained staff. The Registered Person must ensure that the service demonstrates robust systems for seeking the views of the residents and their representatives, so that improvements to the service take into account their experiences of living at the care home. The Registered Person must ensure that staff receive individualised and relevant formal supervision, in order to provide a forum for supporting staff to improve their practice. The Registered Person must ensure that a safe environment is provided (fire exit corridors to be kept free of clutter and hazardous items cupboards to be DS0000007357.V352182.R01.S.doc 30/04/08 31/12/07 31/12/07 31/03/08 31/03/08 31/12/07 30/11/07 Hawthorne Green Care Home Version 5.2 Page 29 kept locked) to promote the security and welfare of the residents. 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 OP12 OP13 Good Practice Recommendations The service should introduce a system to highlight the expiry dates on medications. Nursing and care staff should be encouraged to engage residents with activities. The service should develop more links with community organisations, including resources for people from minority ethnic communities. Hawthorne Green Care Home DS0000007357.V352182.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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.V352182.R01.S.doc Version 5.2 Page 31 - 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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