Inspection on 21/08/07 for Hawthorn House

This inspection was carried out on 21st August 2007.

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

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

Other inspections for this house

Hawthorn House 05/09/06

Hawthorn House 06/03/06

Hawthorn House 20/04/05

Hawthorn House 13/01/05

Hawthorn House 03/08/04

Hawthorn House 27/01/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hawthorn House 19 Ketwell Lane Hedon East Yorkshire HU12 8BW Lead Inspector Angela Sizer Key Unannounced Inspection 21st August 2007 09:30 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 House DS0000036095.V349114.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 House DS0000036095.V349114.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hawthorn House Address 19 Ketwell Lane Hedon East Yorkshire HU12 8BW 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) 01482 898425 F/P01482 898425 Claire Louise Johnson Charles William Johnson Claire Louise Johnson Care Home 22 Category(ies) of Dementia - over 65 years of age (22), Old age, registration, with number not falling within any other category (22) of places Hawthorn House DS0000036095.V349114.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th September 2006 Brief Description of the Service: Hawthorn House is a privately owned residential home that is close to the town centre of Hedon. The home is close to the main road and access to public transport. The home has a minibus available to take service users on days out. The home is registered for 22 people over the age of sixty-five of either sex. It also provides for those service users who may have dementia. The home has recently had an extension built to the rear of home and the accommodation provided is now in one shared room and 20 single rooms, 17 having ensuite facilities. There are two communal lounges, a separate dining room and a conservatory. All areas of the home are accessible to service users via the provision of a stair lift and a passenger lift. The latter was installed at the same time the extension was built. The home is well maintained and there is a car park at the front of the building and a garden to the rear. The weekly charges are £334.03 to £387.03 and there are additional charges for hairdressing, chiropody, toiletries, bingo, newspapers and magazines and in some cases continence aids. This information was provided by the manager on the day of the inspection visit. Information is available about the service through the statement of purpose and service user guide. Hawthorn House DS0000036095.V349114.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key inspection of the home on 5.09.06, including information gathered during a site visit to the home on 21.08.07. The site visit was part of the key inspection process and took place over one day and took a total of 9.5 hours. Prior to the visit surveys were posted out to 22 of the residents and 8 were returned, 15 to relatives and 10 were returned, 10 were sent to staff members and 6 were returned, of the 6 sent to health care professionals 2 were returned and 2 were sent to care managers 1 of which was returned. The registered provider returned the Annual Quality Assurance Assessment and this gave some details about the service including staffing, training, quality assurance system and other procedures. From this information the decision was made about which staff and resident files would be looked at. A discussion occurred with the manager about the recommendations made during the last inspection visit and it was stated that these had been met in full and evidence was seen confirming this. During the visit several of the residents, two relatives and two staff members were spoken to this was to find out what it was like for people who live here. A tour of the building was undertaken; some of the records looked at included the 3 resident files, 3 staff files and other paperwork relating to the maintenance of the home and the care of the residents. This was to ensure that the needs of the residents are properly assessed and there are individual plans of care in place for each person. It is also to make sure that the building is run in a safe way. A discussion with the manager occurred regarding diverse needs and in particular how the residents are currently supported to follow their religion of choice and practise their faith. The registered manager who is also one of the registered providers was present throughout the inspection and was told how the inspection had gone at the end of the day. The inspector would like to thank the residents, manager and staff for welcoming her into the home and contributing to the content of this report. What the service does well: Hawthorn House DS0000036095.V349114.R01.S.doc Version 5.2 Page 6 The home continues to offer an excellent standard of accommodation and the environment is clean, hygienic and the atmosphere is friendly and welcoming, which makes Hawthorn House a very nice place to live. Eight surveys from people who live in the home confirmed that they were very happy to live there and some comments included; “very good home, it’s lovely and clean all of the time”, “it is a lovely place to live”, “my room is very nice”, “I am happy with my room”, “it’s a real home from home, they look after me very well”. Nine surveys were received from relatives confirming that the standard of the environment was of a very good standard, some comments were; “it doesn’t matter when I come the home is always clean and tidy”, “as clean if not cleaner than home”. The ethos of the home is to maintain and promote independence and for the residents to be treated as individuals. Respect and dignity are a high priority for the manager and staff and this was confirmed by speaking to several residents. Residents are supported to carry out activities/hobbies of their choice. From speaking to some of the people who live in the home and two relatives it was clear that they have good relationships with the staff, some comments included; “everybody who works at the home are always friendly when my mother has visitors and make them very welcome”, “they are sensitive to the individual needs of all the people in there. They are very understanding of relatives emotional issues and to make the care home as private for each family as possible”, “they treat all residents as part of the family and give them love, care and attention you would give a family member”. People who use the service have their needs fully assessed prior to moving into the home and prospective residents know that the home will meet their needs prior to admission. The care planning system is clear and is reviewed, this ensures that all of the residents’ needs are recorded and monitored on a regular basis. People who use the service are able to take part in appropriate activities and make choices in their daily lives. Therefore they are supported and enabled to live an independent life as is possible. The menu continues to be nutritious, wholesome and the choice offered is excellent. Some comments from residents included; “give praise to our two cooks, everything is done the way I like it”, “the food and menu is lovely”. The home has a very good complaints procedure and from speaking to residents and relatives they are confident in the management when dealing with any issues. On the whole staff are well trained, experienced and competent therefore ensuring that residents’ needs are fully met and understood. Hawthorn House DS0000036095.V349114.R01.S.doc Version 5.2 Page 7 The home’s quality assurance system ensures that residents and other people who visit the home have their say about how it is run, what is good and what needs changing. What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Hawthorn House DS0000036095.V349114.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 Hawthorn House DS0000036095.V349114.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): 2,3 & 5 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who use the service are issued with a statement of terms and conditions that describes the facilities offered. People who use the service have their needs fully assessed prior to moving into the home. Prospective residents know that the home will meet their needs prior to admission. EVIDENCE: During the inspection visit three of the resident’s files were looked at and there was evidence confirming that a contract/statement of terms and conditions is issued and that this covers all the required areas including the room to be Hawthorn House DS0000036095.V349114.R01.S.doc Version 5.2 Page 10 occupied, overall care and services offered, fees payable, any additional costs and the terms and conditions of occupancy including the period of notice. Therefore residents are fully informed of what they will receive for their money. A discussion was held with the manager regarding the assessment process and how the home ensures that any prospective residents will have their needs fully met by the home. The manager stated that, “prospective residents are able to visit the home and try it out before moving in”. She also explained that each person receives either a home or hospital visit from her to ensure that his or her needs are able to be met and to gather more information, evidence of this was seen during the visit. During the inspection visit three of the resident’s files were looked at and there was evidence confirming that the people who use the service either have a community care assessment or an assessment undertaken by the home, this usually occurs prior to or within a few days of admission. The home continues to work with the person and develops a draft service user plan which includes aspects of daily life within the home and more diverse needs such as physical impairment, learning disabilities, cognitive impairment, sensory impairment, intermediate or respite care required, cultural needs and ethnicity. A service user plan is then drawn up detailing what action is to be carried out by the care staff, the home works with this document for the first 12 weeks after admission at which point a review is held to discuss whether all needs have been identified. There was evidence in place to confirm that regular reviews are undertaken, usually on a six monthly basis. From speaking to residents and relatives it was clear that they were fully involved in the assessment process and this was explained to them. A relative spoken to confirmed that the family had been kept informed, “we were able to visit the home before my mother made the decision to move in, the manager always keeps me informed about what is happening”. This shows that people who use the service have their needs assessed both prior to and following admission. A person who uses the service stated; “I came in for two weeks whilst my daughter went for her holiday in the meantime I decided to stay. This was two years ago”, “up to now things have gone very smoothly, hope it stays this way”. Another person said, “I was able to visit with my son and stay for lunch before making my decision to move in, I have settled in well”. This shows that the home promotes inclusion and prospective residents are invited to spend time in the home before making the decision to move in permanently. The home does not provide intermediate care. Hawthorn House DS0000036095.V349114.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 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The care planning system is clear and is reviewed, this ensures that all of the residents’ needs are recorded and monitored on a regular basis. People who use the service receive their medication in a safe way, however improvement is recommended in relation to the returns procedure and for when changes are made to the prescribed medication. This will ensure that there is a clear audit trail in place and therefore make the process more robust. Respect and privacy is promoted within the home and therefore people who live there are treated as an individual and their views are listened to. Hawthorn House DS0000036095.V349114.R01.S.doc Version 5.2 Page 12 EVIDENCE: During the inspection visit three files of people who use the service were seen, these contained individual care plans covering personal and social care needs; communication, personal hygiene and continence, daily routine, past history including medical, religious or cultural needs, hobbies and social interests. A moving and handling risk assessment is undertaken for each person using the service, other risks are also detailed on this document and include dressing/undressing, going out of the building, limitations or communication difficulties. Daily records clearly identified significant events and include activities undertaken, medical assistance and family visits. The plan of care is generated from the home’s assessment of need or the community care plan. The home operates a key worker system and from speaking to several residents it was clear who their worker was and what support they would offer. Some comments made by residents included; “I know who my key worker is, we often have a chat about things”, “I can talk to her when I want to”. There was evidence in place confirming that regular reviews are undertaken, the residents if they are able to are involved in this process and have a chance to give their views. There was written evidence confirming that the person who uses the service or their representative signs the plan. Some comments in the surveys received from relatives included; “we are happy with all aspects of mother’s care”, “they provide a home for the elderly as close to their own environment as possible”, “my mother is very content and happy in her care home and so I feel that she has all her needs and more attended to”. From speaking to the manager it was clear that healthcare needs are monitored on a regular basis, “residents are weighed every six months, but some on a more regular basis and this would be recorded in their individual plans”. The manager has developed a checklist for when residents are discharged from hospital to the home and this covers pressure care, medication issued, belongings, follow up appointments and confirmation is also sent to the GP, this is to ensure that the home as up to date and correct information relating to all aspects of their healthcare needs. A survey received from a staff member detailed how the home meets the healthcare needs of the residents; “we have had a resident who has been poorly in bed for a year, GP’s and family are very happy with her care, all skin is in tact due to the very high standards of care that is received, all her special dietary needs and fluid intakes are met and are logged on a daily chart, all staff check hourly”. Two surveys were received from Health care professionals stating that the health needs of people who use the service were always met and also that dignity and privacy are respected, one stated, “home appears clean, tidy, residents appear happy and well cared for”, “they look after each as an individual, meeting their specific needs. The home has a friendly approach; it feels like ‘home’ when one visits rather than a busy institution. The staff Hawthorn House DS0000036095.V349114.R01.S.doc Version 5.2 Page 13 always seem to have time to listen to residents. It’s a place you’d be happy to have a relative residing there”. The home has policies and procedures in place for administration of medication and staff that dispense medication have undertaken relevant training. One staff member has responsibility for ordering and checking medication. The home has a monitored dosage system in place. The medication for several people who use the service were checked and these where found to be accurate and there were no gaps in recording. A discussion was held with the manager regarding the process of returning medication to the Pharmacist, the manager confirmed that when a resident refuses or does not want their medication “it goes down the waste disposal unit”. Following the inspection visit the CSCI Lead Pharmacist was contacted and advised that it is good practice to return the unwanted or refused medication to the dispensing pharmacist and should be also recorded on the back of the Medication Administration Record to show a clear audit trail. Currently the home operates a system that when a prescription is changed by a GP that this is transcribed onto the Medication Administration Record and signed by the officer in charge, again following discussion and advice sought from the CSCI Pharmacist it is recommended good practice to gain two signatures. There is one service user who self medicates; safe storage is available and staff monitor this. The home has an appropriate system for recording and administering of controlled drugs, there is a CD register and 2 staff signatures are obtained when administering. Residents’ privacy and dignity is maintained within the home and this was confirmed by speaking to some of the residents and two visiting relatives. Some comments included; “the staff knock before they come into my room and they talk to me when they are helping me”, “visitors are welcome at any time, my daughter comes to see me every week, the staff welcome your family and the manager is friendly”. One resident confirmed that staff always calls him by the name he prefers. During the visit residents were observed to be individual in their appearance. A relative also commented that they were able to “visit any time” and that staff are welcoming. It was observed that staff knock on doors before entering. Privacy and dignity is covered in the staff induction process. A number of people who live in the home have their own telephone and a few spoken to said they liked to be able to speak to family and friends on the telephone especially if they lived a distance away from the home. Hawthorn House DS0000036095.V349114.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who use the service are able to take part in appropriate activities and make choices in their daily lives. Therefore they are supported and enabled to live an independent life as is possible. The menu offered is varied and nutritious this ensures that people who live in the home received a healthy diet. EVIDENCE: From speaking to the manager it was confirmed that the activities have been maintained to the same standard as they were at the previous inspection. Activities are arranged for each morning and the programme is displayed on the notice board. A range of activities including quizzes, bingo and craft sessions are provided along with external entertainers who visit the home. People who live in the home explained they could join in if they wish. People living in the home can access a religious service of their choice. For those who cannot go out, clergy visit the home to see individuals and a service is held in Hawthorn House DS0000036095.V349114.R01.S.doc Version 5.2 Page 15 the home once a month. One person said, “I cannot get out any more and so the priest comes to see me”. Records are kept of all activities to ensure stimulation is provided to suit all service users needs. Individual interests are catered for one service user who had an interest in farming is taken out on a regular basis this was confirmed by looking at the written evidence kept and from speaking to the person, “I go out with the owner on a regular basis, I enjoy this very much”. One relative comment card said, “would like to see more visits and outings”. Overall the comments received from the people who live in the home and their relatives were extremely positive and complimentary about the level of activities, outings and social contact that occurs within the home. Some comments included; “I feel that Hawthorn House treats the residents very well in the way that they try to keep them active with craft classes etc. entertainment, bingo and they also take them out on visits whenever possible”. It was confirmed by speaking to several people who live in the home and relatives that family, friends and other visitors can see service users at all reasonable times. People who use the service can choose who they see and can receive visitors in private. One person said, “visitors are welcome at any time, my daughter comes to see me every week, the staff welcome your family”. All relative and visitors comment cards received advised they are always made to feel welcome. Comments from relatives included; “They are sensitive to the individual needs of all the people in there. They are very understanding of relatives emotional issues and to make the care home as private for each family as possible”. It was confirmed by speaking to people who live in the home that they have control over their lives and can make choices. One person said, “ I can make decisions about what I wear, if I want to take part in activities etc”. From speaking to the manager it was confirmed that people are encouraged to handle their own financial affairs for as long as possible. During the visit there was a 90th birthday party occurring, family and friends of the person were welcomed into the home and take part in the festivities. Since the last inspection visit the home has purchased a new mini-bus, the manager stated; “it is used on a regular basis, the last trip was to the villages near Hessle and for a pub lunch, eight service users attended”. The people who live in the home also take part in regular meetings at which they can discuss activities, food and other important areas. One person said, “we have meetings and we can say what we want to do and where we want to go to”. Written evidence was seen confirming this. The menu provided is nutritious, varied and presented in an appealing way. The home has two sittings for lunch and staff helped those service users who required assistance in a discreet and sensitive manner. The dining room is well Hawthorn House DS0000036095.V349114.R01.S.doc Version 5.2 Page 16 laid out with flowers and napkins on the table. Choices are given for both lunch and tea. The lunch choice on the day of the visit was beef stew and dumplings or grilled fish fingers and there were a variety of options for dessert. The surveys received from people who live in the home, relatives and staff were all very complimentary about the food offered and the choice given. Some comments included; “give praise to our two cooks, everything is done the way I like it”, “the food and menu is lovely”. From speaking to the cook it was clear that she had a good understanding the diverse dietary needs of the people who live in the home. It was confirmed that mainly fresh produce is used and that she has undertaken relevant food hygiene and specialised training in relation to the dietary needs of people with Dementia. Hawthorn House DS0000036095.V349114.R01.S.doc Version 5.2 Page 17 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 & 18 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home has a complaints procedure in place that is open and accessible to people who use the service or their representatives; therefore the all complaints are dealt with in an open and fair way. The home has policies and procedures in relation to safeguarding adults, however some staff and management have not undertaken specific training in this area and were unclear about the links with other agencies and the actual procedure in the event of a safeguarding issue occurring. Therefore people who live in the home may not be fully protected from abuse. EVIDENCE: The home has a complaints procedure and this is made available to the people who live in the home and their representatives. There have been no complaints made since the previous inspection. The majority of the service users surveys indicated that they know how to complain and that staff listen and act on what they say. During the inspection visit two people who live in the home were spoken to and both could confirm that if they had a problem or complaint then this would be listened to and acted upon by the management. Two relatives were also spoken to during the visit confirming that the home Hawthorn House DS0000036095.V349114.R01.S.doc Version 5.2 Page 18 responds to complaints in an appropriate manner. Some comments included; “if you have a problem you can talk to Claire or any of the staff”, “it’s lovely this home I have nothing to complain about, but if there were I am sure it would be dealt with quickly”. The home has the Hull and East Riding adult protection procedures manual and its own written procedures. Two staff members were spoken to during the visit and they demonstrated a basic awareness of the safeguarding policy and procedure, unfortunately there was no evidence to confirm that training in relation to safeguarding had taken place. From speaking to the manager it was stated that some staff have completed training on protection of vulnerable adults during the completion of the NVQ award, currently 50 of the staff group have completed the NVQ course. The manager said, “as part of our training and induction process we expect the staff to read all policies including POVA (Protection of Vulnerable Adults)”. Further discussion with the manager identified that training is needed for all staff in relation to safeguarding vulnerable adults, as the induction that the home offers in-house does not include specific safeguarding procedures. This would ensure that people who live in the home are protected from abuse and supported by a staff team who fully understand the procedure. Further discussion with the manager took place in relation to a previous incident when a service user became physically aggressive towards others, although this was dealt with in consultation with a health care professional a safeguarding referral was not made to the local Care Management Team in Social Services. Advice and direction was given at the time of the inspection with regard to the procedure and where any future referrals would need to be forwarded. Following the inspection the manager confirmed that she, the deputy manager and the assistant officer would be undertaking the safeguarding training organised by the Local Authority at the next available date. The home maintains records for the personal finances of residents. The records were checked and were found to be in order and up to date. There are two staff signatures for every transaction in addition to the resident’s signature; receipts are kept with the documentation. Residents have their own individual bank accounts and several of the residents’ families take care of their finances. Hawthorn House DS0000036095.V349114.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,24,25 & 26 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Overall people live in a safe, warm and comfortable environment, however the building does not currently comply with the local fire service recommendations made at the last visit. The home is clean and hygienic, there are infection control procedures in place and staff have received training, however this was in 2004 and it is recommended this be updated in order for staff to update their skills and knowledge in this area. Hawthorn House DS0000036095.V349114.R01.S.doc Version 5.2 Page 20 EVIDENCE: A tour of the building was undertaken confirming that high standards of cleanliness are maintained. Overall the standard of the environment is very good and the home is welcoming and warm. There is a good-sized garden to the rear of the building that encompasses a summerhouse, fruit trees, lawned and seating area. The grounds were tidy, safe and accessible to all residents. Some comments received from people who live in the home include; “very good home, it’s lovely and clean all of the time”, “it is a lovely place to live”, “my room is very nice”, “I am happy with my room”, “it’s a real home from home, they look after me very well”. Nine surveys were received from relatives confirming that the standard of the environment was of a very good standard, some comments were; “it doesn’t matter when I come the home is always clean and tidy”, “as clean if not cleaner than home”. Since the previous inspection the manager stated that the Nurse Call system had been tested and a certificate confirming this was also seen. A recommendation made by the Fire Department remains outstanding; this was to fit intumescent strips and cold smoke seals to all fire doors that do not have them. The home does have a maintenance plan in place and identifies work to be carried out on a priority basis; a monthly audit of the building also takes place. The home provides individual accommodation that is well furnished and comfortable. It was observed during the visit that people who live in the home can bring their own possessions and individual rooms reflected this, they were personalised with pictures, photographs and various furnishings. People who live in the home are provided with a key to their room, unless a risk assessment suggests otherwise. There is lockable storage available in the service users’ rooms for medication, money and valuables. All of the above was confirmed by speaking to residents, relatives and from observation. The lighting for the home was domestic in style and appearance. All of the toilets and bathrooms were clearly marked and were located near to communal areas. The home has two bathrooms; one is assisted and contains a hoist. Evidence was seen confirming that all of the electrical and mechanical equipment in the home are regularly maintained and therefore the home is a safe place to live. The home has a central heating system in place and during the visit the environment was warm and welcoming. Room temperature can be controlled Hawthorn House DS0000036095.V349114.R01.S.doc Version 5.2 Page 21 individually and therefore they have the choice about what temperature they would prefer in their own bedroom. All of the water outlets have regulators fitted that ensure the hot water distributes at a safe temperature. There were records in place to confirm that the water temperatures are monitored on a regular basis. There was no offensive odours detected and the domestic staff should be complimented about the excellent level of cleanliness throughout the home. Service users have access to all parts of the home via a stair lift and a passenger lift. There are a range of aids, hoists and assisted toilets and baths to meet the needs of the individual service users. The home is clean and hygienic and free from offensive odours. The laundry facility includes hand-washing facilities and washing machines have the specified programme to meet disinfection standards. The home has a policy on the control of infection and the manager confirmed that all staff have undertaken infection control training. From looking at written records it was confirmed that training had been undertaken in 2004, it is recommended that this be updated and included as part of the annual training plan to ensure that staff have up to date knowledge about infection control procedures. A discussion was held with the manager regarding the hand washing and drying facilities in the communal bathrooms and toilets, it is recommended that advice is sought from the Infectious Diseases Unit to ensure that the most appropriate methods are being used. Hawthorn House DS0000036095.V349114.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 & 30 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Staff are employed in sufficient numbers and this ensures that people who live in the home have their needs met. People receive support from staff that have not been properly vetted and therefore the protection and safety of the residents may be compromised. Overall, people who live in the home receive support from a well-trained and experienced staff group. However, training in relation to safeguarding adults must be undertaken by all care staff to ensure the procedure is fully understood. EVIDENCE: From speaking to the manager it was confirmed that the staffing levels remain the same as at the previous inspection. There is a staff rota available that indicates that there are three staff on duty in the daytime and evening, and two during the night. In addition to care staff, domestic and catering staff are employed. From speaking to several staff members, relatives and residents it was clear that the staffing levels are sufficient to meet the needs of the people who live there. Some comments received from people who live in the home Hawthorn House DS0000036095.V349114.R01.S.doc Version 5.2 Page 23 and relatives included; “up to now I can honestly say I haven’t come up with anything I can’t manage myself”, “everybody who works at the home are always friendly when my mother has visitors and make them very welcome”, “they are sensitive to the individual needs of all the people in there. They are very understanding of relatives emotional issues and to make the care home as private for each family as possible”, “they treat all residents as part of the family and give them love, care and attention you would give a family member”. The manager and staff were observed during the inspection interacting with the residents in a respectful way ensuring that the person was involved in the process. Inclusion, independence and dignity were all promoted within the home. All members of staff receive induction training and evidence of this was seen on staff files. Staff are offered a range of training and are presently completing a comprehensive health and safety course. 50 of the staff have completed NVQ Level 2 or above in care. The home has a static and committed staff team who welcome training and view this as an essential part of their role and also as a personal development opportunity. One staff member stated; “the training is very good, we discuss training needs, policies and any changes”. This ensures that residents receive support from a welltrained, knowledgeable and qualified staff group. During the site inspection three staff files were looked at, all three included an application form with reference details, two files had two references in place and one didn’t have any. Two out of the three files had a current up to date Criminal Records Bureau check, one did not have either a Criminal Records Bureau or a POVA 1st check. A discussion with the manager occurred in relation to the recruitment procedure and she confirmed that the current practice is for new staff to commence employment without a Criminal Records Bureau or POVA 1st check and two references being in place and these would be applied for within six months of employment. The manager was informed that this practice must cease immediately and was advised to read the guidance regarding the application and retention of the appropriate checks. This practice does not ensure that people who live in the home are supported by a safe recruitment procedure and may put the people who live in the home at risk of abuse from staff that have not been checked out properly prior to being employed. The manager stated that she would adhere to this requirement with immediate effect and the staff member who had commenced care duties without the checks will not undertake any further care duties or enter the home until the appropriate checks are in place, this was confirmed in writing on 22.08.07. The home has a training plan and evidence was seen confirming that this is kept up to date and covers all of the mandatory training. There are written records in place confirming that all staff have undertaken first aid, fire safety, medication, health and safety, moving and assisting, infection control and food hygiene. The staff confirmed that they had not undertaken training in relation Hawthorn House DS0000036095.V349114.R01.S.doc Version 5.2 Page 24 to safeguarding adults, also the infection control training had been undertaken in 2004 it is recommended that this be updated to ensure that the staff team are knowledgeable about current practice issues. Hawthorn House DS0000036095.V349114.R01.S.doc Version 5.2 Page 25 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): 31,32,33,35,36 & 38 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The management of the home is carried out with leadership and appropriate guidance; ensuring residents receive a quality of care and a resident centred ethos is promoted within the home. Supervision is offered to all staff, but for some of the staff it is not as regular as is recommended in the national minimum standards. On the whole the health, safety and welfare of residents and staff are promoted and protected, however the home has not complied with a recommendation made by the Fire Department and should endeavour to meet this as this would fully promote the health and safety of the people who live there. Hawthorn House DS0000036095.V349114.R01.S.doc Version 5.2 Page 26 EVIDENCE: The registered manager is also the registered provider and holds an NVQ Level 4 in care and management. There are clear lines of accountability within the home and there is a deputy manager, an assistant officer and care staff. There is a job description available for the manager identifying the role and responsibilities of the post. During the inspection visit several of the residents were spoken to and some comments included; “the manager is friendly”, “if you have a problem you can talk to Claire or any of the staff”, “the owner is very good”. Two relatives were also spoken to about the care and service offered in the home; “very happy with the home”, “the staff are fantastic and always make me feel welcome”, “the manager always keeps me informed about what is happening”, “all of the staff from the manager to the carers are very good, I have booked my bed here already”. All of the surveys returned from people who live in the home, staff, relatives and other professionals praised the way that the home is managed confirming that Hawthorn House is a well-run home and that the manager has adopted an open door policy to all who live there or visit. The home has a quality assurance system in place and has been awarded Parts 1 and 2 of the East Riding of Yorkshire Social Services Quality Development scheme. The home seeks the views of service users via meetings, quality surveys and reviews. Other stakeholders views are also sought including relatives and friends. There is a clear development plan in place that details planned events such as staff and residents’ meetings and the planning of trips and activities are regular throughout the year. The home has forwarded to the CSCI a copy of the annual service review and this details the improvements and achievements. The home has financial policies and procedures to ensure that people who live there have their financial interests safeguarded. Written records were checked that detailed the personal allowances for individuals these were up to date and correct, the home promotes independence and the manager confirmed that all of the residents or their families have control over their own finances. Supervision is offered to all staff, but for some of the staff it is not as regular as is recommended in the national minimum standards. The manager explained that she understood that because the staff concerned were the deputy and two assistant officers that they needed supervision once every six months, due to fact that they were mainly office based. From further discussion it was clarified that the staff concerned do undertake care duties and have contact with the people who live in the home on a regular basis and therefore require the formal supervision a minimum of six times per year. The home has policies and procedures available for safe working practices. The home had up to date maintenance certificates available. These include Hawthorn House DS0000036095.V349114.R01.S.doc Version 5.2 Page 27 electrical installations, portable appliance testing, lift, hoists, fire alarm and emergency lighting certificates. There are risk assessments in place for the premises and a fire risk assessment that is reviewed on an annual basis. Staff have attended a range of training including fire awareness. There remains an outstanding recommendation made by the Fire Department in relation to the fitting of intumescent strips been fitted to fire doors within the home. An Annual Quality Assurance Assessment received before inspection detailed diverse needs and how these were to be met. It stated, “we treat everyone as an individual by asking their opinions and monitoring their daily activities and preferences. Information is gathered from the care plan assessment along with social services care plan if applicable. Due to the diversity between independent and non-independent residents we now organise activities for all abilities and have highlighted the need for the same outings. Whilst also realising the need for this it also highlighted that the ‘fitter’ residents need more physical stimulation than what we are providing”. Religious and cultural needs are addressed by the home, “we have also arranged a communion session with the Catholic priest on behalf of one of our residents. We also have one gentleman that does not like to be involved with any of the other female residents so we ensure that a one to one meeting/outing takes place with the joint owner”. During the inspection visit the Annual Quality Assurance Assessment was discussed and the manager confirmed that the home promotes the equal treatment of all it’s residents and also that she is going to find out if specific training can be undertaken by her staff team. Hawthorn House DS0000036095.V349114.R01.S.doc Version 5.2 Page 28 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 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 3 X X 4 3 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 3 2 X 2 Hawthorn House DS0000036095.V349114.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP18 Regulation 12,13,18 Requirement All staff including the management must undertake safeguarding training to ensure that the procedure is fully understood and people who live in the home are protected from abuse. People who live in the home must be supported by a safe recruitment procedure, all new employees must have a Criminal Records Bureau and two references in place prior to being employed or having any contact with people who live in the home, this will ensure that staff have been checked out properly prior to being employed and the safety of the residents is not compromised. All staff who undertake care duties must receive formal supervision of a minimum of six times per year. This will ensure that people who live in the home receive care from a wellsupported staff group whose practice is monitored on a regular basis. DS0000036095.V349114.R01.S.doc Timescale for action 21/12/07 2 OP29 19 Schedule 2 21/09/07 3 OP36 18 21/12/07 Hawthorn House Version 5.2 Page 30 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 Refer to Standard OP9 Good Practice Recommendations It is recommended and would demonstrate good practice to return any unwanted or refused medication to the dispensing pharmacist and should be also recorded on the back of the Medication Administration Record, this would ensure that there is a clear audit trail. It is recommended that when the home takes instruction verbally from a GP to change the prescribed medication, then two staff signatures should be obtained, as this would ensure that errors in recording are minimised. The home should meet the recommendation made by the Fire Department, to fit intumescent strips and cold smoke seals to all fire doors that do not have them. This would ensure that the people who use the service live in a safe environment. It is recommended that advice is sought from the Infectious Diseases Unit to ensure that the most appropriate methods are being used in relation to hand washing and hand drying facilities within communal areas. 2 OP9 3 OP19 4 OP26 Hawthorn House DS0000036095.V349114.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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. 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