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Inspection on 04/05/05 for Hawthorn Lodge Care Home

Also see our care home review for Hawthorn Lodge Care Home for more information

This inspection was carried out on 4th May 2005.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The manager has been recruiting new staff over the last few months including a new deputy manager. Residents reported being much happier with the care they received and both inspectors observed positive interaction amongst some staff and residents. Residents were more positive about the food stating that they could now have seconds if they so wished.

What has improved since the last inspection?

The atmosphere in the home has improved with residents saying that they can talk to the manager and she will listen to their concerns. There is a complaints box at the front of the home which residents and relatives clearly use. The manager is ensuring that incident forms are filled out and sent to Commission when necessary. It is hoped with the advent of the refurbishment programme due to start on 9th May 2005 that many of the concerns about the environment will be dealt with.

What the care home could do better:

Although time had been given to bring all care plans up to date and be reviewed this still has not been done with some new residents not having a care plan at all. The manager must ensure that this is done, as no more time will be allowed to do this. The home still have not got all existing staff to have CRB checks, however new staff now have them prior to appointment. The manager is reminded that this is a legal requirement and staff must not be permitted to work without this check. This is in the interests and safety of the residents.

CARE HOMES FOR OLDER PEOPLE Hawthorn Lodge Care Home Beckhampton Road Bestwood Park Nottingham NG5 5LF Lead Inspector Susan Lewis Richard Ramsden Unannounced 4 May 2005, 10:00 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 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 Lodge Care Home C53 C03 S61999 Hawthorn Lodge V225148 040505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hawthorn Lodge Care Home Address Beckhampton Road Bestwood Park Nottingham NG5 5LF 0115 967 6735 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Regal Care Homes Ltd Gemma Else Care home 60 Category(ies) of Old age (OP), over 65 years, x 60 registration, with number of places Hawthorn Lodge Care Home C53 C03 S61999 Hawthorn Lodge V225148 040505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. To admit one named service user with dementia. 2. The named sercice users needs are to be reviewed six monthly with the social worker. 3. When the service users contract is terminated for any reason the registration returns to its pre-existing state. Date of last inspection 09/12/04 Brief Description of the Service: Hawthorne Lodge is a large home that was previously owned by the Local Authority. The home is registered to provide personal care for up to 60 older people. It has several large lounges and one large dining room. Some of the bedrooms are ensuite. There is a passenger lift to the first floor. The home is set in its own grounds in a residential area with easy access to shops and bus routes. Regal Care Ltd bought the home earlier in 2004 and they have indicated their plans to refurbish the building will start on 9th May 2005 and take place over the course of the next year. Hawthorn Lodge Care Home C53 C03 S61999 Hawthorn Lodge V225148 040505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over two days with two inspectors the first day and one inspector the second day. This inspection took place to look at how far the manager had progressed at bringing areas up to date following the last inspection in December 2004. A meeting had also taken place early 2005 between the Commission, the manager of Hawthorn Lodge and the senior management team of Regal Care Ltd. This meeting had been to set out objectives and timescales for outstanding requirements to be met. A partial tour of the premises took place and staff and care records were inspected. Five staff over two days were spoken with and five residents were also spoken with. What the service does well: What has improved since the last inspection? The atmosphere in the home has improved with residents saying that they can talk to the manager and she will listen to their concerns. There is a complaints box at the front of the home which residents and relatives clearly use. The manager is ensuring that incident forms are filled out and sent to Commission when necessary. It is hoped with the advent of the refurbishment programme due to start on 9th May 2005 that many of the concerns about the environment will be dealt with. Hawthorn Lodge Care Home C53 C03 S61999 Hawthorn Lodge V225148 040505 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hawthorn Lodge Care Home C53 C03 S61999 Hawthorn Lodge V225148 040505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Hawthorn Lodge Care Home C53 C03 S61999 Hawthorn Lodge V225148 040505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6 The admissions process has improved since the new company has taken over and a proper assessment of prospective residents prior to them moving in to the home does take place. Where care plans have not been created this has the potential to place residents at risk of not receiving an appropriate service to meet their needs. EVIDENCE: Intermediate care is not provided in this home. All of the Residents files viewed as part of this inspection contained extended social work assessments. The staff at The Hawthorns had also completed the homes own assessment with one of the residents prior to their admission. The homes assessment format contains all the required information. It was noted that care plans had not been produced for the two most recently admitted residents. Hawthorn Lodge Care Home C53 C03 S61999 Hawthorn Lodge V225148 040505 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8,9 and 10 Although some progress has been made towards improved care plans, reviews have not taken place nor are residents involved in this process. These are shortfalls previously identified and place the resident at potential risk. EVIDENCE: Two residents did not have care plans, and the home is still changing over from the format used by the old company to new company’s format. As a result the care plans that were looked at for the purpose of this inspection had not been reviewed since last December. The inspector had agreed with the management team for Hawthorn Lodge and Regal Care that a moratorium would be allowed for a period from January until the end of April. This period is now over and it is expected that all care plans and reviews will be up to date. There is still no evidence on care plans that residents are involved in creating care plans or reviewing them. Letters have been sent out to relatives to ask if they would like to be involved but no replies have been received on the care plans viewed for the inspection. However it should also be noted that there was no proof that these letters had actually been sent as they were not dated or recorded in care notes as having been sent. An interim care plan was seen for one resident who had become unwell to cover that period of ill health. This is considered to be good practice. Hawthorn Lodge Care Home C53 C03 S61999 Hawthorn Lodge V225148 040505 Stage 4.doc Version 1.30 Page 10 Evidence was seen that residents are now weighed and bathed regularly; this was a requirement from the last inspection and is now met. The medication room has recently been moved to a much bigger room and as a result there is more space for storage. The fridge door could not be closed on the day of the inspection as it was heavily frosted. The manager must ensure that the fridge is regularly checked to ensure that this does not happen. The medication is stored appropriately and records are kept in good order. At the last inspection a requirement was made that resident wear their own clothes at all times, in discussion with residents all confirmed that they always wore their own clothes, staff also confirmed that if residents did not have enough clothes then the family was contacted to buy more. Hawthorn Lodge Care Home C53 C03 S61999 Hawthorn Lodge V225148 040505 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 Social activities are not managed well and residents are not stimulated, thereby not having their cultural and recreational interests and needs met. Meals have clearly improved both in quantity and quality; this is clearly appreciated by the residents. EVIDENCE: All residents, visitors and staff spoken with did not believe there was not enough stimulation provided in the home. Visitors commented that ‘there was little for residents to do and they often seemed bored’. Although staff are more involved in talking to residents and they have film evenings and music playing, there appears to little or no activity to encourage a cohesive feel to the home. During the inspection one resident was trying to organise a ‘get together’ and a member of staff did take the resident out to get things for it. This however is not a regular event. The manager reported that she has tried to recruit an activities organiser but has had no success. Staff do some limited activities but are reluctant to do so on a formal basis. Residents can all receive visitors in private and there are no restrictions on visiting times. Staff clearly understood who had access to residents records, however residents spoken to still appeared unaware of their right to access their records. It is Hawthorn Lodge Care Home C53 C03 S61999 Hawthorn Lodge V225148 040505 Stage 4.doc Version 1.30 Page 12 recommended that this is a subject that is regularly on the Residents meeting agenda. The manager reported that the cook had left and that they had a temporary cook, comment cards were seen and all were positive about the food, residents spoken with again were positive saying that they had plenty of food and could have seconds if they wanted. They also confirmed that they could eat in their bedrooms if they wished. During the inspection the Environmental Health Officer arrived and she made reference to the need to deep clean the kitchen particularly the tiled floor and repair the lights in the kitchen. The previous cook had not kept the records up to date the new cook is aware that this needs to be done. The registered manager is responsible in ensuring that this is carried out. Hawthorn Lodge Care Home C53 C03 S61999 Hawthorn Lodge V225148 040505 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 and 18 The manager responds to complaints and takes matters seriously, however the feedback to complainants needs to improve to keep them informed as to what is happening. Residents right to vote must be taken more seriously and a more concerted effort to ensure that those who want to vote can, otherwise their legal rights are not protected. The manager responds quickly to suspected adult protection issues and put plans in place to protect residents from abuse. EVIDENCE: The manager has implemented a comments and complaints box, which is clearly used as it was noted there were several comments in the box on the day of the inspection. Complaints are recorded and dealt with appropriately, residents spoken with felt confident that the manager would deal with any problems. Some staff spoken with still felt that the manager could do more to keep them informed if they had raised concerns. As the inspection took place shortly before the General Election residents spoken with were asked about voting. Some residents were not sure how they were going to get to the polling station some were not sure if they had a vote. It was also noted that there were a significant number of cards left in the front office. These appeared to be for residents who had left, died or did not have the capacity to vote. These cards should not be left lying around and if the person has died or left the home the manager must ensure they are returned to the appropriate authorities. Where the manager has sent Adult Protection notifications Resident on Resident) to the appropriate offices care plans and risk assessments have been created to ensure risks are minimised. Hawthorn Lodge Care Home C53 C03 S61999 Hawthorn Lodge V225148 040505 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 The planned refurbishment is starting and this will hopefully make significant inroads into improving the environment for resident. The grounds of the home remain poorly maintained and do not provide an attractive area for residents to access sunlight. Effort has clearly gone into improving the cleanliness of the home and it is much more hygienic. EVIDENCE: The grounds of the home were very scruffy the grass was long and unkempt; the manager reported that this was due to the lawn mower breaking down. However the flower beds had been planted out, residents had been involved in this, those spoken with said they had really enjoyed this. On the day of inspection residents were seen accessing the grounds and sitting outside. The Commission has now received a letter informing them of a start date for the planned refurbishment this is 9th May 2005. The management team for Regal Care are aware of the areas that need refurbishment and so these are not itemised in this report. The home is much cleaner than on previous visits and the manager is making every effort to ensure that the cleaning staff have the products and equipment Hawthorn Lodge Care Home C53 C03 S61999 Hawthorn Lodge V225148 040505 Stage 4.doc Version 1.30 Page 15 to do their job effectively. The laundry area does need attention, as it was very untidy and shabby. There is a sink in the corner but it does not appear to be used and the sluice was obstructed. It was unclear whether the sluice was actually used or the sluice program on the washing machine. This must be made clearer. Hawthorn Lodge Care Home C53 C03 S61999 Hawthorn Lodge V225148 040505 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27and 29 The procedures for recruiting staff have improved and are far more robust than previously. However the fact that there are a number of existing staff who still do not have current CRB checks is a great cause for concern and does not provide adequate protection for residents. The deployment of staff at key points in the day is not sufficient to meet the needs of the residents. EVIDENCE: On the day of the inspection a member of staff had phoned in sick and so the shift was running below required numbers. Staff spoken with said that although staffing had improved there were occasions where some staff failed to show up for their shift and left either the manager or senior carer on duty trying to get a replacement. All staff spoken with felt that with the size and layout of home and needs of the residents they barely had enough staff on duty. The manager said that staffing was an issue but that it was always being reviewed. There are currently 46 residents and the minimum staff on duty excluding the manager should be no less than 6 carers, however residents needs may increase this number. Staff files were checked and met the standard, however there are a number of existing staff that still do not have up to date CRB checks. The manager is aware of this as is Regal Care and action is being considered. Hawthorn Lodge Care Home C53 C03 S61999 Hawthorn Lodge V225148 040505 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35 and 38 Although some start has been made to involve residents in decision making more regular residents meetings would ensure that this actually was reality. Some of the practices in the home do not safeguard residents financial interests. The manager promotes the health and safety of residents and staff however she must ensure that risk assessments are carried out to ensure safe working practices and maintain the safety of residents. EVIDENCE: The manager is currently undertaking her NVQ 4 and is also receiving training regarding Dementia. Staff and residents spoken with were positive about the manager and staff also commented on the new deputy manager saying she was also very supportive. Regal Care has a quality assurance system and questionnaires are sent to relatives as previously mentioned there is a comments and complaints box at Hawthorn Lodge Care Home C53 C03 S61999 Hawthorn Lodge V225148 040505 Stage 4.doc Version 1.30 Page 18 the front of the home for people to put any issues in. There are residents/relative meetings but these are only every six months. Residents finances are recorded appropriately, however it appears where the manager is waiting for relatives to bring the resident their personal allowance and they have run out of money she is ‘subbing’ the resident so the records show the resident is going into debt. Although the practice is understandable it is unsafe. One resident reported that they had lost a large sum of money; the manager must look into this to ensure this is not a criminal activity and report to the police and Adult Protection Unit if necessary. The manager reported an accident to the Commission where a resident was injured there was no risk assessment on the residents file or safe working practice within the home. The manager has all health and safety records up to date and records all accidents and incidents correctly. The staff spoken with all felt that their personal health and safety was taken seriously. Hawthorn Lodge Care Home C53 C03 S61999 Hawthorn Lodge V225148 040505 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 2 3 x x 2 x 2 x x 2 Hawthorn Lodge Care Home C53 C03 S61999 Hawthorn Lodge V225148 040505 Stage 4.doc Version 1.30 Page 20 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 Regulation 15 Requirement It is required that the registered person shall after consultation with the service user, or representative, prepare a written plan as to how the service users needs are to be met. It is required that the registered person shall keep the service userss plans under review it is require that the registered person shall arrangements for tha safe keeping and storage of medicines in the care home. The registered person must ensure that the fridge where medicines are stored is regularly defrosted to enable it to be closed. It is required that the registered person provides a planned programme of activities designed to stimulate the residents. The residents should be consulted about the type of activities they would like to be implemented. It is required that the registered person shall ensure that the external grounds are appropriately maintained It is required that the registered person shall, having regard to C53 C03 S61999 Hawthorn Lodge V225148 040505 Stage 4.doc Timescale for action Immediate 2. 3. 7 9 15 13 immediate 31/05/05 4. 12 16 1/08/05 5. 19 23 1/08/05 6. 27 18 1/06/05 Page 21 Hawthorn Lodge Care Home Version 1.30 7. 29 Sch 2 8. 38 12 the size of the care home, the statement of purpose and the number and needs of the service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. It is required that information Immediate and documents in respect of persons carrying on, managing or working at a care home be kept within the home. This includes an enhanced criminal record certificate issued under section 115 of the Police Act 1997 be obtained for all staff. It is required that the registered 1/06/05 person ensures that the home is conducted so as to promote proper provision for the health and welfare of the service users where reportable incidents occur risk assessments must take palce to minimise the risk of it happening again. 9. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 14 17 Good Practice Recommendations It is recommended that residents meetings are held monthly and at this meeting residents are reminded of right to access records. It is recommended that residents are regularly reminded prior to elections about their right to vote and the manager ensures residents know how this will be facilitated. ie postal vote or being taken to the polling station. C53 C03 S61999 Hawthorn Lodge V225148 040505 Stage 4.doc Version 1.30 Page 22 Hawthorn Lodge Care Home 3. 4. 33 35 It is recommended that residents meetings are held monthly. It is recommended that the manager stop the practice of subbing residents allowing them them to go into debt, rather make better arrangemnets for families to pay the personal allowance to the resident. Hawthorn Lodge Care Home C53 C03 S61999 Hawthorn Lodge V225148 040505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hawthorn Lodge Care Home C53 C03 S61999 Hawthorn Lodge V225148 040505 Stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!