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Inspection on 01/07/08 for Hawthorn Lodge Nursing Home

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

This inspection was carried out on 1st July 2008.

CSCI found this care home to be providing an Adequate service.

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

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

What the care home does well

People said they enjoyed living at Hawthorn Lodge, and that the staff were kind and helpful. Comments received were very positive about the care. One relative said, "The care home provides all round holistic care and keep us informed of any changes which may occur". There were written care plans in place for each person. This helps staff make sure that each person gets the support and assistance that is needed for them to live safely and comfortably. People living at the home were comfortable and well cared for and all of them said that the food was good. The environment was in the main nicely decorated and well maintained. Staff were motivated and enthusiastic about their work

What has improved since the last inspection?

Since the last inspection the home have secured a contract for the disposal of controlled drugs. This was a requirement in the last report.The last report recommended that activities should be suitable for everyone. People said that they were generally satisfied with the level of activity provided and that staff ask them what they want to do. A new dining room carpet has been purchased and the tables and chairs have been replaced. Some windows have also been replaced. This makes those areas very attractive. Some bathrooms have overhead tracking, which is an excellent aid for staff and should make bathing more comfortable for people who require that level of assistance.

What the care home could do better:

It is recommended that care plan evaluations are more specific to each individual plan. They should include any deterioration or improvements made. This is to make sure that all needs are met. The practice of putting medications in pots rather the using the medication trolley must be addressed as this potentially places the people who live in the home at risk. The temperature of the room in which medications are kept should be monitored to make sure that they are stored correctly. Whilst it is accepted that the home now keep evidence of Criminal Record Bureau checks for all staff, some seen were not appropriate. New staff must have a check carried out by the home before they commence employment and they must be of the correct type. Some staff have not received recent training in fire safety and moving and handling. This potentially places people at risk.

CARE HOMES FOR OLDER PEOPLE Hawthorn Lodge Nursing Home 2 Canberra Grove Hartburn Stockton-on-Tees TS18 5EL Lead Inspector Sue Lowther Key Unannounced Inspection 10:00 1st & 25th July 2008 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 Lodge Nursing Home DS0000000172.V369189.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 Lodge Nursing Home DS0000000172.V369189.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hawthorn Lodge Nursing Home Address 2 Canberra Grove Hartburn Stockton-on-Tees TS18 5EL 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) 01642 570100 01642 652604 Mr M Ramdhan Mrs K Ramdhan Ms Jacqueline Jane Pallister Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability (30) of places Hawthorn Lodge Nursing Home DS0000000172.V369189.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 30 2. Physical disability - Code PD, maximum number of places: 30 The maximum number of service users who can be accommodated is: 30 5th July 2006 Date of last inspection Brief Description of the Service: Hawthorn Lodge is a care home providing both nursing and personal care for older people. It is a converted Victorian building with an extension. The 26 single bedrooms are a minimum of 10 sq.m. The 2 double bedrooms are a minimum of 16 sq.m. There are 3 lounges and a large dining room. There is a passenger lift giving access to both floors. The home is opposite a parade of local shops. There is a small car park at the back of the home. The fees charged at the time of this inspection £370 and £471 per week. This does not include hairdressing, chiropody, toiletries and personal newspapers. Hawthorn Lodge Nursing Home DS0000000172.V369189.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection of Hawthorn Lodge commenced on the 3rd July 2008 and ended on 25th July 2008 when feedback was given to the providers. During the two visits to the home records were examined and a tour of the building took place. Time was spent talking to people living at the home, staff and visitors. The manager supplied some information prior to the inspection on a form called an AQAA. This is an annual quality assurance assessment for home’s to provide information about their service. The inspection focussed on key standard outcomes for people living at the home. We also checked whether requirements from the previous report had been met. What the service does well: What has improved since the last inspection? Since the last inspection the home have secured a contract for the disposal of controlled drugs. This was a requirement in the last report. Hawthorn Lodge Nursing Home DS0000000172.V369189.R01.S.doc Version 5.2 Page 6 The last report recommended that activities should be suitable for everyone. People said that they were generally satisfied with the level of activity provided and that staff ask them what they want to do. A new dining room carpet has been purchased and the tables and chairs have been replaced. Some windows have also been replaced. This makes those areas very attractive. Some bathrooms have overhead tracking, which is an excellent aid for staff and should make bathing more comfortable for people who require that level of assistance. 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 Lodge Nursing Home DS0000000172.V369189.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hawthorn Lodge Nursing Home DS0000000172.V369189.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. People who use the service experience good quality outcomes in this area. Assessment procedures are in place to ensure that the home can meet the needs of the people who live there. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: People are only admitted after a full assessment of need is carried out by an appropriately trained person. This is usually the manager. This is to make sure that the home can meet the care needs of the people who go to live there. The family of one person who had recently gone to live in the home confirmed that they had looked around the home and had been supplied with all of the information they needed to make a decision about whether or not their relative would like to live there. Most of the people who responded to the survey said that they had received enough information about the home before they went to live there. Hawthorn Lodge Nursing Home DS0000000172.V369189.R01.S.doc Version 5.2 Page 9 The home does not admit people for intermediate care therefore assessment of standard 6 is not required. Hawthorn Lodge Nursing Home DS0000000172.V369189.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. People who use the service experience adequate quality outcomes in this area. The people who live in the home are happy with the care received. Care plan evaluation would benefit from expansion to make sure individual needs are met. Improvements are needed in respect of medication practice to avoid errors. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The manager said that all of the people who live in the home have care plans. Three were examined during the inspection. All contained individual plans of care and have relevant plans in place where a risk is identified. They are usually evaluated on a monthly basis. These evaluations would benefit from being individual to each specific problem rather that one statement. They should include any deterioration or improvements made. This is to make sure that all needs are met. Hawthorn Lodge Nursing Home DS0000000172.V369189.R01.S.doc Version 5.2 Page 11 People spoken to during the inspection said that they are happy with the care received and the level of information given. Records examined showed that people receive visits from other healthcare professionals. These include district nurses, doctors, and care managers. Medication is administered by qualified nurses . The home has a comprehensive medication policy. Accurate records of all medicines received, administered and those leaving the home are maintained. Since the last inspection the home have secured a contract for the disposal of controlled drugs. This was a requirement in the last report. However during the inspection the policy with regard to the administration of medication. Staff were seen to put medications in pots and take them on a tray to give to people. This practice may result in the wrong medication being given. The room in which the medications are kept felt warm. It is recommended that the temperature of this room is monitored to make sure that medications are stored appropriately. People spoken to said that staff always treat them with dignity and respect. Hawthorn Lodge Nursing Home DS0000000172.V369189.R01.S.doc Version 5.2 Page 12 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 quality outcomes in this area. The activities are varied and provide recreation for some of the people who live in the home. Family and friends can visit at any time and are made to feel welcome. The meals are of a good standard. Menus are varied and people are given a choice. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: People were asked about visiting arrangements, which are flexible. One of the comments from a visitor included, “We are made welcome to the home, its lovely”. Visitors can see people in their own rooms or in any of the communal areas available throughout the home. The last report recommended that activities should be suitable for everyone. People said that they were generally satisfied with the level of activity provided and that staff ask them what they want to do. One said “Staff can sometimes take me out for a walk or to the shops when they have time. I like that”. Another said “I like to sit in the garden when I can. It is really lovely. The Hawthorn Lodge Nursing Home DS0000000172.V369189.R01.S.doc Version 5.2 Page 13 weather has been good that last few days. I am making the most of it. Staff come out to check on me regularly and sit and chat if they have time”. Comments about the food were good. Specialist diets are catered for and include menus for diabetics and soft menus. Staff were seen to support those who needed help during mealtimes in a sensitive manner. One person said, “The food is good, no complaints”. Hawthorn Lodge Nursing Home DS0000000172.V369189.R01.S.doc Version 5.2 Page 14 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 quality outcomes in this area. The people who live in the home can be confident that their concerns and complaints are dealt with appropriately. However the current practice with regard to Criminal Record Bureau checks for new staff potentially places the people who live in the home at risk. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Information about complaints, how and who to make them to, is made available to the people who live in the home and their families through information displayed in the entrance to the home and in the ‘Service Users Guide’. There have been no complaints recorded since the last inspection. One person said, “If I had a problem I would tell the staff”. The home had a comprehensive adult protection procedure. This gives staff the support they need to make a referral should this be required. The staff spoken to during the inspection were asked about abuse and what they would do if they saw or heard anything inappropriate. All said that they would tell someone, for example the manager, or make a referral themselves if this was more appropriate. Training is provided for all staff in adult protection. One member of staff said, “We have a complaints procedure and are all aware of the no secrets policy”. However the current practice with regard to Criminal Hawthorn Lodge Nursing Home DS0000000172.V369189.R01.S.doc Version 5.2 Page 15 Record Bureau checks for new staff potentially places the people who live in the home at risk. Hawthorn Lodge Nursing Home DS0000000172.V369189.R01.S.doc Version 5.2 Page 16 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 & 26. People who use the service experience good quality outcomes in this area. The home is clean and well maintained. It is decorated and furnished to a good standard and provides a homely environment for the people who live there. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: During a tour of the building the inspector saw that many of the rooms are decorated to the person’s own taste and there was evidence to confirm that people can take in some personal items when they go to live there. This includes pieces of furniture as well as photographs and ornaments. Some windows within the home have been replaced, making those areas look very attractive. Since the last inspection the dining room carpet and the tables and chairs have been replaced. This was a recommendation in the last report. Hawthorn Lodge Nursing Home DS0000000172.V369189.R01.S.doc Version 5.2 Page 17 There was a range of equipment seen around the home to support people with bathing and mobility. Some bathrooms have overhead tracking, which is an excellent aid for staff and should make bathing more comfortable for people who require that level of assistance. The inspector found the building to be clean, tidy and free from offensive odours. Hawthorn Lodge Nursing Home DS0000000172.V369189.R01.S.doc Version 5.2 Page 18 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 quality outcomes in this area. The home has a settled and well-led staff team, in sufficient numbers to meet the needs of the people who currently live in the home. However the files of some staff did not contain the appropriate checks and some mandatory training was out of date. This potentially places people at risk. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: From the rota supplied at the inspection there was sufficient care staff on duty to meet the assessed care needs of the people who were using the service. People said that staff were usually around and answered the call bells quickly. The home had staff files in place, three were examined this inspection. Whilst there was evidence in the home that staff had Criminal Record Bureau checks as required in the last inspection report, some seen were not appropriate. These were not carried out by the home before employment and were not of the correct type. This potentially places the people in the home at risk. However the provider told the inspector during feedback that all staff files have been checked and that new checks will be made immediately for all staff who require this. Hawthorn Lodge Nursing Home DS0000000172.V369189.R01.S.doc Version 5.2 Page 19 Many of the staff are trained to NVQ at level 2 or above. Some mandatory training with regard to fire and moving and handling was out of date. Again the provider explained to the inspector during feedback that a plan had been put in place for this training to be carried out. Staff said that they are supported with regard to personal training needs. Staff comments in this area were positive. Comments included “The home provides up to date continuous training”. Another said, “The manager is always encouraging staff to attend different courses.” Hawthorn Lodge Nursing Home DS0000000172.V369189.R01.S.doc Version 5.2 Page 20 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 & 38. People who use the service experience adequate quality outcomes in this area. The home’s registered manager provides clear leadership, support and guidance to those living and working at the home. However some staff have not received recent training with regard to fire and moving and handling. This potentially places people at risk. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The manager is a qualified nurse and has completed an appropriate management course. Hawthorn Lodge Nursing Home DS0000000172.V369189.R01.S.doc Version 5.2 Page 21 There was an open and friendly culture between the management team and staff working at the home. There was evidence in staff files to show that supervision was taking place and that the staff were being appraised. Staff confirmed that supervision takes place on a regular basis and that they are well supported. People living at the home and visitors who were spoken to during the inspection confirmed that the manager is approachable and that they would go to her if they had any concerns. Regular meetings are held and there are number of systems in place to consult with people living at the home. The manager confirmed that monthly Regulation 26 audits by the owner take place. Personal finances are kept in the home for people who request this. Two signatures are obtained and receipts are kept to ensure peoples’ financial interests are safeguarded. The manager confirmed that all equipment in the home is regularly checked. The maintenance certificates that were seen at this inspection were found to be in order. Health and Safety checks are carried out regularly to safeguard people living and working at the home. However as previously stated, fire training and moving and handling training was out of date for some staff. Hawthorn Lodge Nursing Home DS0000000172.V369189.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Hawthorn Lodge Nursing Home DS0000000172.V369189.R01.S.doc Version 5.2 Page 23 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 OP9 Regulation 13 Requirement The Registered Person must make sure that medication is administered one at a time to avoid errors. Pre-potting of medication is not acceptable. New staff must have an appropriate Criminal Record Bureau check carried by the home before commencement of employment. All staff must receive fire safety training and moving and handling training at regular intervals. Timescale for action 31/08/08 2. OP29 19 31/08/08 3. OP30 13 31/08/08 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 OP7 OP9 Good Practice Recommendations Care plan evaluations should be more detailed and include any deterioration or improvements made. It is recommended that the temperature of the room in DS0000000172.V369189.R01.S.doc Version 5.2 Page 24 Hawthorn Lodge Nursing Home which medications are stored is monitored to make sure that they are stored appropriately. Hawthorn Lodge Nursing Home DS0000000172.V369189.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Hawthorn Lodge Nursing Home DS0000000172.V369189.R01.S.doc Version 5.2 Page 26 - 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!