Inspection on 23/08/09 for Hawthorn Lodge Nursing Home

This inspection was carried out on 23rd August 2009.

CQC 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.

Other inspections for this house

Hawthorn Lodge Nursing Home 01/07/08

Hawthorn Lodge Nursing Home 05/07/06

Hawthorn Lodge Nursing Home 26/01/06

Hawthorn Lodge Nursing Home 22/08/05

Hawthorn Lodge Nursing Home 02/02/05

Hawthorn Lodge Nursing Home 18/06/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report 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 09:00 23rd June & 6th July 2009 DS0000000172.V376200.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Hawthorn Lodge Nursing Home DS0000000172.V376200.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Hawthorn Lodge Nursing Home DS0000000172.V376200.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.V376200.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 1st July 2008 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.V376200.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 Key Inspection was to check that the home meets the standards that the Care Quality Commission say are the most important for the people who use the services, and that it does what the Care Standards regulations say it must. This inspection was conducted in by two regulatory inspectors in two inspection days and a pharmacy inspector for one day. During the inspection, a number of records were looked at, including care records of people who use the service, along with staff recruitment and training records. The medication system was also looked at in detail. Time was spent with people living at Hawthorn Lodge and there was discussion about their lives. Discussion also took place with the manager and a number of staff. The manager has completed the Annual Quality Assurance Assessment (AQAA), the services self-assessment of how well they think they are meeting standards. This was received prior to the inspection and some of information has been reflected within the report to support the judgements made. We have reviewed our practise when making requirement to improve national consistency. Some regulations from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at risk or harm. In future if a requirement is repeated it is likely that enforcement action will be taken. The fees charged at the time of this inspection were between £370 and £477 per week. This does not include the cost of newspapers, hairdressing and chiropody. Feedback was given to the providers and manager of the service. They demonstrated a positive commitment to address the areas that were identified as in need of further development and improvement. It was agreed that a random inspection would take place prior to 31/3/09. What the service does well: Hawthorn Lodge Nursing Home DS0000000172.V376200.R01.S.doc Version 5.2 Page 6 Hawthorn Lodge provides people with a warm and homely environment. There is a lovely garden, with lots of plants and shrubs. People are able to spend time in the garden and it is equipped with tables and chairs. People living at the home are happy with the care provided to them. They spoke positively of the staff team. They said, “The girls are very nice, they are very good to me”. “The staff are nice, they look after you”. “The staff are respectful and courteous to everyone”. “It is lovely here, the staff are so friendly, very nice”. The home provides a good range of equipment to support people with bathing and mobility, including overhead tracking in some areas. There were good records for a person living in the home on anticoagulation medication. Records of controlled drugs were accurate and neat. Staff are happy at Hawthorn. One person said, “This is a really good home, I like coming and it is really friendly”. What has improved since the last inspection? What they could do better: The home must keep evidence to confirm that appropriate consultation has been made regarding the admission assessment with the service user or a representative. This is to make sure that all of the needs of the person can be met. Where a problem or need is identified either within the care plan or in the daily review, then a care plan must be formulated to make sure that staff know how to look after the person properly. When writing daily records staff should be mindful of the content to make sure that the entry reflects the actual problem and that peoples needs are being met. Hawthorn Lodge Nursing Home DS0000000172.V376200.R01.S.doc Version 5.2 Page 7 The policies with regard to medication should be updated to provide sufficient information for staff on current legislation and guidance to make sure that safe practices are followed. Handwritten entries on MAR charts should be checked to make sure they are an accurate record of current treatment The administration records for creams and inhalers should be accurately maintained this will make sure that people receive their medications correctly and the treatment of their medical condition is not affected. The activities programme should be reviewed to make sure that it is suitable for all of the people who live in the home. It is recommended that the menus be reviewed and discussed with a dietician to make sure that the content is nutritious. A record must be kept of all complaints made including the action taken. The safeguarding procedure must be reviewed to make sure that it reflects the guidance contained in the locally agreed procedure. It must contain the contact details of the local authority and police. All staff must receive training in the safeguarding procedure so that they are aware of the action to take in the event that a suspicion of abuse occurs. There is a need to improve the dining area and remove notices which relate to staff. This will make the dining area more homely in line with the other areas within the home. The upstairs sluice should be made secure so that it can only be accessed by staff. Consideration should be given to provide an alternative to the net curtains on bedroom doors which have glass panels fitted. This will increase the dignity and privacy for some of the people who live in the home. Staffing levels should remain under review so that they are deployed in sufficient numbers to meet all of the needs of the people who live in the home. The recruitment procedure should be reviewed. The application form should be received prior to the commencement date to ensure that gaps in employment are explored. The induction training programme should be reviewed to include the recommendations made by Skills for Care. The Regulation 26 visits carried out by the provider only cover environmental aspects. They must also interview people living in the care home, their representatives and the staff in order to form an opinion of the standard of care provided at the care home. Hawthorn Lodge Nursing Home DS0000000172.V376200.R01.S.doc Version 5.2 Page 8 It is recommended that staff supervision sessions take place at least six times a year for all staff. All policies and procedures must be reviewed to make sure that they are up to date, appropriate, relevant and specific to the home. It is recommended that the monitoring of water temperatures be recorded on a weekly basis. It is recommended that the time of fire drills should be recorded along with the time taken to complete and the effectiveness or not of the drill recorded along with any action points. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Hawthorn Lodge Nursing Home DS0000000172.V376200.R01.S.doc Version 5.2 Page 9 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.V376200.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst people are assessed by care managers and the Primary care Trusts they are not always assessed by the home to make sure that all of their needs can be met. EVIDENCE: The AQAA detailed information about the assessment process that is undertaken in respect of people being admitted to the home. It states that a copy of the care plan assessment provided by either the social worker or staff from the ward is obtained and where appropriate someone from the home visits the potential person to complete their own pre admission assessment. It also details that people are able to visit. The home also accepts emergency Hawthorn Lodge Nursing Home DS0000000172.V376200.R01.S.doc Version 5.2 Page 11 admissions, for which an assessment is completed within 24 hours of admission. Care records of people living at Hawthorn Lodge were looked at, one for someone who had been recently admitted to the home and one for someone who had lived at the home for some time. The care records of someone admitted the day before the inspection was also looked at. The file of the person who had lived at the home for a few months contained detailed information from the Social Worker, however a copy of the home’s own pre admission assessment was not available. There was evidence of reviews taking place, ensuring satisfaction with the service. In the file for the person admitted the day before, there was a copy of the Care Managers contact assessment dated 7/4/09, however there was no preadmission assessment completed by the home. The home does not provide intermediate care therefore assessment of Standard 6 is not required. Hawthorn Lodge Nursing Home DS0000000172.V376200.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receiving the service are happy with the way in which care is delivered by staff. Care needs assessments and associated records are in the main good, however there are areas that need to be expanded upon to ensure that all areas of need are attended to. The way in which medication is managed is good. EVIDENCE: The same two care files were looked at in further detail. A range of assessments had been completed including amongst others, personal information, activities of daily living, nutritional assessment, moving and handling assessment and pressure risk assessment. In the file of the person who had lived at Hawthorn Lodge for a few months, a range of care plans were in place, which were being evaluated on a monthly Hawthorn Lodge Nursing Home DS0000000172.V376200.R01.S.doc Version 5.2 Page 13 basis. It was however noted that there were potential needs identified on the assessment for which no care plans were in place. This included, being at risk of falls and suffering from agitation and panic attacks. There was no evidence that the person concerned had been consulted about the care needs assessment and care plans. There was no life history and no social assessment that would outline hobbies and interests. In the daily records of another person there was reference to a wound which required a dressing. However there was no care plan to inform staff what they needed to do about this. There is the need to take more care when writing the daily records and to mindful of tone and content. Examples of this included, “has done nothing but complain”, “remains very demanding re minor things”. A pharmacist inspector carried out the medication part of the inspection and her comments are as follows: The medicine policy needs to be reviewed and updated in line with current practice. The current policy does not provide enough information for staff on current legislation and guidance to make sure that safe practices are followed. There is a lockable medicines trolley that is kept in an office which can be locked. The room is warm and has no ventilation. The fridge used for storing medicines contained food items and medicines which do not require cold storage. As far as could be seen the cupboard used to store controlled drugs met regulations and all records balanced on the day All MAR charts were handwritten. There were some entries which were incomplete and one entry had the strength of a tablet recorded as 50mg instead of 500mg. All MAR chart dividers contained a photograph of the person and a record of allergies. The signature list for staff administering medicines was up to date. There were very few gaps on the MAR charts however the records for antibiotic medication showed that on some occasions medication had been signed for but not given. Creams were administered by care or nursing staff depending on the person. However Daktacort, Fucibet and betamethasone were in use and there were no entries or records on the MAR charts for these administrations. There were also no MAR chart entries for inhalers although there were Salbutamol and Beclometasone inhalers in the cupboard for one person who had a condition listed in her care plan which required inhaler use. Medication records in care plans was variable in quality. One person on anticoagulation medicine had a good record of this and a risk assessment in her care plan. Records of current dosage and INR results and next test date were available. However there was also a care plan evaluation sheet for Hawthorn Lodge Nursing Home DS0000000172.V376200.R01.S.doc Version 5.2 Page 14 paracetamol as pain relief and on the current MAR chart pain relief is listed as co-codamol 8/500. In the main the privacy and dignity of people was being maintained. However the inspector saw that some of the bedrooms had a glass panel in the doors. These were partially obscured by net curtains. These do not give people a good level of privacy and another method should be considered. Hawthorn Lodge Nursing Home DS0000000172.V376200.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst activities take place, this area could be developed further to enhance life yet further for people. Although there is no actual choice on the menu, people are satisfied with the meals provided. EVIDENCE: In the files looked at there was no evidence that a social assessment is completed by the home, which would determines peoples lifestyle interests and hobbies. This information could then be incorporated into activities planned by the home, ensuring that people are provided with opportunities for activities that are suitable for them. One member of staff said that there is a quiz, they sing and dance, play bingo or bowls. They also said that they can sit in the garden and that some of the people living at the home go out with relatives. Hawthorn Lodge Nursing Home DS0000000172.V376200.R01.S.doc Version 5.2 Page 16 Staff spoken to said an improvement would be to have someone dedicated to organising activities. One member of staff said, “They could do with more stimulation, there is no time, they just sit in the chairs”. One person who lives at the home said, “There is nothing going on, nobody has any time to spend with you and I don’t walk as much as I would like to”. Another person said, “I prefer to stay in my room, people pass by and they do talk to me and bring me books”. They also said that they had frequent visitors. People living at the home were spoken to about daily life in the home. They said that they could make their own decisions in regard to getting up and going to bed, however bath times were set. One person said, “Can have a bath when they want to do it to us, not when you want”. People were observed getting up late and having a later breakfast. Staff and people spoken to said that there were visits from a Vicar. The menu was looked at, which was a four week rotational menu. There was no actual choice on the menu, although it was confirmed by one of the staff that alternatives were available and that special diets are catered for. One person who is vegetarian spoke very highly about the meals, they said, “I don’t like red meat, they always make me something I like”. Other people said, “The meals are lovely, they have fed me well, not sure about choices I get what I’m given”. “The meals are nice, they are set meals but you can have something else if you don’t like it”. It was good to see people being able to have their meals in the garden when the weather was fine. It was identified on the menu that there is a lot of egg based meals, with twelve of fourteen tea/breakfast meal being egg based. There was discussion with one of the cooks to establish if the menus had been checked by a dietician to determine nutritional value and balance. They were not aware if this had happened or not. Hawthorn Lodge Nursing Home DS0000000172.V376200.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst people are generally happy and feel safe at Hawthorn Lodge the way in which concerns and complaints are dealt with is not good enough. This along with the lack of training in respect of Protection of Vulnerable Adults does not fully promote people’s wellbeing and protect them. EVIDENCE: There is a complaints procedure available, which is displayed within the home. There were mixed views from people living at the home about complaints. One person said that if they were unhappy they would speak to the matron. Another person said, “If I was unhappy, I would speak to a friend of mine”. Another person said, “If I was unhappy, not sure what I would do, just put up with it”. The AQAA detailed that there had been no complaints since the last inspection. However the CQC are aware of one complaint being made since the last inspection. It was also identified in the care records of people that complaints had in fact been made. However these were not recorded in the complaints book and it was unclear what action had been taken. One member of staff spoken to said that they had covered the topic of abuse when they completed their National Vocational Qualification. When asked about Hawthorn Lodge Nursing Home DS0000000172.V376200.R01.S.doc Version 5.2 Page 18 Protection of Vulnerable Adults (POVA) and No Secrets, they said, “Never done it”. Another member of staff spoken to said they had not completed POVA/No Secrets training. The policy in this area indicated that when a suspicion of abuse occurred sensitive enquiries would be made by the matron and directors. This is not in line with the locally agreed safeguarding procedures. This policy must be reviewed and must include the appropriate details of the action to take and who needs to be contacted. It must include the details of the local social services department and the police. Hawthorn Lodge Nursing Home DS0000000172.V376200.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is clean and well maintained. In the main it provides a homely environment for the people who live there. EVIDENCE: During a tour of the building the inspector saw that many of the rooms are decorated to the persons 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. A good standard of decor and furniture is provided throughout the home. However some of the bedroom doors were fitted with glass panels and net curtains were fitted. These do not provide an adequate level of privacy and dignity. Hawthorn Lodge Nursing Home DS0000000172.V376200.R01.S.doc Version 5.2 Page 20 There is the need to look at improving the dining environment as currently the dining room contains much information that is staff related. One of the dining tables in up against one of the wall which has a staff notice board containing information about policies and procedure. This impinges upon the homely environment and is not conducive to a positive dining experience. Other areas of the dining room also contain filing cabinets and staff information such as annual leave entitlements. It would be better to be able to separate staff area from those used for the purposes of people living at the home. There was a good range of equipment seen around the home to support people with bathing and mobility, including overhead tracking in some areas. However the upstairs sluice door requires a method of security so that it can only be accessed by staff. A very pleasant garden, equipped with tables and chairs is also available to people living at the home. The inspector found the building to be clean, tidy and free from offensive odours. Hawthorn Lodge Nursing Home DS0000000172.V376200.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes recruitment procedure is in the main good, which helps to ensure that people are protected. Mandatory training and other training relevant to the job staff have to do is not up to date. This potentially places people at risk. EVIDENCE: The AQAA detailed that staffing levels are in accordance with Section 31, however this no longer applies and staffing levels need to be determined primarily by the needs of the people living at the home, layout and numbers of people. People spoken to and staff thought that the current staffing levels were not sufficient to fully meet peoples needs and certainly not sufficient to provide activities and to spend time with people. One member of staff said that the day duty was busy and that seventeen of the twenty people currently living at the home needed the assistance of two staff. As the staffing levels during the day are one qualified nurse and two care assistants, this is proving to be difficult. Another member of staff said, “People’s needs are met but we are sometimes run off our feet”. Hawthorn Lodge Nursing Home DS0000000172.V376200.R01.S.doc Version 5.2 Page 22 Three staff files were looked at during the inspection, one for the most recent person appointed and two for a longer standing member of staff. The records were in good order and contained the required information such as fully completed application form and appropriate references. However it was noted that the application form was dated as the day the person commenced employment. It was therefore unclear as to whether the employer had a full picture of the employment history and whether any gaps had been explored Criminal Records Bureau checks are also in place and it was confirmed that no one commences employment until this has been fully issued. Those required following the last inspection have now been undertaken. There was evidence of in house induction, however no evidence of Skills for Care Foundation Standards. The manager was not aware of this and said that they do not use these standards as part of induction process, that they never had used it, even when people are not trained to NVQ Level 2. The AQAA detailed that there is an ongoing staff training programme and training records. This was discussed with the manager who said that there wasn’t one and that, “The Boss does it in it in-house”. There was no system in place to show what training staff had been undertaken and how up to date they were with mandatory training such as fire, infection control, moving and handling and health and safety. The manager said that they usually kept certificates but they were unable to locate the certificates and no training records were made available. A member of staff spoken to on the second day of inspection confirmed that they had completed fire training within the past two weeks. Another member of staff said that the only training they have had since being employed over twelve months ago was fire training. Supervision was discussed with staff, one member of staff said, “We do have them three times a year, I can’t remember the last one”. Another member of staff who has been employed for over twelve months said that they had not had any supervision as yet. People who live at Hawthorn Lodge spoke highly of the staff. They said, “The girls are very nice, they are very good to me”. “The staff are nice, they look after you”. “The staff are respectful and courteous to everyone”. “It is lovely here, the staff are so friendly, very nice”. Staff spoken to were happy working at Hawthorn Lodge. One person said, “This is a really good home, I like coming and it is really friendly”. Hawthorn Lodge Nursing Home DS0000000172.V376200.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has the relevant qualifications. Some policies and procedures are not up to date. This could place people at risk. EVIDENCE: The manager is a registered general nurse and has managed Hawthorn Lodge for a number of years. She has obtained an appropriate management qualification. She is registered with CQC. Hawthorn Lodge Nursing Home DS0000000172.V376200.R01.S.doc Version 5.2 Page 24 The systems in place for seeking the views of people who use the service need to be reviewed. The Regulation 26 visits carried out by the provider only cover environmental aspects. They must also interview people living in the care home, their representatives and the staff in order to form an opinion of the standard of care provided at the care home. The home keeps personal allowances for people who request this. Two signatures are kept for transactions and appropriate receipts are obtained. The manager indicated on the AQAA that the policies and procedures had been reviewed in January 2009. However there was evidence within the sample seen that this was not the case. Some referred to the previous regulatory authority and one was not specific to the home. The AQAA detailed that there is ongoing maintenance and servicing of equipment such as the fire detection equipment and gas appliances. Records were looked at during the inspection, which confirmed this. Weekly fire checks are taking place and being recorded. It is unclear however what the system is for monitoring the water temperatures and the person who had responsibility for this is no longer available. Of the records made available for this the temperatures were recorded 19/4/07, 28/8/08 with only eight rooms recorded and again 24/4/09, when it looks like they were all recorded. There is the need to ensure that water outlets that people living at the home have access to are tested at regular intervals, in respect of baths and showers the Health and Safety Executive recommends weekly. Records were looked at for fire drills, through discussion with the manager it was recommended that the time of the drills should be recorded along with the time taken to complete and the effectiveness or not of the drill recorded along with any action points. Hawthorn Lodge Nursing Home DS0000000172.V376200.R01.S.doc Version 5.2 Page 25 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 2 X X X 2 X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 2 2 Hawthorn Lodge Nursing Home DS0000000172.V376200.R01.S.doc Version 5.2 Page 26 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 OP3 Regulation 14 (1)(c) Timescale for action The home must keep evidence to 31/10/09 confirm that appropriate consultation has been made regarding the admission assessment with the service user or a representative. This is to make sure that all of the needs of the person can be met. Where a problem or need is 30/09/09 identified either within the care plan or in the daily review, then a care plan must be formulated to make sure that staff know how to look after the person properly. Arrangements must be in place 30/09/09 to ensure that medication records are accurately maintained; that the reason for non-administration of medication are recorded by the timely entry of an appropriate code or entry on the medication record; that the meaning of any such codes are clearly explained on each record; and that the person administering the medication completes the Medication Administration Record in respect of each individual service user at DS0000000172.V376200.R01.S.doc Version 5.2 Page 27 Requirement 2. OP7 12 3. OP9 13(2) Hawthorn Lodge Nursing Home the time of administration. 4. 5. OP16 OP18 22 13 A record must be kept of all complaints made including the action taken. The safeguarding procedure must be reviewed to make sure that it reflects the guidance contained in the locally agreed procedure. It must contain the contact details of the local authority and police. All staff must receive training in the safeguarding procedure so that they are aware of the action to take in the event that a suspicion of abuse occurs. The Regulation 26 visits carried out by the provider must include evidence that people living in the care home, their representatives and the staff have been interviewed in order to form an opinion of the standard of care provided at the care home. All policies and procedures must be reviewed to make sure that they are up to date, appropriate, relevant and specific to the home. 30/09/09 31/10/09 6. OP18 18 31/12/09 7. OP33 26 30/11/09 8. OP37 12, 13 & 18 31/12/09 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 When writing daily records staff should be mindful of the content to make sure that the entry reflects the actual problem and that peoples needs are being met. The medicine policy should be updated in line with current guidance so that staff understand how to handle and DS0000000172.V376200.R01.S.doc Version 5.2 Page 28 Hawthorn Lodge Nursing Home administer medicines safely. 3. OP9 Handwritten entries and changes to MAR charts should be accurately recorded and detailed. This makes sure that the correct information is recorded so a person receives their medication as prescribed. The temperature of the medication room should be regularly monitored. This means that medicines are being stored at the temperature recommended by the manufacturers. The activities programme should be reviewed to make sure that it is suitable for all of the people who live in the home. It is recommended that the menus be reviewed and discussed with a dietician to make sure that the content is nutritious. The upstairs sluice should be made secure so that it can only be accessed by staff. There is a need to improve the dining area and remove notices which relate to staff. This will make the dining area more homely in line with the other areas within the home. Consideration should be given to provide an alternative to the net curtains on bedroom doors with glass panels fitted. This will increase the dignity and privacy for some of the people who live in the home. Staffing levels should remain under review so that they are deployed in sufficient numbers to meet all of the needs of the people who live in the home. The recruitment procedure should be reviewed. The application form should be received prior to the commencement date to ensure that gaps in employment are explored. The induction training programme should be reviewed to include the recommendations made by Skills for Care. It is recommended that staff supervision sessions take place at least six times a year for all staff. It is recommended that the monitoring of water temperatures be recorded on a weekly basis. It is recommended that the time of fire drills should be recorded along with the time taken to complete and the effectiveness or not of the drill recorded along with any action points. 4. OP9 5. 6. 7. 8. 9. OP12 OP15 OP19 OP20 OP24 10. 11. OP27 OP29 12. 13. 14. 15. OP30 OP36 OP38 OP38 Hawthorn Lodge Nursing Home DS0000000172.V376200.R01.S.doc Version 5.2 Page 29 Care Quality Commission North Eastern Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.northeastern@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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