Inspection on 12/04/06 for Hawthorne Care Home

This inspection was carried out on 12th April 2006.

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 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

Hawthorne Care Home 07/07/08

Hawthorne Care Home 14/04/08

Hawthorne Care Home 05/11/07

Hawthorne Care Home 11/04/07

Hawthorne Care Home 31/10/05

Hawthorne Care Home 24/01/05

Hawthorne Care Home 10/09/04

Hawthorne Care Home 01/10/03

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Hawthorne Care Home School Walk Bestwood Village Nottingham NG6 8UU Lead Inspector Jayne Hilton Unannounced Inspection 12th April 2006 09:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hawthorne Care Home Address School Walk Bestwood Village Nottingham NG6 8UU 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) 0115 9770331 0115 9770332 Mrs Jagruti Patel Doris Agatha Francis Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (34), Terminally ill (2) of places Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Within the total number of beds a maximum of 2 beds maybe used for the category TI The home is registered to provide personal care with nursing for service users of both sexes whose primary needs fall within the following categories: Old Age (OP) (34) Terminally Ill (TI) (2) 3. The maximum number of service users to be accommodated is 34 One Named Service user may be under the age of 65 Date of last inspection 31st October 2005 Brief Description of the Service: Originally constructed as the village Rectory, Hawthorne Care Home has been extended and developed to provide accommodation and care for up to 34 people over the age of 65 years. A maximum of two beds may be used to accommodate people who are terminally ill and one bed is provided for a named individual under 65 years. Situated to the North of Nottingham City centre in Bestwood Village, Hawthorne Care Home has thirty single bedrooms and three double bedrooms. A passenger lift provides access to the first floor. Fees. The details of the range of fees charged [provided by the administrator on 12/4/06 are as follows £277 residential, £319 very dependent needs and £343 for nursing care. Service users are required to pay for their hairdressing costs, chiropody and newspapers in addition. Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out by one inspector and took place over six and a half hours. The inspector looked around the communal areas of the home and several bedrooms, observed staff practice, partly looked at the storage and dispensing of medication and examined a number of records. In addition the inspector observed the care given to several residents and the use of equipment. The inspector also gained information by speaking with three service users, visiting relatives and several members of staff on duty. The registered manager and the administrator were also spoken with. All key standards were assessed, some only partly however. The requirements set at the previous inspection were also assessed and found to be met. The outcomes for service users, is overall assessed as positive with many improvements for service users noted. What the service does well: Service users and relatives spoken with were generally satisfied that needs were being met. A few of the care plans have been further improved and are now of a good standard. Care plans are overall up to date, reviewed monthly and overall appropriately detailed and the healthcare needs of service users are met. Medication is generally handled correctly. Residents at the home are generally treated with respect and their privacy upheld. Residents are able to remain in contact with their friends and relatives and are able to make some choices. Equality and diversity is promoted in the home and overall service users are helped to exercise choice and control over their lives. Residents said that they were woken with a cup of tea in bed and that drinks were served at frequent intervals. Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 Page 6 Lunch was observed to be unhurried. Comments about the quality of food were good. Evidence was provided in the form of documentation and confirmation from service users that they were assisted to use their right to vote. Staff spoken with had completed training in protecting residents from abuse. They were clear about the homes policies and procedures in this area and how to protect residents from abuse. Risk assessments were in place for use of mechanical restraint, such as bedrails, lap belts and recliner chairs. Footplates were observed to be on all wheelchairs used in the home. The accommodation is generally of a good standard and service users live in safe, comfortable bedrooms with their own possessions around them. The numbers and skill mix of staff meets Service users needs. What has improved since the last inspection? The requirements set at the last inspection, of which, many were outstanding have been actioned. All the care plans and risk assessments have on the whole been brought up to date and be detailed enough to ensure that adequate care is provided. There was some evidence that residents or their representatives are involved with care plans but further work is needed to ensure that they feel valued and taken into account and that they sign the care plan reviews as evidence that they have been consulted with. The social interests of residents are being considered more and are being recorded; further development and innovation would further improve the lives of service users. A record has been kept of any complaints and the action taken to resolve them. Thorough checks and references are now made when new staff are employed in order to ensure that residents are in safe hands. Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 Page 7 A number of structural matters in the home needing attention have been resolved. What they could do better: Quality monitoring is an area that needs to be worked on, the Registered Provider does undertake Regulation 26 visits, but there was no evidence of service user or relative surveys/questionnaires being used or any annual development plan for the home. The Registered Provider may wish to look at the options for improving quality monitoring in the home, such as a professionally recognised quality assurance system. Moving and handling practices were observed throughout the day. Staff were observed to use grip holds and hook lifts when transferring service users from wheelchairs to chairs. As a recent training course had been provided for staff, the manager must ensure that the training provided is up to date and that staff are following correct practice. There was no evidence of a fire safety risk assessment, neither was there any evidence that the home holds a five yearly electrical circuit safety certificate. It was reported that there is a system is in place for the prevention of legionella and the certificate is awaited from a recent check. Evidence of the certificate should be forwarded to CSCI. The home has a clinical room on the first floor but because of limited storage space the staff choose to secure medicines trolleys in the small dining area. There was some items noted to be left on the trolley shelves, such as two boxes of prescription cream, a sharps box, scissors and kidney dishes. The practice needs to be reviewed/risk assessed to ensure health and safety compliance. It is recommended that the assessment and care plan documentation is consolidated and which includes a section for foot care and history of falls and by which care plans can be devised both for the specific topic needs and any individual additional needs. A medication profile would further improve the documentation and promote person centred care. Service users and staff spoken with were not aware of any special events taking place over the Easter weekend or The Queens 80th Birthday celebrations. The manager and the activities person confirmed nothing had yet Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 Page 8 been planned and stated that Easter Bonnet competitions had been organised in past years. The social and recreational needs of service users are being obtained but this information needs to be more detailed and gathered from the personal history and getting to know you better document and used in conjunction with care plans. Innovation and imagination is needed to provide varied, suitable, age appropriate activities and entertainment. It was also recommended that a service user survey be carried out in relation to the current activities provided and what service users would like to be on offer in the future. Where service users are offered activities and refuse this should be noted. Concerns and complaints could be embraced more positively and pro-actively. The induction used currently is a basic type induction. This area needs improvement, as there was no evidence that staff had undertaken sufficient induction and foundation training in the first six months of employment. Some minor repairs are needed and the cleaning routines in the home need to be addressed. There are some identified areas in relation to improving and promoting the dignity of service users for the manager and staff to address also. 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. Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 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 Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, The home knows about prospective residents care needs prior to their admission to the home. Residents are now receiving written confirmation that the home can meet their needs. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home does not provide intermediate care EVIDENCE: The service user files seen all contained copies of the original assessments of care needs that were undertaken prior to the person entering the home. The initial care plan is devised from this assessment of need. Residents are now receiving written confirmation that the home can meet their needs. Evidence of this was seen in records held. Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 Page 11 The assessment tool used is based on the Roper model of activities of living and needs to encompass all of the topics listed in Standard 3.3 to ensure that service users needs are assessed in an holistic way. The manager has introduced a “Getting To Know You better document” which covers likes /dislikes and some preferences of the individual for getting up, going to bed and past history, social and recreational interests etc. It is recommended that the assessment documentation is consolidated into one document and which includes a section for foot care and history of falls and by which care plans can be devised both for the specific topic needs and any individual additional needs. A medication profile would further improve the documentation and promote person centred care. Service users and relatives spoken with were generally satisfied that needs were being met. [See however comments in standards, 10,14,16,18,38]. Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Care plans are in place and are overall up to date, reviewed monthly and overall appropriately detailed. The healthcare needs of service users are met. Medication is generally handled correctly However improved practice is required, including items left out of the trolley or clinical room, which could put residents at risk. Residents at the home are generally treated with respect and their privacy upheld. Some improvement is needed however. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” EVIDENCE: The qualified nursing staff complete the care plans and care staff confirmed that they had access to them and used them to gain information about individual residents needs. Four care plans were examined and on the whole were up to date with clear and detailed information, had up to date risk assessments, had been regularly reviewed. Some plans contained old Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 Page 13 information, some which appeared to have been discontinued without explanation, Several plans had risk assessments for bed rails that were inadequate and out of date as well as new ones for this purpose. Where service users relatives have not wanted to be involved in the care plan and review processes, signed declarations were seen, however where it has been difficult to obtain the involvement of the service user or relative in the care plan, a signed statement should also be obtained. As the new additions of paperwork have been continually added in the meeting of National Minimum Standards, the documentation is cumbersome and untidy. It is recommended that the structure and format of the assessment and care plan documentation is reviewed to include all of the necessary information on admission and ongoing through a process of evaluation and review and which consolidates all of the separate sheets that have been added to comply with the NMS. A separate sheet is in place for the holding of bedroom door keys and lockable facilities. One service user who had suffered a seizure needs to have a care plan implemented for this newly identified need. Records of falls are collated on the computer and are to be included within the care plan/risk assessment documentation. Routine breast screening information was seen where appropriate and where this could not be accommodated. Other health checks are recorded, however the system introduced to monitor foot care has been stopped and the old system reverted to where chiropody treatment is recorded in a book. Information should be recorded within the individual’s record of care and the assessment and care plans for personal/health care need to ensure that appropriate foot care needs are met and maintained. Nutritional Assessment tools are used, alongside Norton Waterlow tools for tissue viability, a tool for the assessment level of dependency, wound assessments, blood sugar monitoring, communication and infection control, all were reviewed monthly. Blood sugar monitoring records should include the actual ‘mmol’ reading and not state “normal” Care plans were in place for continence and pressure areas and detailed where specialist equipment was in use. There was one service user reported to have pressure areas and the manager had obtained advice from the Tissue viability specialist in relation to this. Some visitors commented that they felt their relative residing in the home was found to have food stains on her clothing, which had not been changed for a while and were concerned about the frequency of bathing and had raised this with the manager who had told the relatives that the service user was bathed weekly. On checking the personal care records of the resident, two baths were noted for most months, the previous month noted four baths had been given. When the inspector discussed this with the manager she explained that the Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 Page 14 individual did have daily bed baths, due to the persons individual needs, however there was no other documentation to support this. Some other issues raised were supported within the care plan process and by satisfactory explanations by the manager. The dispensing of medication was observed and appeared to be satisfactory practice. The home has a clinical room on the first floor but because of limited storage space the staff choose to secure medicines trolleys in the small dining area. There was some items noted to be left on the trolley shelves, such as two boxes of prescription cream, a sharps box, scissors and kidney dishes. The manager stated that these had just been in use and the staff nurse had not yet had time to take the items back to the clinic room. Although there are no service users able to walk into the room unaided, the practice needs to be reviewed/risk assessed to ensure health and safety compliance. The procedures for management of medication waste, was not examined at the inspection. It was reported that on one occasion, relatives found their relative with tablets in her hand and the relative had remarked that staff had forgotten to bring a drink of water for her to take the tablets with. The residents and staff members spoken with during the inspection gave information that indicated that residents are treated thoughtfully and with respect, and their privacy is respected for example when personal care is provided. Residents said that staff always knock before entering their rooms and that staff are ‘friendly and willing to help’. Comments from relatives were noted such as “sometimes my relatives hair looks as if it hasn’t been combed” Sometimes my relative has facial hair growth which has not been tended to for some time and we have had to ask for this to be removed.” “We want her dignity to be maintained”. Observations made on the day of staff practice raised no concern in relation to service user outcomes in relation to privacy and dignity. Privacy curtains were observed in double rooms. There was a comment made that staff have been heard to be a little sharp to service users on occasions when they have called for assistance and curtly asked service users “What’s the matter?” Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The home is starting to consult with residents about their interests and a new programme of activities has been introduced. Further development of the activities provision will mean more service users can participate. Residents are able to remain in contact with their friends and relatives and are able to make some choices. Equality and diversity is promoted in the home and overall service users are helped to exercise choice and control over their lives. Comments about the food were positive and there is now a choice of meals. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” EVIDENCE: Since the previous inspection there has been noted improvement in the provision of activities. A member of staff has been delegated responsibility for organising activities and some board games and a floor netball game purchased. A record is being kept of the activities as they are provided and who has participated. Memory cards have also been introduced. A singer/musician duo was visiting in the afternoon of the inspection and which service users and staff were enthusiastically joining in. The staff member responsible for activities reported that the abilities of the service user group Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 Page 16 were limited and only two people were able to play bingo etc. The inspector discussed some ideas for innovation and themed events, which can provide stimulation and activity for which most residents would be able to participate in some way. Service users and staff spoken with were not aware of any special events taking place over the Easter weekend or The Queens 80th Birthday celebrations. The manager and the activities person confirmed nothing had yet been planned and stated that Easter Bonnet competitions had been organised in past years. The social and recreational needs of service users are being obtained but this information needs to be more detailed and gathered from the personal history and getting to know you better document and used in conjunction with care plans. Innovation and imagination is needed to provide varied, suitable, age appropriate activities and entertainment. It was also recommended that a service user survey be carried out in relation to the current activities provided and what service users would like to be on offer in the future. Where service users are offered activities and refuse this should be noted. Residents and relatives said that that visitors can come to the home at any time. Residents can see their visitors in private or in the communal areas. Some residents were able to give examples of how they could continue to have choice and control over their lives, for example by handling their own financial affairs and by bringing personal possessions into the home, going to bed and getting up when they want to. [One resident reported that she could not go to bed until staff had taken their break at 6.30pm, as all staff take their breaks together. The manager denied this would happen and stated that some service users don’t fully understand that staff are entitled to a break]. Assessments and care plans should contain more detail about service users preferences for bathing /shower and frequency and shaving etc [including assistance for removal of facial hair for female service users] Residents said that they were woken with a cup of tea in bed and that drinks were served at frequent intervals. Lunch was observed to be unhurried. Comments about the quality of food were good. Positive comments were also made about the evening soup, sandwiches and cake. Service users confirmed that they have a two menu options for the main meal of the day, Pork casserole and mince beef were the offered choices on the day of the inspection. A record of this is kept. Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Complaint records were available for inspection and appear to be dealt with, but a judgement is made that concerns and complaints could be embraced more positively and pro-actively. Service users legal rights are protected. Staff training and awareness helps to protect residents from any abuse. Attention is needed in relation to ensuring call alarms are placed in reach of service users at all times. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” EVIDENCE: The home has formalised the complaints procedure. There have been no complaints recorded in the file. The manager had however kept all details of two complaints in wallets, one, which had been referred under ‘The Safeguarding Adults Protocols’ and found to be not substantiated. Another, which, CSCI and Social Services had received a copy of; was currently being investigated by the manager. The records were available for inspection. Relatives spoken with who raised some concerns about the service during the inspection reported that they had not made any formal complaints for their own personal reasons and not because they didn’t know how. Service users spoken with said they felt safe and would feel able to raise concerns if needed to. Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 Page 18 When the inspector was feeding back observations and comments to the manager, although she was on the whole receptive and polite she was a little defensive, giving a reason for the issues raised rather than embracing any comments, concerns or complaints made in a constructive way. The inspector’s judgement is that the manager may feel that comments about the service are so detrimental, that complaints are seen as a negative, rather than to be embraced and used constructively to improve the service. It is recommended that the manager and staff explore ways to encourage service users and relatives to raise any concerns and if need be make formal complaints where they feel this is appropriate and that all are fully documented. Evidence was provided in the form of documentation and confirmation from service users that they were assisted to use their right to vote. Staff spoken with had completed training in protecting residents from abuse. They were clear about the homes policies and procedures in this area and how to protect residents from abuse. Risk assessments were in place for use of mechanical restraint, such as bedrails, lap belts and recliner chairs. Footplates were observed to be on all wheelchairs used in the home. One service user, who was confined to bed, due to disability could not reach the cord to the call alarm to ring for attention. The service user stated that her bedroom door was mainly left open, so she could shout for assistance if she needed it but would not be able to alert staff if she felt ill in the night etc. The manager reported that she was not aware of this, as a pull cord should be attached and left in reach of the service user. On investigating the matter the manager agreed that the cord was missing and suggested that it may have been pulled out when the bed was changed that morning. The manager also explained that there was a risk to the service user getting tangled in the cord and therefore the inspector recommends, it should be secured in a way that is both safe and in reach to the service user. The inspector had noted that relatives had made comment to being informed by staff that the service user would call for attention frequently. Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24,26 The accommodation is generally of a good standard however there are some areas where repairs or attention is needed. Service users live in safe, comfortable bedrooms with their own possessions around them. The home is overall clean pleasant and hygienic, but there are issues in relation to the appropriate use of cleaning products. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” EVIDENCE: The layout of the home is suitable for its purpose and rooms were well furnished and comfortable. The dining area has been made more spacious for service users with the purchase of new furniture. There was an improvement in the general tidiness of the home overall. Relatives reported that they had noted improvement in this area over the recent months. There is said to be a programme of maintenance [the record was not available for inspection] and bedrooms are decorated as they become vacant. The residents’ rooms seen Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 Page 20 were personalised and residents said they had been able to bring their personal belongings when they moved into the home. Relatives reported that there was a period of time food spillages had been observed under their relative’s bed but had not happened recently. The garden area to the rear of the building was observed to require some tidying from the winter months. The quiet room now has adequate heating, repairs have been made to the radiator and it felt warm to the touch on the day of the inspection. The storage space is limited and an under stairs area is used to keep wheelchairs and other equipment. On the day of the inspection the area was tidy and kept as safe as it could be, however provision of alternative storage facilities would be more appropriate. Grab rails are sited around the homes walkways and hoists and manual handling equipment was observed around the home and in use. There was a piece of broken skirting board on the first floor that requires repair and some woodwork throughout is in need of cyclical painting. A square of wallpaper was loose on the main staircase and needs re securing. Generally overall the décor and the environment were satisfactory. Cleanliness in the home was overall satisfactory, however recently purchased floor covering in some bathrooms and toilets appeared grubby. The domestic staff spoken with were asked what they used to clean the flooring and they stated a product, which is a disinfectant and not a cleaning agent. They also said they used a scrubbing machine periodically. As there was no cleaning agent/product on the domestic’s trolley, apart from a toilet bowel sanitizer, the inspector enquired what cleaning product was used for baths, sinks and toilets and general cleaning. The domestics did not provide evidence of a cleaning product name and stated that they had left it at the other end of the building. There was no cleaning product observed by the inspector on the continued tour of the building, neither was any evidence provided of the product used. The floor covering was not sealed at the edges, the matron reported that the contractor had to come back and complete this work. The walk in shower room flooring was cracking and the possibility of water seeping underneath and damaging the floor. [The bathroom and toilets on the ground floor were not seen at this inspection due to being in use] Staff were observed to wear personal protective equipment for tasks and adequate supplies of gloves and paper towels were seen in the home. Some staff have undertaken training in MRSA and some are due to update re training in infection control, which the manager and administrator reported was being arranged. Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 Page 21 The laundry and sluicing facilities were not assessed at this inspection. There was no malodour present on the day of the inspection. Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The numbers and skill mix of staff meets Service users needs. Service users are in safe hands at all times. Service users are protected by the homes recruitment practices Staff are trained and competent to do their jobs Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rosta was examined and were satisfactory for 26 residents in residence. There are four carers and two trained staff on each shift, which does include the manager, which equates to one staff per five service users. Two carers and one trained nurse works nights. Adequate catering and domestic hours are provided. Four staff was reported to be undertaking NQV level 2 and three staff undertaking NVQ level 3. Some staff were reported to have left who had achieved NVQ’s and new staff will be enrolled once funding becomes available. The induction used currently is a basic type induction. This area needs improvement, as there was no evidence that staff had undertaken sufficient induction and foundation training in the first six months of employment. Training records were examined and mandatory training is provided, recently, moving and handling, training had been provided and training in Dementia Care. Updates were said to being arranged in Infection control. Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 Page 23 Training should be provided in dealing with challenging behaviour, dealing with epilepsy. Three personal files of the most recent recruited staff were examined and found to be satisfactory. Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Service users live in a home, which is run and managed by a person who is fit to be in charge. The systems for quality monitoring require improvement Appropriate measures are in place to ensure that residents’ financial interests are safeguarded. The health, safety and welfare of service users is generally promoted and protected. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is registered and is a first level nurse with many years experience in nursing care. The manager appeared to have a good rapport with service users, staff and relatives. Relatives made comment that they had not seen much of the Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 Page 25 manager in recent months. The inspector was satisfied that suitable arrangements had been notified to the Commission in relation to any absence of the manager. Quality monitoring is an area that needs to be worked on, the Registered Provider does undertake Regulation 26 visits, but there was no evidence of service user or relative surveys/questionnaires being used or any annual development plan for the home. The Registered Provider may wish to look at the options for improving quality monitoring in the home, such as a professionally recognised quality assurance system. The home does not act as an agent for any resident. A small amount of petty cash is available for residents to access. Records of service users finances were seen at the last inspection. Secure facilities were seen for the safe keeping of monies and valuables. Receipts are given where service users valuables are kept safe on their behalf. Moving and handling practices were observed throughout the day. Staff was observed to use grip holds and hook lifts when transferring service users from wheelchairs to chairs. As a recent training course had been provided for staff, the manager must ensure that the training provided is up to date and that staff are following correct practice. Manual handling plans were in place in service users care plans and staff, were noted to be considerate and interactive when assisting service users with transfers. Accident records were being kept in line with Data Protection and fire safety records were satisfactory. There was however no evidence of a fire safety risk assessment neither was there any evidence that the home holds a five yearly electrical circuit safety certificate. Portable appliance testing records were seen and the annual gas safety certificate. Records were also seen for water outlet temperatures. It was reported that there is a system is in place for the prevention of legionella and the certificate is awaited from a recent check. Evidence of the certificate should be forwarded to CSCI. Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 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 3 18 2 3 X X X X 3 X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 X X 2 Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 Page 27 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 12,13, Medicines Act Requirement Ensure items such as scissors and sharp boxes are not left on the medicine trolley shelves Ensure service users are offered water to take with their medicines. Ensure service users have call alarms, which are placed within reach at all times. Ensure all parts of the home are kept clean and suitable arrangements are in place for maintaining satisfactory standards of hygiene in the home. This requirement is in relation to Bathrooms and bathroom flooring. [Domestic staff need to have cleaning schedules and provided with and use appropriate cleaning materials for the task in hand.] 4 5 OP33 OP38 24 17, 23 Ensure quality-monitoring systems are in place. Ensure service users health, DS0000026443.V288217.R01.S.doc Timescale for action 12/05/06 2 3 OP18 OP26 12 16[2][j], 23[2][d] 12/05/06 12/05/06 12/07/06 12/07/06 Version 5.1 Page 28 Hawthorne Care Home welfare and safety is promoted, in relation to the following. Ensure that a fire safety risk assessment is carried out. Ensure the home has an electrical safety certificate and this is renewed every five years. Ensure systems are in place to prevent legionella. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP3 Good Practice Recommendations Review the assessment and care plan structure and format, archive old information, and include a detailed evaluation and service users/relatives in the review process. Include a foot care, a history of falls and medication profile section in the assessment and care plans Review the assessment and care plan structure and format, archive old information, and include a detailed evaluation and service users/relatives in the review process. Include a foot care, a history of falls and medication profile section in the assessment and care plans Review the assessment and care plan structure and format, archive old information, and include a detailed evaluation and service users/relatives in the review process. Include a foot care, a history of falls and medication profile section in the assessment and care plans Blood sugar monitoring records should state the actual numerical reading. Implement a care plan for the service user who suffered a seizure. The manager should address the issues/comments raised within the report in a constructive way and to ensure that DS0000026443.V288217.R01.S.doc Version 5.1 Page 29 2 OP7 3 OP8 4 5 6 OP8 OP8 OP10 Hawthorne Care Home service users dignity is upheld. In relation to staff attitude. Clothing with food stains. Food spillages under beds. Personal care tasks. In relation to bathing preferences and personal care needs, these need to be covered within the assessment and care plan process and documented when met by staff. [The plan should include assistance to remove facial hair for female service users] The manager should address the issues/comments raised within the report in a constructive way and to ensure that service users dignity is upheld. In relation to staff attitude. Clothing with food stains. Food spillages under beds. Personal care tasks. In relation to bathing preferences and personal care needs, these need to be covered within the assessment and care plan process and documented when met by staff. [The plan should include assistance to remove facial hair for female service users] The activities provision should be further developed to include service users interests, be more innovative and arranged so that more service users can participate or be included. Where service users are offered and refuse to participate, this should be documented. The registered manager should explore ways to encourage service users and relatives to air concerns and complaints and use any issues raised to constructively improve service. Repair the piece of broken skirting on the fist floor hallway Re paste the loose wallpaper square on the main staircase. Report the cracked floor covering in the walk in shower and ensure the sealing of the edges to the floor covering in the bathrooms and toilets are finalised. Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 Page 30 7 OP14 8 OP12 9 OP16 10 OP19 11 OP30 Provide an induction and foundation for new staff, which meets skills for Care standards. Provide training for staff in the management of epilepsy and challenging behaviour The registered person should address the comments made in the report in relation to training and moving and handling practices of staff. 12 OP38 Hawthorne Care Home DS0000026443.V288217.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Nottingham Area Office 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. 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