Inspection on 14/04/08 for Hawthorne Care Home

This inspection was carried out on 14th April 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hawthorne Care Home 07/07/08

Hawthorne Care Home 05/11/07

Hawthorne Care Home 11/04/07

Hawthorne Care Home 12/04/06

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 Linda Hirst and Karmon Hawley Unannounced Inspection 14th April 2008 10:10 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.V362444.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 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 njh1963@yahoo.co.uk 1st Care Limited Care Home 36 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (34) of places Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Hawthorne Nursing Home is registered to provide accommodation and care to males and females whose primary care needs fall within the following categories :Old age (OP) 36 - the category old age refers to people aged 65 years and over Within the total number of beds at Hawthone Nursing Home a maximum of 5 beds may be used for the category DE(E) One named person accommodated within Hawthorne Nursing Home may be under the age of 65 years (Reference Minor Application No. V1889 dated 07.03.05) The maximum number of people to be accommodated at Hawthorne Nursing Home is 36 3rd March 2008 2. 3. 4. Date of last inspection 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 36 people over the age of 65 years. The home can admit up to a maximum of 5 people whose primary care need is dementia. There are currently over this number of people with Dementia and the home. 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. The home sits in its own grounds and is close to local shops, public houses and local transport links. There is a car park to the front of the building. The statement of purpose, service user guide and a copy of the last report are in the reception area, opposite the acting manager’s office if people who live at the service, relatives or visitors wish to see them. The current fees charged at the home range from £334 to £375 per week and people who live at the service are required to pay additional costs for hairdressing, chiropody, trips out, personal toiletries and clothes and newspapers. Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 5 Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 0 star. This means that the people who use this service experience poor quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people who live at the home and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people who live there and how they can and intend to improve their service. We did not receive this in time to help it plan the visit and decide what areas to look at. But we know that the acting manager did send this to us within the time agreed and she has given us a copy of this now. We have reviewed all of the information we have received about the home since we last visited and we considered this in planning the visit and deciding what areas to look at. We sent out 3 surveys to people living at the home, 3 to relatives and 3 to staff to get their views on the service being provided. We received all of these back. The people living at the home told us that the home is, “well run,” and that the “staff do very well under stressful circumstances.” Staff told us that the acting manager is “always available if needed,” and they said they get access to the training they need to do their jobs. Relatives told us, “everyone is clean and well fed,” and another said, “all of the staff are helpful and sympathetic to…our needs.” We were told consistently that there are not enough staff to help people with their needs, “there are times, when the staff are short, which can cause impatience, with trying to deal with individuals.” We were also told that there is not enough stimulation at times, “My mother is always saying she is bored. This could be six of one and half a dozen of another, e.g. not enough stimulation.” Our evidence from this visit is that there are appropriate activities being provided and that this area of the service has improved a lot since our last visit. We did this inspection with two inspectors; it was unannounced and took place over one day, including lunchtime. The main method of inspection we use is called ‘case tracking’ which involves us choosing four people who live at the service and looking at the quality of Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 7 the care they receive by speaking to them, observation, reading their records and asking staff about their needs. Part of this inspection looked at the quality of care people with dementia experience when living at Hawthorne Nursing Home. Because we are unable to communicate effectively with all of the people with dementia, we have used a formal way to observe people in this inspection to help us understand their experiences of life at the service. We call this, the ‘Short Observational Framework for Inspection (SOFI). This involved observing 5 people who live at the service, over two hours and recording their experiences at regular intervals. We made judgements about their state of well being, and how they interacted with staff members, other people who use services, and the environment. We discreetly observed people in the dining rooms, during the lunchtime period. We spoke to three members of staff and three people who live at the home to form an opinion about the quality of the service being provided to people being accommodated. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who live at the service. English is the first language of all of the people who live at the home at the moment, though there are people living at the home from minority ethnic groups. The staff team come from a wide variety of racial and cultural backgrounds and experiences. During the course of our visit we began to find evidence a continued breach of the Conditions of Registration and we issued a code B notice under The Police and Criminal Evidence Act 1984 to enable us to take documents from the home with a view to assessing the findings in relation to enforcement action. We have visited the home twice since our last inspection and our Pharmacy Inspector has looked specifically at the safety of medicines. We have issued a Statutory Notice to the owners to secure improvements in this area, but because this is part of an ongoing legal process at the moment we have not looked at the arrangements for medication on this visit. What the service does well: Most of the staff have received training about Dementia and they showed understanding and compassion towards the people who live at the service. They are guided by clear care plans which consider issues of independence, privacy and dignity and the acting manager checks how staff support people who live at the service to make sure they put this into practice. We found that there are lots of different activities for people who live at the service to get involved with, both group ones and individual. There are Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 8 activities which are targeted at people with Dementia as well as those people who are more able and the people who live at the service can choose whether to be involved or not. People who live at the home told us that their relatives can visit them at anytime and there are places where they can talk with them in private. They feel they can choose their own lifestyle and have not restrictions placed on them. The people who live at the service like living at the home, they find the staff caring and kind. They say that they look after them very well. They feel the home is well run. What has improved since the last inspection? The statement of Purpose is now a clearer document but it still does not fully reflect how the services being provided for people with Dementia meet their holistic needs. We found that the care plans have significantly improved, containing good, person centred detail and highlighting people’s preferences, need for independence and giving clear guidance to staff about how to preserve people’s privacy and dignity. We saw evidence that health care needs are being properly assessed, monitored and there is now better contact between the service and other external health care professionals to maximise people who live at the service’ health. We found many of the staff have a better understanding of how to treat the people who live at the service with respect for their privacy and dignity, but as can be seen below, there are still issues to be addressed with some staff members. We saw staff showing respect for people’s choices and decisions and the care plans offer them guidance on how to do this for people who find it harder to communicate. We found the recording and management of complaints have improved since our last visit and that the people living at the service can be assured their concerns will be responded to properly. We found that the owners and acting manager have taken steps to address the concerns we had on our last visit about safeguarding people who live at the service from harm and abuse, although as can be seen below there is still some confusion about when to refer staff to the Protection of Vulnerable Adults list which needs to be clarified with the owners and acting manager. We found the arrangements for preventing the spread of infection have improved a lot. Staff have had training and they understanding has improved, links have been set up between the home and the Infection Control Service. Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 9 We found that all of the staff files we looked at have all of the information and documents needed to make sure that staff are suitable to work with vulnerable people. The staff told us they have received a lot of training since our last visit and we saw their training records and certificates. Most staff showed they understand people’s needs better when we interviewed them and watched them with the people who live at the service. We have found significant improvements in the management of the service since our last visit, and although the acting manager is still not registered with us, this is unavoidable at the moment. The owner and acting manager hope to have the matter finally resolved shortly. We found that the acting manager has addressed a number of serious concerns we had on our last visit and is following up training through supervision, audits and staff meetings to make sure that the care being provided is of the standard she would expect. What they could do better: We found that the information in the statement of purpose could be better and that the specialised care being provided to people with Dementia is highlighted so that people have the information they need to make an informed choice about care. We also found that the acting manager could be clearer about the category of registration for the service. She must check out what the person’s primary need for care is to make sure the assessed needs of people can be met. We found that the care plans about health care needs could be updated more quickly in some instances to reflect the care that is needed. We found that there needs to be clear guidance to all staff about promoting and encouraging people to have more food if they are underweight or losing weight to maximise their health and wellbeing. We are not satisfied that the way the home manages medication is safe or that people who live at the service receive their medicines as prescribed by their Doctor. We are involved in a legal process with the owners at the moment about this issue. Our observations raised some concerns about a member of staff which the owner and acting manager needs to look into to make sure that people who live at the service are supported in a caring and compassionate way, especially when they are being assisted to eat. Our observations and comments from people who live at the service, relatives and staff all provide us with evidence that there are not enough staff on duty to meet the needs of the people living at the home. People have to wait for help with their needs and this needs to improve. Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 10 Although there have been lots of improvements in the service, the acting manager and owners need to make sure they work on the areas which have been raised following our visit to make sure that the home runs in the best interests of the people living there. The owners must make sure they write reports every month on the findings from their visits to show they are being responsible and are checking on the quality of care. The acting manager needs to make sure that she keeps us up to date with incidents that happen at the home so we can make sure the service is running well. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 11 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.V362444.R01.S.doc Version 5.2 Page 12 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who live at the home do not have enough information to make informed choices about whether the home can meet their needs. The service has failed to comply with its Conditions of Registration. EVIDENCE: The statement of purpose has been rewritten, but we found that although it states that there are five places for people with Dementia, it does not give any indication as to how the service will meet the needs of these people. People told us in their surveys that they did not receive enough information about the home before admission to help them make informed choices. One relative said she “found out what I need to know myself.” None of the three people returning surveys have seen a contract. Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 13 We looked at the care plan of the last person to be admitted to the service and found that there was a copy of the assessment by Adult Social Care and Health staff. We also looked at the care plan the service have put in place and found that it details the person’s needs well. However, we began to discover evidence that the person’s primary need for care may be because of their Dementia, so we issued a Code B Notice under The Police and Criminal Evidence Act 1984 with a view to assessing the findings in respect of taking enforcement action. When we looked at the care plans of all of the people who live at the service living at the home, there are already more than 5 people whose need for care is because of their Dementia living at the home. Staff we interviewed told us there are, “quite a few,” people at the home with Dementia. We spoke with the acting manager about this, she told us that she was assured by the placing officer that the person who has just been admitted needed care because of their physical needs. Intermediate care is not provided at the service and the standard is not applicable. Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. We found that the health and personal care needs of people who live at the service are assessed and provided for. Medication management remains an issue of concern because of the risk of ill health that people who live at the service face if they do not receive their medicines as prescribed to them. EVIDENCE: We looked at the care plans of three people who we observed during our SOFI in detail and found that these have improved significantly since our last visit. The format of care plans is clear and consistent, making it easy for staff to locate information. There is evidence that people who live at the service and their relatives have been consulted about care planning, and we found the plans to be person centred and detailed. When we cross referred our Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 15 observations and the care plans we found that most of the staff are following the plans of care and responding to people with Dementia in a consistent way. Most of the staff we spoke with showed good understanding of the needs of people with Dementia and about how to support them when their behaviour is challenging. We had concerns about how one person responded to people who live at the service and these have been passed to the owner and acting manager for them to investigate. The people living at the home told us that they are well cared for, “we like to look after ourselves but the staff are there if needed.” The health needs of people who live at the home are risk assessed using recognised nursing tools and if an area of need is identified there is a care plan written to address this. We saw evidence that staff record the care given to frail people who live at the service on a chart every day. We saw evidence of food monitoring, although in one instance the food intake of a person was very poor. When we checked this with the acting manager she said that the GP had discussed end of life care with the person’s family and this is what is being provided. The care plan did not reflect this key change however, and we also saw the person eating well at lunchtime, but the staff member who was assisting did not offer the person another helping. We have visited the home twice since our last inspection and our Pharmacy Inspector has looked specifically at the safety of medicines. We have issued a Statutory Notice to the owners to secure improvements in this area, but because this is part of an ongoing legal process at the moment we have not looked at the arrangements for medication on this visit. It does mean though that the quality rating in this area is affected. We did a two hour observation of five people during our visit and we saw some examples of good practice, where staff were talking to people with Dementia, engaging with them even if they could not respond back and managing some challenging behaviour well and in line with the person’s plan of care. Most of the staff interactions we saw were positive for the person concerned. We saw lots of examples where staff responded and reassured people in distress. Most of the people we observed spent their time in either a passive or positive state of being. Most of the staff we interviewed showed that they understand the need to support and reassure people with Dementia, they also told us the acting manager observes the delivery of care to make sure staff respect people’s dignity and privacy. People who live at the service told us, “the staff are very kind to us, very accommodating…they are polite at all times,” and they said the staff are, “always kind and caring… they are respectful.” Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 16 However, during our observation we saw one member of staff acting in a way which appeared to mock some people who live at the service, saw the person knowingly put another person’s tights on a resident and this staff member was not warm and responsive towards people with Dementia, and they failed to engage or respond to people who live at the service in a respectful way. We interviewed the person, who denies using other people’s clothing, and has a limited understanding of how to engage with people with Dementia. We have referred this matter to the owners for them to investigate and respond to. Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live at the service can live a flexible lifestyle in accordance with their needs and preferences, but people who need help to eat do not always receive this in a prompt and considerate manner. EVIDENCE: The service has employed a new activity co-ordinator who works during the week 9am to 3pm. We spoke with her and she told us her role is, “to provide people who live at the service with some sort of activity, anything as long as they are not watching TV day in day out.” She told us she does larger group activities in one lounge and more one to one activities in the lounge for people with Dementia. We observed her doing hand massages and nail care with the people who live at the service with Dementia and found her practice to be very good. She engages with people who live at the service well, explains to them, offers choices and speaks directly to them rather than talking about them. We looked Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 18 at the records of activities and these are clearly planned with an understanding of the skills and abilities each activity promotes. In the past nine weeks since being in post there have been daily activities, including; making door badges for people who live at the service’ rooms, baking, memory tray work, gardening, reminiscence work, painting and doing crosswords. The activities co-ordinator told us there is no budget for activities but there are plans for fundraising which will create a budget for further activities. The people we spoke with confirmed there are regular activities in the home, but they do not always join in. We had comments from surveys about the lack of activities but our evidence suggests that this area is being addressed well. People who live at the service told us that there are no restrictions on visiting and a quiet lounge is made available for visits. Visitors were seen coming regularly to the home, we also saw one person going out with a relative. The local church visits and takes a service at the home and the activities coordinator has started taking people out for walks now that the weather is improving. Relatives commented that they are kept informed about their loved ones. The people who live at the home consistently told us in surveys and interviews that they can choose how to spend their time, “there are no restrictions, I can do mainly as I please but I do need help.” Our observations provided evidence that people make their own choices and move around the home freely. We observed lunch, which looked and smelled appetising, if people need a soft diet, this is blended separately to promote appetite and maintain different colour and texture of foods. We watched the two staff help people who live at the service to eat, one did this very well, taking her time and chatting to the person, checking they were enjoying the meal and were ready for more food. However, the other member of staff did not offer assistance in such a positive way, she did not communicate well with the person and did not forewarn her as she began to offer food, resulting in the person being startled. We saw the staff member consistently put more food into the person’s mouth whilst she was still eating. The person finished the food, but was not offered any more which, given that she was willing to eat would have potentially increased her already low calorie intake. (See OP8 and OP10). We interviewed the staff member and she told us, “You have to take your time,” she knew that the person has a poor appetite and needs encouragement and told us, “you have to compensate for the food they have not had,” indicating she understands the plan of care and best practice but does not follow this through. She referred to people needing assistance to eat as, “feeders,” in her interviews with us which is not respectful. People who live at the service told us the food is “very good.” Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at the service’ complaints and concerns are investigated and responded to appropriately and they are safeguarded by trained staff who will protect them from harm or abuse. EVIDENCE: We have not received any complaints about the service since our last visit. We have now received copies of the complaint investigation we asked for during our last inspection. When we looked at the complaints file there have been two complaints since the last inspection, one concerning night time disturbance of a resident, and another about missing laundry. The records show that these issues were properly investigated, acted upon and outcome letters have been sent to the people who complained telling them what action has been taken to resolve the issues. People who live at the home gave us conflicting information in their surveys about whether they know how to complain, but the relatives completing surveys were clear about the action to take. The procedure is displayed in reception. The staff we spoke with know what action they have to take when complaints are made about the service. Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 20 When we last visited the home there had been three safeguarding alerts (two of which we made following our visit) these have now been investigated and disciplinary action has been taken by the owners; which the acting manager feels has been effective in bringing about the necessary changes. There have been two further safeguarding referrals since we visited, one concerning over sedating a person living at the home, which was upheld and action has been taken to resolve the issue, (we have received confirmation of this from the relative on our survey.) The other issue concerned verbal abuse of a person living at the service but the alerter subsequently withdrew the allegations. Action was taken in respect of the staff member highlighted in the alert. There still appears to be some confusion from the owners about when to make a referral to the Protection of Vulnerable Adults list but we have hopefully clarified this with them now and the necessary changes need to be made to the home’s policy on safeguarding. Our observations provide evidence that there has been a change in the atmosphere and working practices of the staff since our last visit. Although not all staff are responding in a way which promotes the privacy and dignity of people who live at the service (see OP10 and OP15) we found that many are responding with warmth and respect for people who live at the service and are following the new plans of care. People living at the service told us, “the staff are respectful, I can talk to the staff,” and, “We have no problems, we are settled and happy here.” Staff we spoke with understand their obligations to report and blow the whistle on poor practice and they said they would do this. They have had training on safeguarding and whistleblowing. They told us the “most important thing is to make sure people are safe and well looked after.” Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live at the service live in a safe, clean and tidy home which meets their needs. EVIDENCE: We did a partial tour of the accommodation to make sure that the outstanding areas of concern have been dealt with. We found that some parts of the home have had new flooring or carpet fitted, there are new bath panels in place and a new boiler has been fitted, (although the people who live at the service and staff told us that the temperature needs regulating as the home is now too warm.) There are radiator guards in place to prevent burns to people who live at the service. Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 22 We noticed several areas of the home needed redecorating, but we saw that there is an action plan to address these areas following maintenance audits. We found that all areas of the home were clean and tidy and the arrangements for the prevention of cross infection were in place and correct procedures are now being followed. The service now has an identified cross infection link nurse to take their work forward in this area. The staff we spoke with clearly understood how to prevent cross infection and are following the home’s policies. We saw evidence of regular infection control audits during our visit. The people living at the home did not have many comments to make about the accommodation, but one relative commented in a survey, “I would like the driveway and vehicle & standing area made better, for wheelchair users.” Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who live at the service are supported by staff who have received training in their needs but there are not enough staff on duty to make sure that the holistic needs of the people who live at the service are met in a timely manner. EVIDENCE: We looked at the staff rota and found that there is a nurse on each shift and between three and four care staff on duty to cover two lounges and two dining areas. We received many comments from people who live at the service, relatives and staff to indicate that the staffing levels are not sufficient to meet the dependency needs of the current people who live at the service. One person told us, “they could do with more staff as we have to wait a long time for help,” a relative commented in their survey, “There are not enough staff at times, because, when they are busy with one patient, there is nobody to supervise the others and they are left on their own, which can cause accidents.” Staff members also told us, “they could do with one or two more staff as when care staff are changing the beds there is no one in the lounges.” Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 24 Our own observations also indicated that there were times when there were not enough staff to meet the needs of the people who live at the service. For example at lunchtime we noticed that five people in the dining room needed full assistance to eat, but for forty minutes there was only one member of staff available to assist with this. One person who is at risk because of poor nutrition waited in the dining room in their wheelchair for 45 minutes before they had help from staff to eat. We also saw that at various times during our observation in the lounge, there was only the activity co-ordinator with the people living at the home, and she is not employed to undertake personal care. This does not represent all of our evidence, but it does show the need for a review of the staffing levels at the service. The acting manager told us in her Annual Quality Assurance Assessment that 22 permanent and bank staff are employed, of these 6 people have achieved their National Vocational Qualification Level 2 and a further 4 are undertaking this at the moment, this will still leave a slight shortfall in the 50 target which should be addressed. One of the staff we spoke with confirmed that she has just started doing her National Vocational Qualification Level 2 training. The induction for new staff is more in depth and the acting manager told us she has a planned meeting with Skills for Care trainers to move the common induction forward and to provide this for all staff. We looked at the staff files and found that staff have provided the information and documents needed to ensure they are suitable to work with vulnerable people. Those we spoke with said they have had Criminal Records Bureau checks and they also said they have regular supervision which one person told us has been, “very helpful.” We found that there has been lots of training provided for staff since our last visit and this is evidenced in the staff rota, in staff files and on the training matrix which has been developed. The training has included Dementia care, Supporting people with challenging behaviour, the Mental Capacity Act, Safeguarding, Manual Handling, Dignity and Respect training. The acting manager asks all staff to complete a post training questionnaire on what they have learned and how they will apply the knowledge. The staff we spoke with confirmed that they have had plenty of training. The people who live at the service we spoke with praised the staff as, “very kind,” “marvellous,” and one person told us, “I think they do very well under stressful circumstances.” Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the service has improved but more work is needed to make sure the home runs in the best interests of the people living there. EVIDENCE: The service is without a registered manager at the moment as a result of an ongoing legal situation with the former manager. There is an acting manager in post and she has addressed a number of serious concerns we had on our last visit. She is following up training through supervision, audits and staff meetings to make sure that the care being provided is of the standard she Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 26 would expect. We have found significant improvements in the management of the service since our last visit. That said there remain some concerns which the owner and acting manager need to address in terms of securing the safety and wellbeing of the people who live at the service (OP3, OP9, OP10, OP15, OP27.) It is important that these issues be addressed without delay. People who live at the service told us in surveys that the home is “well run,” and staff told us, “the acting manager is always available if needed.” We found that the service has not yet sent out surveys to people living at the home and their relatives, but they have been doing monthly audits of the service on issues such as medication, housekeeping, maintenance, laundry, Nursing, Health and Safety, Infection Control and care. The audits clearly state if compliance has been achieved, if there are shortfalls the action plan specifies what action is required and the timescale for completion. The audits are clear and completed well. The acting manager intends to send out surveys in about four weeks with the intention that these will be done bi annually. There are also plans to hold residents’ meetings with the support of the activity coordinator. The service does not hold money on behalf of people who live there. The service pays for any items the people need and then invoices them (or their representative.) We saw the receipts and individual account sheets for the people who live at the service. If the people need clothes and their relatives want the staff to get these, they check what is needed and how much they can spend. None of the people who live at the service or staff had any comments to make in this area. The acting manager told us in the Annual Quality Assurance Assessment that all Health and Safety testing and servicing has been undertaken as required. We checked that the Fire safety tests and training records and found that these have been completed on time and as required. We found that accidents are well recorded and no patterns of falls or accidents are evident and there were not any which should have been reported to us. However we did note that the acting manager had not notified us of the two safeguarding allegations (See OP18) as required. We found that there have been gaps in the monthly visit reports by the owners and given the situation in terms of the medication issues it is important that the owners provide continued evidence that the home is being conducted appropriately and in the best interests of people who live at the service. Failing to do this may reflect on their own fitness to remain registered. Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 27 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 2 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation 4, Sch 1 Requirement The Statement of Purpose must reflect the conditions of registration and highlight the specialist services you provide to help prospective people who live at the service make informed choices when selecting a care home. People whose needs are not reflected by the registration categories and the content of your statement of purpose, must not be admitted to the home in order to ensure their assessed needs can be met. This requirement is outstanding. Timescale of 30/11/07 not met. A code B Notice was issued under The Police and Criminal Evidence Act 1984 with a view to assessing the evidence in respect of further enforcement action. Following a management review of the service the provider has been formally Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 29 Timescale for action 31/05/08 2. *RQN S24 Care Standards Act 2000 14/04/08 3. OP9 17(1)(a) warned to comply with the conditions of Registration in a Provider warning Letter. Medication records must be accurate, complete and up to date to ensure that medication is given correctly and care staff know how it should be given correctly and safely for example when it is prescribed for ‘when required’ use or when it is administered via a PEG. This requirement is outstanding, timescales of 31/5/07, 12/11/07 and 29/2/08 not met. The legal process is still ongoing in relation to this area. Medication policies and procedures must reflect current medication management and staff practice must follow written policy and procedure to ensure that medication is managed safely and correctly. This requirement is outstanding, timescale of 29/2/08 not met. The legal process is still ongoing in relation to this area. 14/04/08 4. OP9 13 (2) 14/04/08 5. OP10 12(4)(a) 6. OP10 12(4)(a) 31/05/08 The issues we raised concerning the conduct of a named member of staff must be investigated and sent to us, along with the action taken to ensure people who live at the service are properly supported by all staff. You must ensure that people 31/05/08 who live at the service are treated with dignity and respect and have their needs attended to DS0000026443.V362444.R01.S.doc Version 5.2 Page 30 Hawthorne Care Home promptly and with consideration. The service has improved significantly in this area but the requirement has not been fully met, timescale of 30/11/07 not met. Given the improvements, we are prepared to extend the timescale for a final time but this matter must be resolved to avoid further action. The holistic needs of the people who live at the service must be reviewed and a calculation produced for staffing levels to meet these needs and ensure the health, safety and wellbeing of the people in your care. The issues of concern raised in this report must be addressed and resolved so that the home runs in the best interests of the people living there. All incidents specified in this Regulation must be notified to us at the commission to enable us to risk assess and monitor the service being provided to people who live at the service. Timescale for compliance of 30/11/07 not met. However we accept that there was a genuine misunderstanding about the failure to notify the two incidents in question. We are therefore prepared to extend the timescale for a final time but this matter must be resolved to avoid further action. A report must be produced every month and sent to us at the commission, which shows how the home is being conducted to DS0000026443.V362444.R01.S.doc 7. OP27 18(1)(a) 30/05/08 8 OP31 10(1) 15/07/08 9. *RQN 37 30/05/08 10 *RQN 26 30/05/08 Hawthorne Care Home Version 5.2 Page 31 make sure the people who live at the service are safe and well cared for. 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 OP8 Good Practice Recommendations You should make sure that minor changes to care plans are done promptly to make sure that staff are clear about how to support the people living at the service effectively. People who live at the service who are at risk nutritionally should always be offered second helpings if they are eating well to maximise their health and prevent further weight loss. Medication reviews and reviews of information relating to medication in care plans should be undertaken for all people who live at the service and in particular those with dementia and other mental health conditions to ensure that the management of these conditions follows current good and best practice guidance. Outstanding Medication for when required use or where a variable dose is prescribed should not be kept in monitored dosage containers with regular medication so that people who live at the service can receive such medication when they require it and at the dose they require at the time. Outstanding All people who live at the service should be assisted to eat in an unhurried, caring and supportive way to maximise their health and wellbeing. All people who live at the service must be aware of what they should do if they have any concerns or complaints. The Safeguarding Adults policy should state when a referral will be made to the Provisional Protection of Vulnerable Adults list so the staff are clear and people who live at the service can be protected. The condition of the driveway should be improved to make the home more accessible to people using wheelchairs. 50 of care staff should be trained to National Vocational Qualification level 2 so that people who live at the service DS0000026443.V362444.R01.S.doc Version 5.2 Page 32 3. OP9 4. OP9 5. 6. 7. OP15 OP16 OP18 8. 9. OP19 OP28 Hawthorne Care Home 10. OP33 are supported by competent and qualified staff. The people who live at the service and relative’s consultation process should be further developed to determine people who live at the service and relatives satisfaction levels in relation to service provision Outstanding Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hawthorne Care Home DS0000026443.V362444.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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