Inspection on 05/11/07 for Hawthorne Care Home

This inspection was carried out on 5th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Hawthorne Care Home 07/07/08

Hawthorne Care Home 14/04/08

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 & Sharon Rosenfeld Unannounced Inspection 5th November 2007 09:50 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.V353959.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.V353959.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 Doris Agatha Francis 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.V353959.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 Hawthorne 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 11th April 2007 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. 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 manager’s office if residents, relatives or visitors wish to see them. The current fees charged at the home range from £290 to £370 per week and residents are required to pay additional costs for hairdressing, chiropody, trips out, personal toiletries and clothes and newspapers. Hawthorne Care Home DS0000026443.V353959.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users 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. This inspection involved two inspectors; it was unannounced and took place in the daytime, including lunchtime. The main method of inspection used is called ‘case tracking’ which involves looking at the quality of the care received by a number of residents. We also use evidence from our observations; we speak to them about their experience of living at the home; we look at records and talk with staff about their understanding of residents needs. Part of this inspection looked at the quality of care people with dementia experience when living at Hawthorne Nursing Home. Because people with dementia are not always able to tell us about their experiences, we have used a formal way to observe people in this inspection to help us understand. We call this, the ‘Short Observational Framework for Inspection (SOFI). This involved observing 10 residents, over 2 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 discretely observed people in the dining rooms, during the lunchtime period. We spoke with the acting manager, the operations manager and administrator, three members of the care team and the cook. We asked for the views of one relative and a resident who was not part of the “case tracking” so that we could form an opinion about the quality of the service. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of residents at the home. We did a partial tour of the building, including all communal areas and a sample of bedrooms to make sure that the environment is safe and homely. English is the first language of all of the residents living at the home. The staff team come from a wide variety of backgrounds and speak various languages. Due to the short notice of this inspection, we did not have time to send out any surveys to the residents and relatives, but we took account of the views of relatives who were present during our visit and looked at the file containing compliments. Hawthorne Care Home DS0000026443.V353959.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: We found that the document which tells residents what the service aims to do does not reflect the services being provided and because of this the service lacks a clear vision. This means that people are coming to live in the home when the staff do not understand their needs and do not have the training or skills to meet these. We found that not all of the residents can be assured that their needs can be properly met at the home. Hawthorne Care Home DS0000026443.V353959.R01.S.doc Version 5.2 Page 7 The acting manager understands the idea of person centred care and recognises that the home have not used this approach when they provide help to the residents. The care plans could be used in a better way to make sure that information about each resident’s past, their experiences, abilities, strengths and personality is recorded in more detail. This particularly important for people with dementia and will help the staff to get to know each person as an individual, and so become more aware of their personal preferences. Care plans generally need to offer up to date and clear guidance to staff so they can help residents in a consistent way. We found that there needs to be better recording and monitoring of some health care needs and that referral for possible treatment could enable residents to maintain their health and wellbeing. We found the arrangements for looking after and giving out medication to the residents is not safe and we could not prove that people get their medicines as prescribed by their doctor. We found there was a difference between how the service aims to provide care to the residents and how it is actually provided. Some staff we observed did not show respect for resident’s choices and did not help them in a way which supported their independence and dignity. We found the activities provided could be reviewed in consultation with the residents to make sure they have access to activities which they want to do and can enjoy. The acting manager needs to think about how residents can be occupied and entertained when the activities organiser is not working at the home so that they can have a full and enjoyable life. We found that the record of complaints was not being kept properly, making it difficult to see whether the manager has investigated the concerns and taken action to address these. We also found that the managers and owners have not taken action as agreed to prevent further incidents of abuse of residents. The recruitment and supervision practices of the home is not good enough to make sure that the staff who work at the home are suitable to work with vulnerable people and this places residents at risk of harm and potential abuse. We found that many of the residents have very high levels of need and the owner must make sure that there are enough staff, who are appropriately trained and skilled, available to meet the range of residents needs. The owner needs to be clear with the staff about how they are expected to behave and how they should provide care to the residents. She needs to draw up an action plan to identify the areas needing improvement to make sure that the residents are safe, well cared for and that the service being provided is in their best interests. Hawthorne Care Home DS0000026443.V353959.R01.S.doc Version 5.2 Page 8 We found that staff practices did not follow the policy and procedure on infection control and this could put residents at risk. We have not been satisfied that the appropriate measures have been put in place to meet fire safety legislation. The management of the service must improve to resolve the issues of concern we have highlighted from our visit and to make sure the home is run in the best interests of the people who live there. 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.V353959.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hawthorne Care Home DS0000026443.V353959.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. 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. The service does not have a clear statement of purpose and people are admitted to the home although the staff do not have the skill, understanding and training to meet their needs. EVIDENCE: We found that the statement of purpose does not include information on the aims and objectives of the service in terms of providing care to people with dementia. The document is a standard company template and has not been changed to fully reflect the service provided at this home and it also states that, ‘the home is part of the West Midlands’. The service is currently registered to admit up to five people with dementia and the company want to increase this to eleven. We looked the care files of every resident who has been admitted to the home and found that out of the Hawthorne Care Home DS0000026443.V353959.R01.S.doc Version 5.2 Page 11 25 people living there, 12 had dementia as their primary need for care. Of these we found nine had been admitted since June this year. This represents a failure to comply with the conditions of registration, which is an offence. The evidence from our observations and staff interviews indicates that not all staff understand how to support people with dementia with their needs (See OP7, O10, OP14). The training records we saw show that only half of the staff group have received any training on supporting people who have dementia and those who have did not cover person centred approaches to working with people with dementia. The training was done in 2006 and has not been updated since. The training record also indicates that only half of the staff have received training on supporting people with challenging behaviour. The last person to be admitted to the service was “case tracked” and it was discovered that this person was admitted without the staff having the training to meet their identified needs around mental health. We saw a copy of the assessment from the social worker on file, which gave clear details about the person’s mental health needs, but these had not been added in to the care plan. The care plan we saw was not detailed enough to offer clear guidance to staff about the signs and symptoms of depressive illness or hallucinations and it did not indicate when staff should contact professional health care staff for support and guidance. The staff training records provided no evidence that any of the staff have had training on mental health needs. Intermediate care is not provided at the service and this standard is not applicable. Hawthorne Care Home DS0000026443.V353959.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The arrangements for health and personal care do not ensure that residents get the care and support they need in a way that promotes their dignity and maintains their safety and wellbeing. EVIDENCE: We looked at the care plans of three residents. We found evidence that relatives were involved in care planning and review and in one case a resident had filled in his personal and social history form, himself. However, the care plans were not detailed enough on key areas of need, such as person centred approaches for people with dementia, mental health needs, religious and cultural needs, and on specific directions to staff on safe moving and handling. The staff who were interviewed gave conflicting views about the information they receive, one saying care plans enabled him to learn about the Hawthorne Care Home DS0000026443.V353959.R01.S.doc Version 5.2 Page 13 needs of the residents, the other saying no information had been given about the needs of people with dementia and how to interact and care for them. In some cases the care plans had not been updated to reflect the current needs of residents (they did not correspond with information given to us by the staff) and in others, needs, which have been resolved still feature in the care plans. Residents and relatives who we interviewed did not have any specific comments to make on care planning but our observations would indicate that the staff do not always respond to residents’ needs in a consistent way. Each of the care plans we looked at contain approved nursing tools to assess the residents’ risks in terms of skin care, infection, nutrition and dependency in some cases the risks identified had clear care plans for staff to follow (Eg there were clear guidelines for staff on the signs of high and low blood sugar for people who have diabetes.) There is evidence that residents have special mattresses and cushions provided to prevent the development of pressure sores. However, not all health care needs are being well managed. We found a situation where a resident has lost weight in a short period, but there was no risk assessment, care plan or evidence of monitoring food and fluid intake. We found one person has behaviour assessment charts in place as he can be “aggressive,” but these were not fully completed which would make identifying triggers difficult. We found that there had been no cross referral to the person’s blood sugar levels which may also have impacted on his behaviour. The person was observed interacting with residents, staff and visitors over a two-hour period, and there was no evidence of any difficult or challenging behaviour during this time, although staff said he does not like being told what to do. One of the staff members we interviewed said that the resident had never been aggressive toward him, another said she had been assaulted that morning. None of the residents or staff made any comments about health care, but we observed a nurse making an assessment of a wound and taking the resident to a treatment room to apply a dressing. We observed the end of the medication round which was done by a registered nurse. We found the medication trolley to be in a state of disarray, a used syringe had been left on top of the trolley and we could not see any sharps disposal on the trolley. Accident records indicate that there was a needle stick injury to a nurse undertaking a medication round on 01 July 2007. The nurse asked people if they wanted their pain relief before she gave it to them but we observed her signing the medication administration record before the medication was administered. She did not stay with residents to ensure they had taken their medicines, although she did return to check the medication had gone a short time later. This is not best practice. Hawthorne Care Home DS0000026443.V353959.R01.S.doc Version 5.2 Page 14 The medication administration record had many gaps on it, some of the missed medication is essential for maintaining residents’ health and there was no indication of whether the medication had been refused, spat out or whether there was any other reason for the omission. We tried to find out if the medication had been given, but the containers were held together in a box with loose tablets, blister packs and creams for return to the pharmacist and there have been no records maintained of medication returned to the pharmacist since 2005. This makes auditing medication impossible and is unsafe practice. The stocks of medication held at the home appeared high, and this, combined with the lack of returns records, increases the likelihood of medication going missing. We looked at the policy on the promotion of service users’ rights and choices. This states that residents have the right to take personal responsibilities and to expect all staff to accept the degree of risk involved, along with the right to have their dignity respected and be treated as an individual. We did two observations during our visit, one in each lounge and our findings are that residents are not treated in a manner which shows respect for their dignity. (E.g. an experienced staff member, on two occasions was heard copying what a resident said as she walked past him). She also told a resident, who had asked, (at the appropriate time when everyone else was being helped to the dining room,) if he could have his lunch, that he wasn’t going to get any today. Although this was said in a light-hearted tone, the resident was upset by this and objected. She did not; however offer any reassurance to him that she was joking. During one of our observations staff ignored a resident for two hours whilst the person repeatedly beckoned them and said, “please,” to attract their attention. They ignored another resident who was visibly agitated and distressed for thirty-five minutes. When another resident became distressed and uncomfortable about this behaviour she was told to “leave (the resident) alone, (the resident) doesn’t need any help,” and was told to “sit back.” We were particularly concerned about one member of staff who repeatedly refused to have any physical contact with a resident who wished to hold hands and we saw the person respond angrily towards the residents. The dementia training programme, delivered in March 2006 did not include person centred approaches to working with people with dementia, and this lack of knowledge showed in staff’s practice. One experienced staff, described a group of residents as ‘feeders’. The use of terms such as this are not helpful in the promotion of a service where the focus should be on the individual rather than a symptom of their condition. Observations showed some staff did not know how to properly engage with the residents. One inexperienced staff thought she would treat residents with dementia like children, as this is how she interpreted their behaviour. Another qualified staff described a resident’s symptom of dementia in front of her and other residents. Hawthorne Care Home DS0000026443.V353959.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are helped to maintain relationships that are important to them. The range of activities available is not wide enough to cater for the varying skills and preferences of the full resident group. EVIDENCE: The home employs an activities organiser for 12 hours over three days a week. Unfortunately, this person was not on duty during the inspection. Some resident’s records give examples of past hobbies and interests but none really identify current interests or record the person’s preferences about the kind of lifestyle they want to have within the residential setting. Just over half of the staff team, received 3 hours training in the provision of activities for people with dementia in March 2006. One member of staff was observed attempting to engage two residents in activities using a colouring book and a jigsaw. She did not always interact with them positively, because she was inexperienced and had received no instruction about their individual needs, and although she worked hard to support them, she did not have the Hawthorne Care Home DS0000026443.V353959.R01.S.doc Version 5.2 Page 16 skills to support them with confidence. During our other observation we saw a member of staff more or less insist on a resident joining in with a game of dominoes, but no other residents engaged in activities during the two-hour period. Several visitors arrived at the home during the course of the day and we saw on several occasions a good rapport between them and many of the residents. One resident was taken out by her relative and she said this was a regular occurrence. We spoke to a relative who said that she visits every day at whatever time she pleases, she said she is kept informed about any changes in her relative’s condition. She said the senior staff in particular have developed good relations with her father and know how to make him feel at ease. One visitor commented that they are kept informed when they arrive about important issues concerning their relative and that staff contact them promptly at home, by telephone, with information if necessary. From our observations, many of the times when residents were happy, relaxed and at ease was when they were chatting together or to their visitors. The staff at the home clearly encourage visits. The home’s philosophy is that residents have a ‘right to live their chosen lifestyle and will take an active part in any decisions about daily living that affects their lives’. Observations and interviews with residents, staff and visitors showed that the home promotes this philosophy with some residents more than with others. Information provided by the home says that ‘no limitations are imposed on daily routines such as getting up and going to bed other than for medical reasons or practical limitations’. However, a staff member we spoke with said that the staff wake a set number of people in the morning at a specific time. A relative told us that a resident was moved to another bedroom because the room was required for someone else who needed closer observation on the ground floor. Although there were no objections to this happening and there have been no ill effects on the resident who had to move, proper consultation with the resident and relative did not take place. We observed one person ask if she could to go to her room to sleep. She was told by staff that she couldn’t and was instructed to sit in the lounge again. No explanation was given as to why she was prevented from going to her room. The menu recorded that a choice of meals is available for breakfast, lunch and tea. The cook said the menu is reviewed regularly following discussion with residents. One resident said she was satisfied with the quality of meals and confirmed she always received a choice. Another resident was observed being offered a different choice at lunchtime after she had decided she didn’t want what she had ordered. Hawthorne Care Home DS0000026443.V353959.R01.S.doc Version 5.2 Page 17 The cook is considering new ways of offering choice to people with dementia who live at the home. She plans to photograph the meals available so that a pictorial menu can be produced. She has already devised a record that will show, after consultation with residents and their relatives, their food preferences. Lunch was observed and two people needed help to eat, the staff sat beside, or in front of residents to assist them. One member of staff sat and chatted to the resident and asked if she was ready for more food and if the food was nice. One person was eating without assistance, a staff member then came to the table and stood at his side and began to feed him. The staff talked to one another at times and not to the resident they were assisting. Two residents commented that they enjoyed the food. One resident had received her meal during the first sitting, but we observed that she remained at her table until all sittings had finished. The observation showed staff did not speak to her, nor was she engaged in any activity for this prolonged period of time. Hawthorne Care Home DS0000026443.V353959.R01.S.doc Version 5.2 Page 18 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 and 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Complaints are not properly recorded and investigated and residents cannot be confident that their concerns are heard and responded to properly. The residents are not properly protected from harm and abuse by the actions of the staff, managers and the provider. EVIDENCE: The complaints procedure was displayed in the reception of the home and the policy complied with legal requirements. The policy says that comments and suggestions will be encouraged and “processed,” and that positive comments or suggestions can be recorded in the comments book. The nurse in charge of the shift was not aware of the existence of this book. We have received a complaint about the home since our last inspection and this was referred to the provider to respond to and was not substantiated. We looked at the complaints file held at the home and found that although there was a record of all comments and complaints these did not identify the person who complained, the resident it was about and, in some cases there was no evidence of investigation or outcome. There have been five complaints about the service since the last inspection, concerning laundry going missing, staff entering rooms without permission, being kept informed about appointments Hawthorne Care Home DS0000026443.V353959.R01.S.doc Version 5.2 Page 19 about lighting and about restraint and care practices. The investigation of the last complaint was not available as required by law. The relatives and residents we spoke with made no comments about complaints, although one relative said she would confidently raise any concerns she had with the manager. The service has its own policy on the prevention of abuse which indicates that all staff will receive training on the indicators of and prevention of abuse, however, the policy does not make any reference to what action the company will take to protect residents in the event of allegations. The policy on restraint indicates that, “restraint must never be used without formal assessment of the risk to safety for both service users and staff and after discussion regarding the proposed restraint (with other professionals) and their advice about alternatives.” It also states that there will be, “discussion with relatives or advocates, ensuring their views are recorded in their care plan.” Despite this we found that in some cases bed rails are being used which have not been authorised by the relative and there is no evidence that their use has been discussed with any outside professional. There has been an allegation of physical abuse by a member of staff since the last inspection and this matter is still under investigation. While the managers have taken appropriate action to protect the resident, safeguarding procedures have not been fully followed, as the alleged perpetrator has not been referred for inclusion on the Provisional Protection of Vulnerable Adults list. We have concerns about the failure of the service to comply with the agreements reached following previous safeguarding allegations, but when we discussed this further with senior managers it was apparent they had no awareness of this information. During our observation we had concerns about a member of staff who was responding angrily to residents, ignoring them, and who was seen twice pushing residents firmly back into their chairs. We brought these matters to the attention of the senior managers and they are currently investigating the issues raised. The staff who was interviewed was aware of the actions he should take in relation to reporting safeguarding issues. Hawthorne Care Home DS0000026443.V353959.R01.S.doc Version 5.2 Page 20 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, 20, 21, 22, 23 and 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The accommodation is homely, comfortable and personalised. Residents, staff and visitors are not protected by robust fire safety and infection control policies and procedures. EVIDENCE: A partial tour of the premises was undertaken, including all communal areas and a sample of residents’ bedrooms. The communal areas including the lounges and the larger of the two dining rooms were comfortable and homely, clean and free from unpleasant odours. Some areas have been redecorated and the bedrooms we saw had been personalised with the resident’s own belongings. A pleasant, enclosed garden has been created to the front of the home with access from the lounge. There is a choice of seating areas for Hawthorne Care Home DS0000026443.V353959.R01.S.doc Version 5.2 Page 21 residents use. One resident said ‘I like living here, it’s lovely and spotlessly clean’. We found there is a maintenance programme and the provider employs a person to undertake general maintenance duties. The replacement of the wooden covers over the pipes under the radiators in resident’s bedrooms that have been affected by water leaks is not on the maintenance plan. There is a smell of damp wood in room 8 and the pipe work under the radiator in room 22 needs repair. In May 2007 the Nottingham Fire and Rescue Service visited to the home and reported six areas of non-compliance with fire safety legislation. At the inspection we were shown a copy of report by a company employed by the provider to address the deficiencies. The report was a poor copy and was illegible; therefore we have not been satisfied that compliance with fire safety legislation has been achieved. The staff told us that the alarm call system had been updated and improved. The features were demonstrated and included a different tone that alerts the staff to an emergency situation where urgent help is needed. The infection control policy states, “gloves must be worn” with all methods of clinical waste disposal. During our tour of the building, a staff member was told there was a used continence pad on a toilet floor. We saw her use a paper hand towel to pick it up and dispose of it. She did not wash her hands after this and continued showing me around the home. We saw clinical waste bags which had been left in the porch area to the side of the building waiting to be taken to the clinical waste bins. During one of our observations a resident sustained a wound to her leg which bled onto a footstool. A staff member used a tissue to clean this up but did not use disinfectant to ensure any residue of blood was properly removed. We saw an unclean container in one of the bathrooms which was used to store a range of items used for personal care such as: a hairbrush; a comb; a razor; a lady shave; a toothbrush and unused stool sample bottles. The items were not labelled with names. The staff member could not identify who the items belonged to and told us they are used when people are bathed. The bath had a small smear of faeces in it. The toilet further along the corridor was fitted with a raised toilet seat and we also saw what appeared to be a smear of faeces on the handrail. Next to this in the bathroom a new toilet/bidet has been fitted that the staff say has been useful in assisting residents with their personal hygiene. Certificated evidence of Legionella tests and separate water temperature records were seen. Hawthorne Care Home DS0000026443.V353959.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Recruitment practices are not sufficiently robust to ensure that residents are protected from staff who may harm or abuse them. The number, experience and skills mix of staff on duty does not ensure that resident’s needs are understood and will be met. EVIDENCE: The acting manager said that they are in the process of recruiting more care staff. It was one staff member’s first day at the home and her first experience of care work. The observation highlighted that she showed compassion and kindness toward the residents, doing her best to communicate with people and anticipate their needs. She was largely left to her own devices however, and during the observation, received no positive information about the residents personalities, strengths and needs to enable her to carry out her role with confidence and in a way that would have a positive impact on the residents. She had been assigned to work alongside people with dementia for the duration of her shift. During a 2-hour observation there were at least 3 occasions when misunderstandings occurred that could have been avoided had she received some basic information about the resident’s communication Hawthorne Care Home DS0000026443.V353959.R01.S.doc Version 5.2 Page 23 needs. This evidenced that there were not enough staff on duty who were skilled in meeting residents needs. We looked at four staff files during our inspection, all had key pieces of information and documentation missing which are essential to ensure that staff are suitable to work with vulnerable adults. An urgent action letter has been sent about this issue. The staff records and information provided by the acting manager showed that training has not been given the priority it needs, in recent months. In addition to formal training, it is recognised that other opportunities for learning, through role modelling and from sharing good care practice, could be used. One staff said she asked a question about how to manage challenging behaviour should it occur, and was not provided with a response. The observation showed outdated approaches to the care of people with dementia is still being practiced at the home by experienced, qualified staff, who should be setting positive examples to newer, less skilled staff. The policy on Infection Control was seen. It states the staff must receive adequate training. The training records show that 11 out of a staff team of 30 received Infection Control training in April 2005. The record states infection control training is valid for one year. We observed that some staff do not understand and put into practice measures to prevent the spread of infection and communicable diseases. For example, during one observation, two different staff (one of whom had handled the used continence pad without gloves earlier in the day) were seen taking chocolate from a bag and feeding it, by hand, into the mouths of three different residents. Hawthorne Care Home DS0000026443.V353959.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35, 36 and 38. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The service is not well managed and is not being run in the best interests of residents, ensuring they are safeguarded and safe at the service. EVIDENCE: The registered manager is currently suspended from duty and an acting manager is working at the home and trying to provide continuity during the absence. It is clear from this inspection that a firm decision about the management of the service needs to be made in order to progress the issues of concern we have highlighted during this inspection (OP1, 3, 7, 8, 9, 10, 12, 14, 16, 18, 19, 26, 27, 29, 30.) In the absence of the registered manager the owners need to be very proactive to address the issues of concern and make Hawthorne Care Home DS0000026443.V353959.R01.S.doc Version 5.2 Page 25 thorough checks during their monthly visits to the home in order to demonstrate their own fitness. The records of resident’s finances are computerised. The acting manager does not keep any monies on behalf of the residents. We were told that if a resident wants to purchase something, the administrator authorises the release of funds from the home’s petty cash, and generally a carer will do the shopping for the resident from a list. Once the purchases have been made the resident, or their representative (if they manage the residents finances,)are invoiced and the petty cash is reimbursed. We found that there is no audit that the purchase made by the staff corresponds with what was ordered by the resident so residents are not fully protected using this system. We saw three staff files which have evidence that supervision and appraisal has taken place, but not regularly. One member of staff should have been receiving regular supervision and should not have been undertaking personal care tasks alone. This arrangement provided safeguards to residents after an allegation was made (see OP18) her staff file showed she had received supervision on two occasions, once in 2005 and once in 2006. We also found evidence that she was delivering personal care by herself. The information sent to us by the provider, and a sample of records seen indicates that all of the testing and servicing required by Health and Safety Law is being done at the required intervals. Arrangements are in place for the disposal of clinical waste. There is no action plan on infection control, and all of the staff need to have training in infection control to ensure that the homes policy is implemented and practices are clean and hygienic. (See OP 19, 21 and 26). We found evidence during this inspection that a resident has had scabies and this should have been notified to us along with any other occurrences of infectious illness. Hawthorne Care Home DS0000026443.V353959.R01.S.doc Version 5.2 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 1 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 3 3 3 3 3 X 3 1 STAFFING Standard No Score 27 2 28 X 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X X 2 1 X 3 Hawthorne Care Home DS0000026443.V353959.R01.S.doc Version 5.2 Page 27 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 be rewritten to reflect the services, which are provided at the home. The document must give a clear vision, and provide residents with information to help them make informed choices when selecting a care home. You must NOT admit residents whose needs are outside of the category of registration and whose needs the staff do not understand and cannot meet. Care plans must record in detail how residents are to be assisted with their needs. They must reflect the current needs of the residents so that the staff can assist them in a consistent way. This requirement is outstanding, timescale of 31/5/07 not met. The residents’ health care needs must be properly assessed, monitored and referrals for further treatment must be made where appropriate to ensure their health and wellbeing. DS0000026443.V353959.R01.S.doc Timescale for action 31/12/07 2. *RQN S24 Care Standards Act 2000 15 30/11/07 3. OP7 31/01/08 4. OP8 13(1)(b) 30/11/07 Hawthorne Care Home Version 5.2 Page 28 5. OP9 13(2) You must ensure that the arrangements for managing medication are safe and that residents receive their medicines as prescribed by their Doctor by:• • Ensuring the safe storage and disposal of medication Ensuring the medication administration records are signed after the nurse has witnessed the medication being taken (unless residents are self medicating). Ensuring medication is given to residents as prescribed. If medication is omitted for any reason a code must be entered on the medication administration record to indicate why. Ensuring that full and accurate records are maintained of medication which is disposed of or returned to the Pharmacy to enable proper auditing. Ensuring good stock control of medicines to avoid large stocks of medication being held at the home when this is not necessary. 12/11/07 • • • 6. OP10 12(4)(a) 7. OP14 12(2)(3) An immediate requirement was set. This requirement is outstanding, timescale of 31/5/07 not met. You must ensure that residents are treated with dignity and respect and have their needs attended to promptly and with consideration. Residents must be supported to make choices and decisions DS0000026443.V353959.R01.S.doc 30/11/07 31/12/07 Hawthorne Care Home Version 5.2 Page 29 8. OP16 22 9. OP18 13(6) about the care they receive and the lifestyle they wish to lead in the home. There must be a full record of all complaints, their investigations and outcomes at the service to ensure that concerns are properly responded to and action taken to prevent reoccurrence. The investigation of the complaint about restraint and poor care practice must be forwarded to the Commission. You must ensure that residents are safeguarded from abuse by • 30/11/07 30/11/07 10. OP26 13(3) 11. OP26 13(3) 12. OP29 19, Sch 2 Referring the alleged perpetrator of the recent abuse for inclusion on the provisional Protection of Vulnerable Adults list. • Investigating the reasons why the agreements reached following a previous safeguarding alert were not complied with. • Investigating the concerns about named staff members during this inspection. You must ensure that staff follow 30/11/07 infection control procedures to prevent infectious diseases spreading between residents and staff. You must ensure that all areas of 30/11/07 the home are kept clean in line with Infection Control Procedures. You must ensure that residents 15/11/07 are protected from staff who may harm or abuse them by; • Ensuring that you have full and complete evidence that you have obtained the information and documentation required by Version 5.2 Page 30 Hawthorne Care Home DS0000026443.V353959.R01.S.doc 13. OP30 18(1)(c) (i) 14 OP30 18(1)(c) (i) 15. OP31 10(1) 16. OP36 18(2) 17. *RQN 37 Regulation on every staff member. • Investigating the missing information regarding the previous safeguarding allegations and providing a report to the Commission on your findings. This is an urgent action. You must ensure that staff are trained to understand and practice measures to prevent the spread of infection and communicable diseases. You must ensure the staff are trained and competent so that they can understand and meet the needs of the residents in the following areas: • Person Centred Dementia care. • Mental health. • Challenging behaviour. The management of the service must improve to make sure the issues of concern we have highlighted are addressed and resolved and that the home is run is the best interests of residents. Staff must receive appropriate supervision to ensure they are working in line with the philosophy of care at the home and that residents are being cared for properly. You must notify the commission in writing without delay of all of the incidents specified in this Regulation to enable proper monitoring of the service. 31/12/08 30/04/08 31/12/07 30/11/07 30/11/07 Hawthorne Care Home DS0000026443.V353959.R01.S.doc Version 5.2 Page 31 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 OP18 OP18 Good Practice Recommendations Your policy should reflect the action which will be taken in respect of alleged perpetrators of abuse in order to safeguard residents You should ensure the use of bed rails is authorised by residents, relatives, advocates or outside professionals in line with the policy of the service to make sure they are being used properly. Professional guidance should be sought from the Infection Control Specialist Nurse regarding the efficacy of systems to control and prevent the spread of infection at the home. The residents and relative’s consultation process should be further developed to determine residents and relatives satisfaction levels in relation to service provision You should check that the purchases made by the staff correspond with what was ordered by the resident to ensure residents are fully protected. Care staff should receive formal, recorded supervision a minimum of six times per year. 3. 4. 5. 6. OP26 OP33 OP35 OP36 Hawthorne Care Home DS0000026443.V353959.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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.V353959.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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