Inspection on 07/07/08 for Hawthorne Care Home

This inspection was carried out on 7th July 2008.

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

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

Other inspections for this house

Hawthorne Care Home 14/04/08

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Hawthorne Care Home School Walk Bestwood Village Nottingham NG15 6GN Lead Inspector Linda Hirst Unannounced Inspection 7th July 2008 10:50 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.V368057.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.V368057.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hawthorne Care Home Address School Walk Bestwood Village Nottingham NG15 6GN 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.V368057.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 14th April 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.V368057.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 1 star. This means that the people who use this service experience adequate 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 acting 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 received this back from the acting manager in good time and the form was well completed and helped us to plan our visit and to decide what areas to look at. We also 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. The main method of inspection we use is called ‘case tracking’ which involves us choosing three people who live at the service and looking at the quality of 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 an hour, 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. English is the first language of all of the people living at the homes living at the home at the moment but there are some people living there from minority ethnic groups and we looked at the care plan of one person to make sure their Equality and Diversity needs are being assessed and addressed. The staff team come from a wide variety of backgrounds and experiences. Hawthorne Care Home DS0000026443.V368057.R01.S.doc Version 5.2 Page 6 We spoke to two members of staff and three people who live at the service to form an opinion about the quality of the service being provided to people living at the home. 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. What the service does well: We found that medicines are safe, well recorded and administered resulting in people receiving their tablets as their Doctor prescribed. People are treated with dignity and respect by most staff and they have much more contact with them now, this has resulted in more positive moods and better quality staff interactions. 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 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. The staff offer people choices and they showed us that they respect these when we watched them providing care to people. People who need assistance to eat are offered this in an unhurried way. We found the recording and management of complaints is good and that the people living at the service can be assured their concerns will be responded to properly. People who live at the home told us they feel safe and the staff have had training and understand what kind of behaviour is abusive and what they should do about it to protect people. The home is clean, tidy and homely and people are happy with their rooms. We found that the changes to the tasks care staff do have resulted in people’s needs being met more promptly. The staff have had a lot of training and the recruitment practices are robust and protect vulnerable people from those who may harm or abuse 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. Hawthorne Care Home DS0000026443.V368057.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: We found that the care plans are not kept up to date and not all of them are written with the focus on the person receiving care, as a result staff have inconsistent advice about people’s needs which may affect the care they provide. We found that the individual Equality and Diversity needs of people from minority ethnic communities could be written down properly so that all of the staff know how to help people stay well and healthy. Some plans about people’s specific health care needs could be clearer and offer staff more guidance to maintain the safety and wellbeing of people living at the service. We also found that there are restraints on the personal and physical freedoms of some people, but there has been no written assessment of their capacity to consent or refuse this under the Mental Capacity Act 2005. This may mean their rights are being compromised. Hawthorne Care Home DS0000026443.V368057.R01.S.doc Version 5.2 Page 8 We found that staff could work harder to chat with people with higher levels of dependency so that their emotional and social needs can be met. Residents’ meetings would be a positive development and these could be used to develop the new menus alongside those who live at the home to cater for their preferences. 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.V368057.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.V368057.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 good. This judgement has been made using available evidence including a visit to this service. People who want to live at the service have the information they need to make an informed decision about moving into the home. Their needs are assessed so they can be assured that these can be met at the service. EVIDENCE: We found that the statement of purpose has been rewritten to reflect how they will meet the needs of people with Dementia. There is a copy of the statement of purpose for people to read in the reception area outside the acting manager’s office. None of the people we spoke with had any comments to make about the information they received before admission. There have been no new admissions to the service since our last visit, so we were not fully able to check the pre admission assessment process. All of the Hawthorne Care Home DS0000026443.V368057.R01.S.doc Version 5.2 Page 11 files we looked at have an updated initial assessment of need, and there were copies of Social Work assessments and reviews on people’s files. We found, however, that the acting manager is very clear about the categories of registration and has refused admission to people who are outside of the category of registration. The service is only registered to accept five people whose main need is their Dementia, and they already have over this number of people living in the home. The service are considering reviewing their registration categories once their acting manager’s registration has been decided. We found the staff have had further training on supporting people with Dementia since our last inspection, including some on person centred approaches. Our observations showed continued improvements in the delivery of care for people with Dementia by staff. The three people we spoke with all have Dementia but they told us they like living at the home and they said the staff are very good to them. The staff we spoke with showed an improved understanding of how to support people with Dementia, “I treat them like a normal adult instead of how I have in the past. I show them pictures if they can’t communicate verbally and see if they can point to what they want, sometimes people will tell you what they want though.” Intermediate care is not provided at the service and the standard is not applicable. Hawthorne Care Home DS0000026443.V368057.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, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care planning system is not robust enough to make sure that staff have the guidance they need to meet the personal and health care needs of people living at the service. The system in place for medicines is safe and people receive their tablets as prescribed by their Doctor. EVIDENCE: We looked at the care plans for three of the people who live at the service. We found the format of care plans to be good, but the quality of information on them was variable. We found one plan was up to date, person centred and reflected the current needs of the person concerned. However, another of a person we observed had not been reviewed since April 2008 and the information recorded on daily Hawthorne Care Home DS0000026443.V368057.R01.S.doc Version 5.2 Page 13 records and from our observation shows that it is not a true reflection of the current needs of the person concerned. We found that one person’s “getting to know you better” form was not completed as the family have refused to fill this in. However, given that the staff know the person very well themselves they should be able to complete this based on their knowledge of the preferences of the person. We also found that the plan of care for this person did not address their Equality and Diversity needs fully. There was no assessment of specialist skin and hair care needs, although their spiritual and religious needs were documented. None of the people who live at the service that we spoke with could comment on care plans. One person told us, “they (the staff) look after us here and make sure we have what we need.” Staff told us that nurses write the care plans, “I think the care plans, for me personally are holistic. I think they give a flavour of what people are like from the ones I have looked at.” We found that all of the people whose plans we read have been assessed using approved nursing tools. The care plans about people’s health needs, we found were of variable quality. For example we saw one plan about a person with Diabetes which gave a comprehensive and detailed account of the “normal” range for their blood sugar levels, the readings at which the person has, in the past become hypoglycaemic and the action needed if this happens. Another plan for the same area of need omitted all of these details and was very basic, giving minimal guidance to staff about how to meet the person’s individual needs. We found several areas relating to restraint, restrictions on privacy and freedoms in terms of care plans without any written evidence being undertaken of the person’s capacity as defined by the Code of Practice on the Mental Capacity Act 2005. (Examples were the use of specific chairs and wander mats). We also found that the use of bed rails has in most cases been assessed, but in many cases these had not been reviewed or authorised by the nurse or next of kin. That said, the people we spoke with said their health is well cared for, “I am well and if I need to, I see a Doctor but I’m alright thanks.” Staff told us that the care staff and nurses work well together, “I think we provide good quality nursing care, the District Nurses come in, Dieticians and the Tissue Viability Nurses as needed.” Following the issue of a Statutory Notice for unsafe medication practice, and a legal interview with a nominated representative for the provider; we have accepted their admissions of previous shortcomings and the actions they have put in place to ensure the safety of people living at the service. We are not taking any further legal action in respect of medication at the present time. Hawthorne Care Home DS0000026443.V368057.R01.S.doc Version 5.2 Page 14 We looked at medication during our visit and found the acting manager in the middle of an audit of medicines. We found the storage of medicines to be safe, appropriate and secure. We found the records of medication to be clear without any gaps being evident and there are cross checks on all boxed medication to make sure that the records tally with the tablets being held on the premises. We randomly checked some boxed medication and found the audit trails to be correct. If medication has been dropped, spat out or refused, a record is made on the back of the Medication Administration Record. Nurses are also recording the date perishable medicines are opened to make sure people receive the full therapeutic effect of these. There is appropriate storage for Controlled Drugs and the records tally with the amounts being held on the premises. We found there is a contract with an appropriate disposal company and we saw Doom kits in the home for the disposal of Controlled Drugs. We observed the nurse administering medication and found that this was done safely and ensures as far as possible that people are given their medication as prescribed by their Doctor. None of the people we spoke with commented on their tablets, although they all have them prescribed. Staff told us, “tablets are given out safely, we don’t find any left on the floor, the nurses make sure people have taken them.” A nurse we spoke with told us, “the medication audits are working well.” We did an observation of the interactions between people living at the service and the staff and found there have been improvements. The staff interacted with people living at the home more and the majority of interactions we saw were good. The impact of this on the people who live at the home is that they spent the majority of their time in a passive or positive mood state. We saw some very sensitive, supportive and discreet interactions during our observation, particularly from the Deputy Manager and a student Nurse. The people we spoke with told us the staff are kind, “they are very nice to me, they look after me you know.” Another person said, “some are better than others, but there are some nice people here.” We observed and interviewed a person we had been concerned about previously and they said, “I have been kind to the residents and minding what I say. I have found my supervision helpful.” Hawthorne Care Home DS0000026443.V368057.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, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use services are able to make choices about their life style. Social, educational, cultural and recreational activities meet individual’s expectations. EVIDENCE: At the end of our observation we saw the activities co-ordinator taking a person into the garden to water the plants and baskets which they helped plant. The staff we spoke with told us that she had been doing hand massages and painting people’s nails that morning, and we saw people discussing this with staff. We found that the records of activities includes, movement to music, memories, reading papers/magazines, dominoes, games, walks, soft ball, quiz, painting, gardening, church services. The care plans we saw also reflect that these activities are being provided regularly. One person we spoke with said, “I just watch TV all day, I like to have some time in my room as well, but it’s good to mix with others sometimes.” Others said, “we keep ourselves to Hawthorne Care Home DS0000026443.V368057.R01.S.doc Version 5.2 Page 16 ourselves, we like time alone but we come down sometimes for a drink and some food.” Staff we spoke with feel that the activity co-ordinator, “gives people a lot of things to do with their time. If it’s nice she will take (people) out for a walk.” We observed relatives coming and going during the day, they conversed easily with staff during this time. The people we spoke with told us they can have visitors when they like, “my family come and see me, they haven’t been for a while though.” They also told us they have their choices respected and they said they get up when they want and go to bed when they want, “we spend our day as we like really. I don’t like to be told what to do.” During our observation we saw people being asked if they would like to do things, rather than directed and being given choices of food, drink and where to sit. Some people preferred to walk around and the staff did not try and stop them or direct them to chairs, but equally if they were distressed they took the time to talk with them. We observed lunch and a number of people needed to be assisted to eat, but they did not have to wait for long periods of time for staff to help them. The staff we saw sat beside people and helped them to eat in an unhurried way, waiting until they had finished their mouthful before offering them more. We did find that staff could engage with people with very high levels of dependency more when offering this assistance, even if they are unable to respond verbally. We found on a couple of occasions that staff members moved to clean food from people’s face and clothing but without telling them, which startled them unnecessarily. A nurse told us that, “some staff engage people better than others,” and we saw her, and the acting manager correcting practice during our observation. The cook told us that vegetarians and people needing soft diets are provided for, and we saw that food is blended separately to main colour, texture and appetite. She also said the menus are being updated at the moment, it is strongly recommended that people who live at the service be actively involved in this process. People we spoke with said the food is “very good.” One said, “it could be better and I have never known a pub that won’t serve beer.” That said, the person was having a glass of beer at tea time. People told us they get plenty to drink; one person was thirsty and asked for a drink which was brought to her. Another said, “There are drinks on the table there for us if we want them.” Hawthorne Care Home DS0000026443.V368057.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. 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 use the service are able to express their concerns, and have access to a robust, effective complaints procedure, and are protected from abuse. EVIDENCE: We saw the complaints procedure displayed in the lounges and in people’s bedrooms. We received a complaint about an investigation undertaken by the providers about poor care practice but found that the providers responded appropriately to the complaint and provided evidence of a full investigation. This investigation is also duplicated in the complaints record for the service. People we spoke with did not make any comments about complaints and could not remember if they have made any. Staff told us they have not dealt with any complaints but they told us they would report it to the acting manager, “I think it would be dealt with properly and fairly.” We found that there has been a safeguarding issue since our last visit, about physical abuse, and this was referred to Adult Social Care staff to investigate. The allegation was not substantiated and the allegation was withdrawn, the providers took appropriate advice about making a referral to Protection of Vulnerable Adults list but this was not needed. We found that the safeguarding policy has not been updated in line with our recommendations and the flow chart which has been developed needs amending to provide staff with clarity in Hawthorne Care Home DS0000026443.V368057.R01.S.doc Version 5.2 Page 18 terms of making safeguarding referrals. We found the local safeguarding procedures are available in the office. The training matrix we saw shows that all staff apart from one new starter have had safeguarding training and our interviews with them showed that they know what kinds of behaviour are abusive and what action they should take if allegations are made. One staff member told us that she reported another person about their conduct towards people living at the service, but the Deputy Manager denied that such a conversation has taken place. We have therefore referred the matter to the acting manager for her to look into. People we spoke with said they feel safe, “the people here look after me, they’re nice people.” Hawthorne Care Home DS0000026443.V368057.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. 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 building, looked at all communal areas, the laundry, kitchen and a sample of bedrooms to check the home is well maintained, safe and clean. We found that there has been continued improvements to the environment and the maintenance audits show that the acting manager and providers continue their plans for improving the premises. We found the home to be well maintained, clean and tidy in all areas, with evidence of the personalisation of Hawthorne Care Home DS0000026443.V368057.R01.S.doc Version 5.2 Page 20 bedrooms and lounge areas. Some parts of the home look like they could benefit from redecoration and the acting manager told us there are plans to undertake this within the next year. The kitchen is clean and tidy and there are good stocks of food in the home for the people living there. People we spoke with said they like their rooms and like spending time there. “we have everything we need.” Hawthorne Care Home DS0000026443.V368057.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff who work at the home are trained, skilled and in sufficient numbers to support the people who use the service with their holistic needs. EVIDENCE: We looked at the staff rota which shows that there is a nurse and three or four care staff on day time shifts with the acting manager being extra to this staffing number. There is a cleaner on each week day but not on the weekends and they are recruiting for a weekend cleaner at present. The acting manager and staff told me there has been a change in how staff are deployed, the cleaners make beds rather than care staff and in the afternoon the residents tend to congregate in the main lounge to allow staff to support and supervise them better. The staff we spoke with feel this is better for the people living at the service, “we can observe them together and they can mingle with other people and talk. They have been working on staffing levels and we have been pulling together as a team like we should. It is better organised now.” People who we spoke with told us that they don’t have to wait for long for help, and this was borne out by our observations which showed that people are assisted more promptly with their needs. Hawthorne Care Home DS0000026443.V368057.R01.S.doc Version 5.2 Page 22 We found that five care staff have already achieved their National Vocational Qualification level 2, and a further two are doing this training. If they achieve this qualification the service will meet the target of 50 of care staff trained to National Vocational Qualification level 2. We looked at the training matrix and found that training has been provided this year on the Mental Capacity Act 2005, safeguarding, Infection Control, Basic First Aid, Fire safety, Basic Food Hygiene, Health and Safety, Control of Substances Hazardous to Health and Dignity, respect and Person Centred Care. The staff we spoke with confirmed that they have done this training and the Deputy Manager told us she is doing her National Vocational Qualification level 4 and Registered Managers Award at the moment. We looked at three staff files and found that they contain all of the information and documentation required by Law to protect vulnerable people from those who may not be suitable to work with them. The people we spoke with said the staff are “very good,” and “nice people,” one said some are better than others, and one complained that he had to wait for his beer. Hawthorne Care Home DS0000026443.V368057.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 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 continues to improve but more attention is needed to care planning practices to make sure that the service being delivered is in the best interests of the people living at the home. EVIDENCE: The situation regarding the former registered manager has now been resolved and the acting manager will now apply to become registered with us. She continues to address issues of concern raised and all of the requirements from our visit in April this year have been complied with. We found clear evidence from supervision notes that she is checking the performance of staff and Hawthorne Care Home DS0000026443.V368057.R01.S.doc Version 5.2 Page 24 following this up through audits and staff meetings to make sure that the care being provided is of the standard she would expect. Staff we interviewed told us, “She asks for feedback, she has been fantastic, she is very thorough, supportive and she will back my decisions. She is always there and the staff feel they can approach her. She manages the care side well.” Now that the home appears to be entering an upward phase of development it is important that the quality of record keeping is kept high on the agenda (See OP7, OP8) to make sure that the service continues to improve and run in the best interests of people living there. We have been receiving regular monthly reports from the provider about how the home is being conducted and regular audits take place 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. Questionnaires have been sent out to all of the relatives and we looked at the ones which have been received so far (an action plan will be formulated in response to the issues raised.) Areas for improvement highlighted were around staffing levels and stimulation, ventilation and odour control and redecoration,” the home is generally very homely and welcoming but there are signs of wear and tear and looks overdue for redecoration.” Positive comments included, “(the home is) always clean and pleasant smelling,” “I am kept informed when necessary,” and “on afternoon visits there are always multiple carers in attendance.” There have not been any residents’ meetings as yet but the acting manager has asked the activities co-ordinator to gauge interest with a view to starting these shortly. This would be a positive development. 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. We did not look at Health and Safety testing during this visit as we inspected this in detail during our visit in April 2008 and found it well organised. People who live at the service told us, “it’s alright here, you could change things but it works well.” Hawthorne Care Home DS0000026443.V368057.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X X Hawthorne Care Home DS0000026443.V368057.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 14(2) Requirement Timescale for action 04/09/08 2. OP7 12(4)(b) 3. OP8 13(4)(c) 4. OP8 13(7 & 8) Care plans must reflect the current needs of people who live at the service and enable staff to offer care in a consistent and person centred way. Care plans must assess in full 15/08/08 the Equality and Diversity needs of people from minority ethnic groups to make sure the staff understand how to meet these needs and keep people well and healthy. Plans about people’s health care 04/09/08 needs must give clear and detailed guidance to staff about the action needed to maintain their health and wellbeing. People’s capacity must be 15/08/08 assessed in line with the Code of Practice under the Mental Capacity Act if you are restricting their personal and physical freedom or their right to privacy to ensure this is in their best interests. Hawthorne Care Home DS0000026443.V368057.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations If families refuse to complete documentation which offers information about choices, lifestyle and preferences the staff should complete these based on their knowledge of the person to make sure their wishes are recorded and respected. Staff should interact with all of the people who live at the service; even if they are unable to respond verbally or have high levels of dependency to make sure their psychological and emotional needs are met. New menus should be developed in consultation with the people who live at the service to make sure their views and preferences are catered for. The Safeguarding Adults policy should state when a referral would 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. Outstanding Meetings for people living at the service should be started up to give them an active voice in the development of the service and to make sure the service runs in their interests. 2. OP15 3. 4. OP15 OP18 5. OP33 Hawthorne Care Home DS0000026443.V368057.R01.S.doc Version 5.2 Page 28 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.V368057.R01.S.doc Version 5.2 Page 29 - 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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