Inspection on 11/05/07 for Hawthorne Lodge

This inspection was carried out on 11th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Lodge 08/06/10

Hawthorne Lodge 10/05/10

Hawthorne Lodge 17/02/10

Hawthorne Lodge 06/01/10

Hawthorne Lodge 30/11/09

Hawthorne Lodge 06/11/09

Hawthorne Lodge 06/10/09

Hawthorne Lodge 19/08/09

Hawthorne Lodge 07/04/08

Hawthorne Lodge 12/06/06

Hawthorne Lodge 23/01/06

Hawthorne Lodge 22/09/05

Hawthorne Lodge 30/03/05

Hawthorne Lodge 05/08/04

Hawthorne Lodge 23/03/04

Similar services:

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

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

CARE HOMES FOR OLDER PEOPLE Hawthorne Lodge 164/166 Hawthorne Road Bootle Liverpool Merseyside L20 3AR Lead Inspector Mrs Claire Lee Key Unannounced Inspection 11th May 2007 9:00 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 Lodge DS0000005377.V332403.R02.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 Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hawthorne Lodge Address 164/166 Hawthorne Road Bootle Liverpool Merseyside L20 3AR 0151 933 3323 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) Stirrupview Limited Property & Estates Mrs Lea Jones Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Hawthorne Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 25 OP Date of last inspection 12th June 2006 Brief Description of the Service: Hawthorne Lodge is registered to provide accommodation and personal care without nursing for twenty five older people. The home is a mock Tudor style building located on the corner of two busy streets in Bootle. Due to its location there is good access to public transport, and many local facilities are a short journey away. The shared areas include two lounges, a dining room and back garden. Bedrooms are either single or double rooms, screens are provided in double rooms for privacy. The home has a passenger lift and chair lifts access rooms that have a number of stairs to them. The home has a small grassed area with patio furniture to the rear and there is also car parking space. A keypad fitted to the front door and other doors are alarmed so that staff are aware of and can offer assistance to any resident who wishes to go out. The home provides twenty-four hour personal care to residents; meals and laundry costs are included in the basic fee. The home will arrange for newspapers, hairdressers, private chiropodists and dry cleaning and these costs are met by the resident. In the past there have been a number of thefts from the home and subsequently following police involvement the home has CCTV cameras which view the laundry room, office, store room and corridors only. The weekly fee rate for accommodation is £365.00 per week. Hawthorne Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A site visit took place as part of the unannounced inspection. It was conducted by one inspector over one day, for duration of approximately eight hours. Eighteen residents were living in the home at the time of the visit. A partial tour of the premises took place and observations were made. A selection of care, staff and service records were also viewed. The Registered Manager was present and the Deputy Manager for part of the inspection. Interviews were conducted with management, four staff and eight residents. There were no visitors to the home at the time the interviews were conducted. During the inspection three residents were case tracked (their care files were examined and their views of the home were obtained). This process was not carried out to the detriment of other residents who also took part in the inspection process. All the key standards were inspected and also previous recommendations from the last inspection in June 2006 were discussed. Satisfaction survey forms “Have Your Say About …” were distributed to a number of residents prior to the inspection. Comments included in the report are taken from the survey forms and also during the site visit. What the service does well: Residents interviewed were generally pleased with the overall service and said that they were well looked after. They appeared relaxed, content and comfortable. Staff were observed providing appropriate care and support to residents throughout the day and had time to sit and have a chat with them. The manager completes a needs assessment for each resident prior to admission. This ensures staff can meet their individual needs. Each resident had a care file, which was available for the staff and residents to read. There was information relating to personal care needs, instructions to staff how to deliver the care and evidence of a review to ensure the information was accurate and to report any change. Residents interviewed fed back positively regarding the staff and care received. Comments include: “Nice home” “Staff are good really” Hawthorne Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 6 “The staff work hard” “It is a friendly home” “The staff are very good” “The girls are polite” The daily routine was flexible and a resident reported that the times meals were served was ‘ok’ and that they could go to bed late or early. The manager has introduced activities for the residents and several commented on how much they enjoy the cheese and wine evenings, which the staff organise. There is a three week menu and recent changes have proved popular with the residents. Meal times are well managed and residents were served lunch in the dining room or in their rooms if preferred. A resident said, “The food is fine and we have plenty to eat”. Residents interviewed had no complaints and knew who to speak with if they had a problem A resident referred to communication being good within the home and that the manager was always available. Likewise another resident said they would always speak to the principal carer if they were worried about their tablets or any other issues. What has improved since the last inspection? Residents are now consulted with regard to their plan of care and the review process. This ensures they are involved with the care provision and are informed of any change. The manager for residents who wish to administer their own medications completes a risk assessment. The completion of the risk assessment helps provide staff with the knowledge that the resident is able to administer their own medicines safely. An activities programme has been developed for the residents to meet their preferred hobbies and interests. Social arrangements had been recorded for each resident. The lounge carpets identified as being soiled at the time of the last inspection have been cleaned. They still need replacing as they are stained and this is discussed further under ‘What the home could do better’. Hawthorne Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 7 A copy of the Infection Control Policy was forwarded to the Commission following the last inspection. Staff are provided with the policy details to ensure they are aware of how to minimise cross infection. Moving and handling training has been given to staff. The training matrix evidenced dates of training given to provide staff with the knowledge and skills to move residents safely. This must also be given to new staff and is stated under ‘What the home could do better’. A copy of the safety certificate for the manual handling hoist, bath hoist and chair lifts was forwarded to the Commission following the last inspection. The safety certificates ensured the equipment was safe to use at this time. The equipment now requires to be inspected again and this is stated under ‘What the home could do better’. What they could do better: A number of good practice recommendations should be implemented with regard to the safe handling, storage, administration and disposal of medicines to ensure the ongoing safety of the residents. The recommendations are listed in the main report and advice was taken from a Commission pharmacist at the time of the site visit with regard to the advice given to the manager. The menu should include details of the alternative meals available at each meal to ensure residents are aware of the choice on offer. The fridge and freezer in the kitchen should be cleaned as the shelving was dirty and foods should be covered and dated when placed in the fridge. This is in line with environmental health guidance to protect the residents. The overall environment must be improved to provide residents with pleasant safe, comfortable accommodation. A number of requirements are raised in the report and are as follows: • • There is a very small grassed area/patio to the side of the building however it is unkempt and must be maintained for residents to use. A new door is to be fitted to a ground floor toilet as the existing door is damaged. Hawthorne Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 8 • Two new lounge carpets must be purchased as existing ones are badly stained. The carpets are unsightly for the residents to look at and are dirty thus posing a health and safety risk. The carpets were cleaned following the last inspection but have yet to be replaced. (This is an outstanding requirements from the last inspection June 2006, timescale of 12/7/06 not met). The manager stated that quotes for new carpets were being obtained. The exterior of the building must be painted due to improve the overall appearance of the home for the residents. (This remains an outstanding requirement from the last inspection in June 2006, timescale of 12/07/06 not met). A coffee table should be replaced in the lounge as the existing one is old and marked. It is in poor condition for residents to use. The laundry room wall requires new plaster as the existing plasterwork is coming away from the wall. There is an increase in the risk of cross infection, as the laundry room wall cannot be easily cleaned. The manager must complete a risk assessment to identify the use of window restrictors for windows above ground height. This will ensure they open to safe width to minimise the risk of injury to them. The manager must complete a risk assessment to identify the use of radiator covers or radiators to have low surface temperatures. This will minimise the risk of injury to them. • • • • • With regards to recruitment staff must not commence employment until a police check - CRB (Criminal Record Bureau) disclosure has been obtained by the manager. CRBs are not portable and cannot be accepted from past employers. New staff receive an induction by the manager however this should be given in line with the Skills for Care induction standards. The home has a training matrix and a programme of staff training. A number of staff require training in safe working practice to ensure they have the skills and knowledge to care for the residents. Dates of future training are to be forwarded to the Commission. A member of the care staff is under the age of eighteen. The National Minimum Standards states that staff below the age of eighteen should not be employed to perform personal care. Guidance regarding employing staff under eighteen can be gained from the Skills for Care induction standards and also Health and Safety Executive. The manager is to staff members under the age of eighteen are enrolled on the Skills for Care induction standards and also a risk assessment should be completed for care practices, which the employee undertakes. The manager is accountable for ensuring staff are competent in these areas and suitably trained. Hawthorne Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 9 Records in the home must include a photograph of staff and also residents. This is required for proof of identity. The manager stated that the owner conducts Regulation 26 visits in accordance with the Care Standards Act 2006 and completes a monthly report of the visit. The visit includes a tour of the premises, chatting with residents and staff and viewing a number of the home’s records. There was no evidence of these reports at the time of the site visit and they must be made available for inspection. A copy of May 2007’s visit is to be forwarded to the Commission. A number of safety contacts for equipment and services to the home were examined. Those seen were in date except for the moving and handling equipment. A date was arranged at the time of the site visit for the equipment to be serviced. Equipment for lifting persons is to be serviced twice a year in accordance with the Lifting Operations and Lifting Equipment Regulations (L.O.L.E.R) to protect the health and safety of residents. A copy of the service contract is to be forwarded to the Commission when available. 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 Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 10 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 Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 11 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): Standards 2 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were provided with a contract, which provides them with details of terms and conditions of residency. Pre admission assessments were undertaken to ensure staff could meet their needs in full. EVIDENCE: Residents whose care was case tracked had been given a contract stating terms and conditions of residency. The manager stated that contracts would be amended to include the most recent increase in fee rate. Residents have an assessment of need which is carried out by the manager. Three assessments were viewed and this included residents who had recently been admittred. Inspection of admission documents confirmed the satisfactory standard of information recorded regarding general health, mobility, risk of falls, nutrition, medical and social care. Hawthorne Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 12 There was evidence of detailed information for one resident who requires specific care with the support of the staff and district nurse service. Optical and dental details had not been included for one resident and this was brought to the manager’s attention. The manager is looking to introduce another record of assessment, which she feels will be beneficial for covering all aspects of the assessment process. Assessment documentation from social services and also transfer letters from hospital were on file to assist the home with collating the assessment information. A resident said, “The staff made me feel welcome when I came”. Standard 6 is a key standard to be assessed however the home provides long term care only for residents who have personal care needs. This standard was therefore not inspected. Hawthorne Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 13 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): Standards 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care and social needs of residents were identified in an individual plan of care and medicines administered in accordance with the home’s medicine administration policy. Staff were observed delivering care and support in a respectful manner. EVIDENCE: Residents who were case tracked had an individual plan of care, which was easy to read and contained information relating to personal and social care. Care documentation had been reviewed regularly to report any change in the resident’s condition and staff and residents had access to care documentation. There was therefore a good understanding of the medical, nursing and personal care needs of the residents. Consent to the plan of care is obtained from the residents however for the three new residents who were case tracked; there was no evidence of this on file. Hawthorne Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 14 The manager was advised to obtain their consent at the next review. Care plans included details of key areas, for example, personal care, mobility, medication, continence management, medical conditions affecting the resident’s welfare and social care. Staff had been provided with details of on how to deliver the care and there was evidence of appointments with external health professionals and GP services. Supporting care documentation included the completion of a dependency assessment, record of a resident’s weight, risk assessment for needs identified and daily record sheet to evidence care given. Advice was given to the manager regarding how to record risks identified and the inclusion of further details regarding the control measures needed. One resident was receiving the district nurse service and the notes of the visit were accessible for staff to read. The nurse stated that communication was good in the home and that the manager passed on the necessary information to staff with regard to the care provision. Feedback received from residents via Care Home Surveys and discussion confirmed residents had a regular visit from a chiropodist and the medical support they needed. The following comments were made with regard to the care and support given: “Very good care” “”The girls look after me well” “The staff give me good care and help” Medicines are administered to residents from blister packs, which were dispensed by a local pharmacist. Two medicine trolleys are kept in a locked medicine room however there are no locks to the two trolleys. Advice was sought from a Commission pharmacist at the time of the site visit regarding this. The manager was advised that a lock should be purchased for the trolleys to increase the safety measures in place for medicines stored in the home. The medicine trolleys are not brought out of the medicine room; medicines are administered individually from the blister packs to the residents by staff. Medication Administration Records (MAR) viewed had been correctly completed to record the details of the quantity of medication received in the building and administered by staff in the home. The date medicines are received in the building should also be recorded on the MAR to enable the home to complete an audit trail of medicines received. Suitable systems had been established to account for medication returned to the pharmacist however this should include the dosage of medicines to be returned and day of the month returned. This will help provide a more accurate record. It is good practice to also keep a list of staff signatures for those staff responsible for administering medicines to residents so that their signature can be easily identified. A staff member stated that she has recently received medicine training and she described the correct procedure to be when ordering and administering medicines. Another member of staff said that she was receiving medicine training with the principal carer with a view to undertaking more formal training at a later date. Hawthorne Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 15 Six staff are responsible for administering medicines to residents. External medicine training for staff was given in April 2007 and is also being given this month. The manager had completed a risk assessment for a resident who administers their own medications and the resident had signed a disclaimer for this practice. Advice was sought from a Commission pharmacist at the time of the site visit as staff ‘pop’ out the medication for the resident from blister packs and is therefore offering a prompt. The home were advised to record this detail within the plan of care and also on the MAR to ensure staff are clear as to the fact that they are signing to evidence this and not administration directly to the resident. In light of the above recommendations it would be beneficial for the manager to review the policy and procedure for safe handling, storage, administration and disposal of medicines to ensure the ongoing safety of the residents. Feedback received from residents confirmed that they were treated with respect and that staff were polite in their approach. Staff interviewed gave good examples of how they promoted the principles of respect, privacy and dignity when assisting residents with personal care. A staff member was also observed to knock on a bedroom door before entering. A resident said, “The staff are always polite, I never have any worries”. Hawthorne Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 16 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): Standards 12,13 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The daily routine, activities and meals were flexible and varied to meet the needs and wishes of people living in the home. EVIDENCE: Following the last inspection the manager has introduced an informal activities programme and social interests and hobbies recorded when undertaken. Care files seen also included a ‘pen picture’, which recorded relevant social information to enable staff to get to know the resident better. Residents interviewed confirmed they have a hairdressing service and also take part in bingo, cheese and wine parties, sing a longs and trips to the local park. These are arranged by the staff. Holy Communion is offered to enable residents to practice their chosen faith. Some visitors were seen popping in during the morning and a resident said that her family are able to come any time to see her. Overall feedback was generally good regarding the social arrangements in the home and that there was ‘more going’ on now. Hawthorne Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 17 Residents interviewed were happy with the daily routine; this was discussed in relation to time of meals served, time of getting up in the morning and retiring at night. A resident said they liked to be independent however staff were “Around to help with walking and came when she rang the bell for help”. Likewise another resident said, “The home is a nice place to live in”. Rooms viewed had been personalised with pictures and personal possessions to help residents to feel more at home. Care files seen also included details regarding whether the staff should open mail on their behalf and whether they wished to have a key to their bedroom. This evidenced a good record of personal choice. The television was noted to be on very loud in the lounge however the manager confirmed that staff were aware of the volume and this was the residents’ choice. The new cook has been employed since the last inspection and some changes have been made to the menu, which residents said they liked. A copy of the three week menu was displayed in the hallway for residents to view and meals were served in the dining room. Residents can have meals if their own room if preferred. Residents interviewed said they could have an alternative to at lunch and tea however this was not recorded on the menu. This information should be added to ensure residents are aware of the daily choice. A resident said the cook makes cakes for afternoon tea. Feedback from Care Home survey forms and discussion with residents regarding the choice, presentation and standard of cooking was good and comments regarding the meals include: “Very nice food” “Good choice” “Fresh vegetables are cooked each day” “The food seems tasty most of the time” Staff were observed to give encouragement to residents with their meals, this was provided in a professional manner. The kitchen was viewed and the fridge and freezer were found to be dirty and in need of cleaning. Certain foods in the fridge were also uncovered and not dated. This was brought to the manager and cook’s attention as unsafe environmental practices may place residents at risk. Hawthorne Lodge DS0000005377.V332403.R02.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): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were confident that their concerns would be listened to and the home’s complaint and abuse policy and procedure safeguard and protect vulnerable people in the home. EVIDENCE: There is a complaint policy and procedure however it would be beneficial to have this displayed for residents to view. The complaint log was seen and no complaints have been logged since 2006. The manager was advised that an incident/grumbles book was beneficial for recording any incidents to residents and staff within the home. Feedback received from residents via Care Home Survey forms and through discussion confirmed that the residents were aware of how to complain and that the staff would listen to their concern and act appropriately. A resident reported that they would speak to “The principal (carer) and the manager”. Another resident said, “I have never needed to make a complaint”. A staff member interviewed stated that she would tell the manager straightaway if a resident wishes to make a complaint. A concern was brought to the Commission’s attention in August 2006 and the complainant is satisfied with the outcome of the Commission’s investigation and action taken by the owner. Hawthorne Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 19 There is an abuse policy and procedure and also a copy Liverpool and Sefton’s Adult Protection Procedures. The documents provide guidance to staff on the procedures to follow in response to suspicion or evidence of abuse. A staff member interviewed discussed the concept of abuse and what to do should she witness an alleged incident. Adult protection training was last given to staff in February 2006 as part of their training programme. Hawthorne Lodge DS0000005377.V332403.R02.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): Standard 19, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment must be improved to provide residents with an attractive, clean and comfortable home in which to live. EVIDENCE: Hawthorne Lodge is a detached building in mock Tudor style. There is a very small grassed area/patio/ area to the side of the building however it is not maintained for residents to use. There is some garden furniture available and with summer approaching residents could benefit from sitting outside in safe and pleasant surroundings. A resident said the garden would be better landscaped. The exterior of the building is also in need of painting. This work was not carried out last year and must be undertaken to improve the general appearance of the home for the residents and to keep the home in good state of repair. Hawthorne Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 21 A passenger lift services all floors and also there are two chair lifts to rooms, which can only be accessed by a small number of stairs. Residents have the use of a hip bath (a bath designed to assist residents who are less independent) and three other bathrooms. Bathrooms have bath hoists and toilets have raised toilet seat and hand rails. The toilet situated next to the laundry room is to be replaced as it is badly damaged. The toilet in the shower room is operating as the flush works however the handle should be replaced, as part of it is broken. At the last inspection both lounge carpets were stained and although they have been cleaned the stains remain and are very bad. The manager stated the home is obtaining quotes for their replacement; they must be purchased as soon as possible as they are unsightly for residents to look at and are dirty thus posing a health and safety risk. A new coffee table in the lounge is also needed, as the existing one is very old and the surface marked and worn. Smoking is permitted in the dining room and the smell of smoke did not permeate this room at the time of the site visit. Smoking is not permitted at meal times. Emergency lighting is provided throughout the building and subject to an in house monthly safety check and an annual maintenance contract by an external company. Records seen were current to protect the residents. CCTV cameras view the laundry room, office, store room and corridors only. They are not positioned in residents’ bedrooms or the bathrooms/toilets. Bedrooms seen were adequately furnished and a number have been repainted. A resident who has recently moved to a large room was very pleased with her accommodation and said that the room was comfortable and that she had items from home with her. Two residents sharing a room had a screen in place to provide privacy. Only two radiators have individual controls to control the temperature and none have protective covers in place (confirmed by the home’s maintenance man). The manager must complete a risk assessment for radiators that are unprotected to minimise the risk of injury to residents. When touring the building a number of windows above ground height did not have restrictors in place. These are required to ensure they are opened to a safe width and to minimise risk of injury to the residents. The manager must complete a risk assessment to identify their use. Further information can be obtained from the Health and Safety Executive regarding these control measures. The maintenance man carries out checks of the hot water to the baths. This ensures the hot water is delivered a safe temperature. Records seen were current and a check of the hot water to a bathroom recorded a safe reading. Hawthorne Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 22 The laundry room is situated on the ground floor and staff had access to gloves and aprons and COSHH (Control of Substances Hazardous to Health) were in place for products in use. When entering the home there were no unpleasant smells and residents interviewed said the home was kept clean and their rooms dusted regularly. The plasterwork in the laundry room is coming away from the wall and must be replaced to control the risk of cross infection, as it cannot be easily cleaned. As there is no segregation of foul and clean linen this work must be carried out urgently. There is a maintenance plan for the building and in light of the requirements raised this must be reviewed urgently. Work is to be undertaken to improve the overall accommodation for the residents and to protect their welfare. Hawthorne Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sufficient numbers of staff are employed to care for the residents however recruitment practices are not robust and some staff have not completed the necessary training, to confirm they are competent to undertake their roles effectively. This may place residents at risk. EVIDENCE: The staffing rota and pre inspection questionnaire completed by the manager evidenced that sufficient numbers of staff were on duty to provide care and support to the residents. A resident interviewed said, “There are lots of staff on duty and they are always around to help”. The home employs a principal carer who provides support to senior and junior care staff. During the morning of the site visit the Deputy Manager was on duty with the principal carer, three care staff, cook, domestic assistant and maintenance man. Two care staff work at night and both are awake; there are no staff who provide a sleep in service. Residents spoken with confirmed that staff were good at their jobs and were willing to spend time with them with various aspects of personal care. This was discreetly observed in practice. Hawthorne Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 24 For the purposes of recruitment three staff files were viewed for staff who have recently been employed. The home has recently joined an umbrella body for the purposes of undertaking police checks for new staff however two files evidenced a lack of CRB disclosure and/or POVA check. The CRBs on file were from previous employers. CRB disclosures are not portable and to protect the residents a CRB must be obtained for their position of work at the home. Files seen had completed job application forms and references from past employers. Staff should complete a health declaration form as part of their application to ensure they have no medical condition that would affect them working at the home. The files seen did not contain a photograph of staff for proof of identity. Evidence was seen of a staff contract and induction for new staff. The induction is at present a checklist only and it is strongly recommended that the a more detailed induction programme be implemented to ensure it complies with the ‘Skills for Care’ common induction standards which have replaced Training Organisation for Personal Social Services (TOPSS) induction standards. A staff member stated that she had received an induction and this included a tour of the premises, discussion regarding a number of the home’s policies and fire prevention procedures. Whilst reviewing staff files it was noted that a member of the care staff was under eighteen years of age. The National Minimum Standards states, “Staff providing personal care to service users are at least aged 18”. The member of staff received an induction with the manager, has completed NVQ Level 2 in Care and training in moving and handling and first aid in January 2007. The home must ensure staff under eighteen are capable and competent to undertake work in the home and they should be enrolled on the Skills for Care induction standards as part of their training. The manager should also complete a risk assessment with regard to care practices being undertaken by the staff and provide regular supervision to monitor competency and training needs. Further details regarding employment of staff under the age of eighteen can be obtained from Skills for Care and also Health and Safety Executive. There was evidence of a training matrix for staff. They receive training in safe working practices and this included first aid, moving and handling, food hygiene and infection control. They must be given to new staff and this includes the cook who must attend a course in food hygiene as her existing certificate has expired. Staff also receive training in health and safety and medicine awareness. Dates of courses arranged are to be forwarded to the Commission. Sixteen care staff were employed in the home. The manager reported that 60 have completed a National Vocational Qualification (NVQ) at level 2 or above in Care. A certificate was seen in one file viewed. Several staff members are waiting for accreditation before commencing NVQ level 3. Hawthorne Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35,36,37 and 38. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The management and administration of staff training, staff recruitment and improvements to the environment are in need of attention to confirm the health, safety and welfare of the people using the service is fully protected. EVIDENCE: The manager, Mrs Lea Jones, was registered with the Commission for Social Care Inspection and manages the home with the support of the owner, Deputy Manager and full compliment of staff. Mrs Jones has many years experience caring for older people and has just completed NVQ Level 4 in Management. Mrs Jones is awaiting accreditation of the course. Hawthorne Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 26 Mrs Jones was present for the site visit and discussion took place regarding the general management of the service. Mrs Jones reported that she has not recently undertaken a course in moving and handling and will arrange to undertake this training. Mrs Jones is undertaking medicine training later this month. Residents and staff said that Mrs Jones was approachable. An external consultant undertakes an annual quality assurance assessment of the home and survey forms to gain the views of residents regarding the service form part of the assessment. The survey forms were not available at this time as the manager reported that they were with the external consultant. Eight Care Home survey forms were returned to the Commission at the time of the inspection. They reported no concerns regarding the service. Residents meetings are not held and a resident reported that she did not feel they were necessary. Likewise a resident said, “I can talk to the staff and matron whenever I want, the matron pops in to see me”. The manager holds meetings with the staff and the owner completes a visit to the home in line with Regulation 26 of the Care Standards Act. At the time of the visits the owner views the premises, meets with staff, residents and relatives and compiles a report of his findings. The reports however were not available. They must be kept at the home and made available for inspection. A copy of last month’s visit is to be forwarded to the Commission to evidence the most recent report. The pre inspection questionnaire reported that the manager is not the appointee for handling residents’ financial affairs. Financial records were viewed for a resident and this evidenced a balance sheet with expenditures. A financial record for one new resident was required and the manager set this up at the time of the site visit. Financial records must be in place for all monies held on their behalf. The manager stated that other residents looked after their financial affairs independently or with support from family members. The home has a safe for the safe keeping of monies. Staff receive supervision and a record was seen for these sessions in files viewed. A staff member confirmed that she meets with the manager on a regular basis to discuss training and care practices. Staff also reported that they receive a handover at each shift to discuss the needs of the residents. The care files and MARs for the residents case tracked did not have a photograph of the resident. This record is required for identification purposes. Other care files seen had a photograph in place. An accident book is in place for the reporting of accidents that affect the well being of the residents. A report seen had been completed in sufficient detail. Hawthorne Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 27 The fire log book was viewed and this evidenced an up to date safety contract for the fire prevention equipment and nurse call system. Fire alarms had been tested each month and a fire drill/training was last given to staff in February 2007 to ensure staff were aware of the procedure to follow in the event of a fire. The pre inspection questionnaire evidenced maintenance records and service contracts. A spot check was undertaken of the contracts for the gas, electric, moving and handling hoist and bath hoist and chair lifts. The moving and handling hoist and bath hoist required servicing to ensure the safety of the residents. The Deputy Manager booked a date for this safety check for later this month. Equipment for lifting persons is to be serviced twice a year in accordance with the Lifting Operations and Lifting Equipment Regulations (L.O.L.E.R). A copy of the service contract is then to be forwarded to the Commission. Two wheelchairs did not have footrests in place. These are needed to prevent injury to the resident and they were put in place at the time of the site visit. One was also found to be stored in front of a fire exit on the ground floor. It was removed and stored appropriately. There has been no formal equality and diversity training in the home however the care is person centred and discussion with residents confirmed that they could choose how they wish to spend their care and how they wish their care to be delivered. All staff must attend training in safe working practices to ensure they have the skills and knowledge to undertake the work. This includes moving and handling, food hygiene, infection control and first aid. The cook requires food hygiene as the certificate has expired. Dates of courses arranged are to be forwarded to the Commission. With regards to the environment the manager must protect the health and welfare of the residents. A risk assessment is therefore required to identify the use of window restrictors for windows above ground height. This will ensure they open to safe width to minimise the risk of injury to them. A risk assessment is also required to identify the use of radiator covers or radiators to have low surface temperatures to minimise the risk of scalding to a resident. Hawthorne Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 x 3 3 X 3 2 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 x 3 3 2 2 Hawthorne Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 29 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 OP19 Regulation 23 (2) (b) Timescale for action The exterior of the premises is to 11/09/07 be kept in good state of repair. It requires painting due to wear and tear. (Outstanding requirement from the last inspection June 2006, timescale of 12/7/06 not met) The external grounds must be 11/08/07 maintained for residents to use. This applies to the grassed area/patio area, which is in need of attention. The interior of the premises is to 11/08/07 be kept in good state of repair. The toilet door next to the laundry room is badly damaged and must be replaced. All part of the home must be 11/07/07 kept clean and comfortable for the residents. The lounge carpets are badly stained. They must be replaced to improve the lounges for them. (Outstanding requirement from the last inspection June 2006, timescale of 12/7/06 not met) The risk of cross infection must 11/08/07 DS0000005377.V332403.R02.S.doc Version 5.2 Page 30 Requirement 2. OP19 23 (2) (o) 3. OP19 23 (2) (b) 4. OP19 16 (2) (c) 23 (2) (d) 5. OP26 13 (3) Hawthorne Lodge 23 (2) (b) 6. OP29 19 Schedule 2 7. 8. OP37 OP38 17 (1) (a) Schedule 3 18 (1) (a) (c)(i) 9. OP38 13 (4) (a) (c) 10. OP38 13 (4) (a) (c) 11. 26 (5) (a) be minimised to protect the residents. The laundry room wall requires re plastering as the plaster is coming away from the wall and the wall cannot be cleaned easily. The home must be kept in good repair. Staff must be fit to work in the care home. A police check - CRB disclosure must be obtained for staff prior to starting work at the home and a photograph must be taken of staff for proof of identity. Records to be kept in a care home must include a photograph for each resident. Staff must have training appropriate to their work. Staff require training in moving and handling, infection control, first aid and food hygiene to ensure they qualified, competent and experienced to work in these areas with the residents. Residents must be protected from hazards that affect their safety. The manager must complete a risk assessment for the use of radiator covers or low surface temperature to minimise the risk of injury to them. Residents must be protected from hazards that affect their safety. The manager must complete a risk assessment for the use of window restrictors to ensure windows can only be opened a safe width to minimise the risk of any injury to them. The owner conducts regulation 26 visits. Regulation 26 reports must be kept at the home and made available for the key inspection. 11/07/07 11/06/07 11/08/07 11/08/07 11/08/07 11/07/07 Hawthorne Lodge DS0000005377.V332403.R02.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. Refer to Standard OP9 Good Practice Recommendations Recommendations are made regarding the home’s safe handling, storage, administration and disposal of medicines that will further protect the residents: • The returns’ book for medicines should include the dosage of medicine being returned and the day of the month medicines are returned to the pharmacist. • A list should be kept of staff signatures for those staff responsible for administering medicines to residents. • Date of medicines received in the building should be entered on the MARs. • Locks should be purchased for the two medicine trolleys stored in a locked medicine room • Further details should be recorded on the MAR and care plan for a resident who requires a ‘prompt’ with administering her own medicines. Alternative meals should be recorded on the menu to ensure residents are aware of the choice available. The manager should ensure safe environmental practices are implemented at all times to protect the residents - foods stored in the fridge should be covered and dated. The fridge and freezer should be cleaned. The complaint procedure should be displayed for residents to view to enable them to make a complaint if they wish. The coffee table in the lounge should be replaced, as it is worn and old. The manager is very strongly recommended not to employ staff under the age of eighteen to provide personal care to residents. A staff member under the age of eighteen is to be supervised at all times and to be enrolled on the Skills for Care induction standards as part of their training programme. A risk assessment should be completed for care practices undertaken by the employee. Staff should complete a health declaration form as part of the their job application to ensure they are fit to carry out their work for which they are employed. DS0000005377.V332403.R02.S.doc Version 5.2 Page 32 2. OP15 3. 4. 4. OP16 OP24 OP29 5. OP29 Hawthorne Lodge Hawthorne Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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 Lodge DS0000005377.V332403.R02.S.doc Version 5.2 Page 34 - 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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