Inspection on 19/08/09 for Hawthorne Lodge

This inspection was carried out on 19th August 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 22 statutory requirements (actions the home must comply with) as a result of this inspection.

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 07/04/08

Hawthorne Lodge 11/05/07

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 16/02/2010.

Key inspection report Care homes for older people Name: Address: Hawthorne Lodge 164/166 Hawthorne Road Bootle Liverpool Merseyside L20 3AR     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Claire Lee     Date: 1 9 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 40 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 40 Information about the care home Name of care home: Address: Hawthorne Lodge 164/166 Hawthorne Road Bootle Liverpool Merseyside L20 3AR 01519333323 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Lea@hawthornelodge.co.uk Stirrupview Limited Property & Estates care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 25 Date of last inspection Brief description of the care home Hawthorne Lodge is registered to provide personal care 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 small back garden. Bedrooms are either single or double rooms. The home has a passenger lift and there are chair lifts to access rooms that have a number of stairs to them. 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. Care Homes for Older People Page 4 of 40 0 Over 65 25 Brief description of the care home Bathrooms have equipment to help residents with bathing arrangements. Residents have the use of a call bell with an alarm facility. CCTV cameras view public areas only. There is car parking space to the side of the premises. The weekly fee rate is three hundred and eighty three pounds a week. Care Homes for Older People Page 5 of 40 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: An unannounced visit took place as part of the inspection and this was carried out over one day for a duration of approximately nine hours. The term resident is used in this report as this is what the people staying there like to be called. Eighteen residents were accommodated at this time. During the time spent at the home different areas were looked at and a number of care, staff and health and safety records were checked to see what care the residents living there received. Discussion took place with four residents, three staff and the manager. The manager only commenced employment the week of the inspection and this must be taken into consideration when reading the report. The previous inspection was conducted on 7th April 2008 and the service was rated good at that time. There has been no manager in post since earlier this year and the AQAA (Annual Assurance Assessment) was not completed in sufficient detail for the Care Homes for Older People Page 6 of 40 Annual Service Review in April 2009. This has resulted in an inspection being conducted at this time. An AQAA comprises of two self-questionnaires that focus on the outcomes for people. The self-assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service, including staff numbers and training. There was insufficient information in the AQAA and little evidence to support the statements made. During the inspection two residents were case tracked (their files were looked at and they were asked for their views of the home). Other residents also took part in the inspection and all the key and other standards were assessed during the visit. Reference is made to them in the report. A number of comments included in the report are taken from interviews with residents and staff. The Commission has different methods for collating information. An expert by experience is a person who has because of their shared experiences of using a service and/or ways of communicating visits a service with an inspector. This is to help them to gain information as to what it is like to live or use the service. An expert by experience accompanied the inspector for this inspection and details of their findings have been included in the report. Care Homes for Older People Page 7 of 40 What the care home does well: What has improved since the last inspection? What they could do better: A number of requirements have been raised following this inspection. Recommendations have also been made to help staff improve different practices. The service user guide and statement of purpose provide information regarding the home. Both documents should be displayed for residents and their families to view. The service user guide must contain details of the complaint procedure so that residents and their families have the information they need to make a complaint and have confidence it will be investigated within the timescale stated. Previous inspection reports should be displayed so that residents and their families have details of the standard of care, facilities and management of the home. Residents assessments were looked at to ensure their needs were assessed. The documents seen gave basic details regarding different aspects of daily living though some areas such as continence, risk of falls and medicines did not have information recorded. There is a risk therefore that all needs are not assessed and staff may not have the skills and experience or have sufficient information to support them with their individual needs. Residents had a plan of care. The information seen did not always provide details of current health care needs and the level of support required by the staff to support them effectively and safely. Care plans must identify health and social care needs so that residents receive care in a a safe and supportive manner. Risk assessments had a lack of information regarding how the risk is monitored, the impact it has on the resident and how it is minimised by the staff. Referrals to outside health care professionals had also not been made following incidences that affected the residents health. Residents needs must be monitored so that their health and well being is promoted and maintained by the staff. Care plan reviews should be completed in more detail and record a summary of care over a period of time. This helps to evidence the residents current state of health. Care Homes for Older People Page 8 of 40 Resident and/or relative involvement should be sought to ensure everyone is familiar with their plan of care and are in agreement to changes made. Recording systems did not accurately evidence all medicines received in the building or given to residents. Medicines were also not securely stored. The storage and administration of medicines must be safe to ensure the health and well being of the residents. This information was passsed to a Commission pharmacy inspector following the inspection. The residents rights, choices and preferences were not always recorded in sufficient detail or appeared to be promoted by the staff. For example, there was no current social programme in the home for residents to take part in. Residents must be given the opportunity to join in with meaningful social events according to wish and preference as part of their chosen lifestyle. There was no menu to show the choice of food served to the residents and the way in which meals was served showed a lack of respect for their individual choice. A written menu must be provided so that residents are aware of the meals being served and the choice available. A review of the quality and choice of meals should take place to ensure meals and snacks are to residents liking. The cleanliness of the kitchen must be improved as certain areas were dirty. This includes the replacement of fly screens covering windows in the kitchen. Care staff assist with serving meals and general kitchen duties. There is no dishwasher and a member of the care staff is taken off the floor to undertake kitchen duties. A dishwasher should be purchased to assist them with this. It was noted that a number of utensils in the kitchen are worn and could do with replacing to assist with food preparation. This has been raised with the owner but yet to be replaced. The complaints procedure should be displayed so that residents and their families can easily access the information they need to make a complaint. Any concerns or complaints should be recorded in the complaint log. This will help evidence the nature of the complaint, investigation and any action taken to resolve the issue. Staff require training in safeguarding people as they were unclear of procedures to be followed. This will help to ensure staff are familiar with the forms of abuse and how to report an alleged incident. It will ensure residents receive support in a manner that focuses on their protection and well being. Deprivation of Liberty training should be provided for all staff to ensure they are aware of the safeguards to protect people who may lack capacity to make decisions. There was no maintenance book available to show work completed or decoration of rooms. This should be kept to evidence the general upkeep of the home. A risk assessment is also required to ensure the environment is safe. This must include window restrictors, trip hazards, control of damp and general maintenance. Improvements are needed to improve the standards of decor, furnishings and fittings in the bedrooms. A number of bedrooms viewed required decoration, new furniture, repair of window restrictors (to ensure the windows do not open too wide), control of damp, general cleaning for odorous smells and screens for a double room to ensure Care Homes for Older People Page 9 of 40 privacy for the residents. Some bedroom windows did not open and secondary double glazing was not secure. Trailing electric leads were seen for electrical appliances and exposed wires for a call bell. The light to bedroom windows is also affected by the growth of plants outside the home. Environmental health were advised of the concerns regading the environment following the inspection. Residents are currently not living in comfortable accommodation and the lack of maintenance in relation to health and safety has the potential to place them at risk. Not all rooms were personalised with individual items from residents homes and bed linen seen appeared washed out due to general wear. Maintenance of the bedrooms should include checks to ensure bedrooms are homely in appearance and purchase of new bed linen. Residents had their lunch together in the lounge. It was noted that the general cleanliness of this room could be improved prior to and after meals. Not all the bathrooms were available for the residents to use. Residents must be offered a choice of bathing facilities according to their assessed need. Bathrooms and the laundry room must have paper hand towels and liquid soap to reduce the risk of cross infection. The ground floor lounge requires some new furniture and repair of the wall lights to provide pleasant comfortable accommodation for the residents. There is a small smoking lounge for residents to use. The wall paper and hand sink were dirty, the armchairs and carpets had numerous cigarette burns and the ash tray was full. The room had a window but there was no extra ventilation to reduce the smell of smoke. A risk assessment should be completed for the use of the smoking lounge as the carpet and furniture has burn marks. The smell of smoke can permeate from this room into the dining area. Staff files seen showed that recruitment practices were not robust. This places residents at risk. Staff must be recruited safely to ensure the ongoing protection of people who use the service. There was a staffing rota. This should record names of staff working on each shift to ensure accuracy. Discussion with staff confirmed that on occasions they work excessive hours. This may affect the health and safety of people in the home. Guidance should be sought regarding employment law and hours worked. Staff require training in safe working practices. This will ensure they have the skills and knowledge to undertake their work safely. A training plan should be implemented to record courses undertaken by the staff and those planned. This will help to identify their training needs. National Vocational Qualifications (NVQ) in Care are provided. NVQ certificates should be kept on file to evidence NVQ courses undertaken. The Skills for Care Induction Standards should be implemented for new staff as this provides a formal introduction into care. A review of the induction programme would Care Homes for Older People Page 10 of 40 be beneficial so that new staff are fully supported in their job role. All new staff must have an induction and this includes the manager who is new in post. Quality assurance does not appear to be a core management tool. A review of the quality of the service must be conducted to ensure it is being run in the best interests of people who use the service. This helps to provide information as to whether the residents and their families are happy with the care or feel improvements can be made. The AQAA should be completed in sufficient detail to evidence the service provision. Fire safety records were not up to date to evidence safe working practices. Staff require fire training and fire safety equipment must be tested to ensure it is working safely. This is to ensure residents health and safety is protected and maintained at all times. A fire safety officer was advised of the concerns raised at the inspection. A insurance certificate for the home was displayed however this was out of date. The current insurance certificate should be displayed in the home to evidence management of the business. The Certificate of Registration by the Commission was not displayed. This is an offence under the Care Standards Act 2000. The manager is new in post and should apply to the Commission for Quality Care for the position of registered manager. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 11 of 40 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 12 of 40 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents cannot be confident the home can identify or meet their individual care needs and personal aspirations. Evidence: The service user guide and statement of purpose are documents that give information regarding the home. The documents were not displayed for residents at the home or prospective residents and their families to view when looking round. It was difficult to locate both documents and when found they did not have any details of the complaint procedure. This is required to ensure residents and their families know how to raise a concern and how it will be investigated within the timescale stated. Contact details for the Commission were also out of date and there was no other information displayed in the main hall for residents to look at. Residents interviewed were also unsure of the admission process to the home. The Certificate of Registration issued by the Commission and the most recent Care Homes for Older People Page 13 of 40 Evidence: inspection reports were not displayed. Failure to display the Certificate of Registration is an offence under the Care Standards Act 2000 and is stated under Standard 38 of this report. It was evident that residents and their families had insufficient information to decide whether Hawthorne Lodge can provide the care and support they need for their individual lifestyle. The AQAA stated the following, we give a full assessment before giving a placement to the service users (residents). Resident assessments were looked at to ensure their needs were assessed. The documents seen gave basic details regarding different aspects of daily living though some areas such as continence, risk of falls and medicines were not recorded. There is a risk therefore that all needs are not assessed and staff may not have the skills and experience or have sufficient information to support them with their individual need. One assessment had not been completed following the residents admission to the home with limited information from social services. Intermediate care is not provided at Hawthorne Lodge. Care Homes for Older People Page 14 of 40 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents do not receive care and support according to individual need and this may impact on the quality of their lives. Evidence: Residents had a plan of care. The information seen did not always provide details of current health care needs and the level of support required by the staff to support them effectively and safely. Care must be person centred to ensue good outcomes for people. Risk assessments had been completed however there was a lack of information regarding how the risk is monitored, the impact it has on the resident and how it is minimised by the staff. The staff team did not have sufficient information to monitor the residents health in relation to a number of risks assessed or the information was not in accordance with the plan of care. It was noted that a number of referrals had not been made to outside professionals following incidences that affected the health of the residents. Care plan reviews also recorded no change rather than giving a summary of care over a period of time to help evidence the residents current state of health. Residents interviewed were unsure of the their plan of care and what it entailed. Resident and/or relative involvement should be sought to Care Homes for Older People Page 15 of 40 Evidence: ensure everyone is familiar with their plan of care and are in agreement to changes made. A sample of the daily care records written by the staff were looked at. These showed a lack of information regarding resident incidents that had been reported in the accident book with regard to falls and injuries. Poor recording shows a lack of understanding of how to monitor the health needs of the residents and to seek medical advice when needed. This has the potential to place people at risk. The majority of medicines were administered via a monitored dosage system called a blister pack. A number of medicine charts were looked at and these showed that medicines were not always signed as being given. Medicine charts also showed that some supplies had not been properly recorded when received into the home. This informtion was passed to a Commission pharmacist following the inspection. Medicines were stored in a clinical room and this was found to be unlocked and a cupboard for the storage of medicines was also unlocked and open. Prescribed lotions for a resident were found in a bathroom and had not been locked away following use. Medicines must be stored safely and given to people correctly to make sure their health and well being is protected. With regard to respecting the choice and wishes of the residents care plans recorded basic details, for example, preferred times of getting up, retiring at night and times meals are served. Lunch was at a set time however residents were seen to be offered their breakfast at different times. There was no menu available to evidence the choice of food offered to the residents. Staff were seen to eat a cooked meal in front of the residents. This shows an example of a lack of respect towards the residents. They do not have a staff room however staff meals should be consumed in private as the dining room is part of the residents home. One resident was unable to eat lunch as it was too hard and staff made no attempt to ask whether she would like anything else. The same dessert was served to all the residents. Tea was served by the staff prior to lunch and the cups refilled from a large plastic jug of milky tea. The tea cups did not have saucers and no other hot drink or an alternative cold drink was offered. Food remains were collected on a trolley in front of residents whilst they were drinking their tea. The way in which meals were served shows a lack of respect towards the residents. Care Homes for Older People Page 16 of 40 Evidence: Staff were observed to spend little time in the lounges with the residents and there appeared to be little interaction with them or between fellow residents. The choice of activities offered to them must be improved as this is limited. This will help to ensure residents can take part in a varied and stimulating programme of events rather than just watching television or listening to music. A resident reported that they rely on family members to ensure they have contact with people outside of the home. The residents rights, choices and preferences need to be recorded in more detail in the care files and also observed by the staff. This is important for respecting and valuing the various strands of equality and diversity so that staff can provide care and support to residents. This help them to continue their chosen lifestyle with support. Care Homes for Older People Page 17 of 40 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents expectations and lifestyles are not respected by the staff to ensure their well being. Evidence: The AQAA reports that in house activities include DVD films, a library, bingo and trip to a safari park. At the time of the inspection staff were not undertaking any activities with the residents. Leisure facilities were limited. Residents were watching television and the TV picture in the first floor lounge was poor. There was no current plan for activities and the manager was unsure what social arrangements were currently being provided. Staff said a BBQ and an outing took place earlier in the year. An up to date activity record should be kept to evidence the social programme for the residents.This helps to plan future events and residents participation and enjoyment. A resident said that there was not a lot to do each day and that they relied on their relatives coming in for social contact. There is little consideration given to supporting residents individually. This was evidenced through discussion with residents and a lack detail within the social records. The garden is to the side of the building. It is not landscaped and has only a small amount of garden furniture. It is not enclosed and leads on to the car park. Care Homes for Older People Page 18 of 40 Evidence: The AQAA did not give any details regarding the menu, only that it was extensive. There was no evidence to support this. Discussion with staff confirmed that fresh vegetables are only cooked once a week as the delivery is only one day a week. Frozen vegetables were served at the time of the inspection. There was a bowl of fruit however the oranges were dry and unappetising. The menus were not available and the daily menu displayed was for the previous day. This was later taken down but not replaced. A number of residents said that they were not offered a choice and discussion with staff confirmed that one hot meal is served at lunch time. Staff said that they ask residents what they would like however talking with residents confirmed that they did not know what the meal was. They did say that they could have an alternative and would ask if they did not want what was served. It was difficult to evidence any choice as the menus were not available. Consideration must given to providing suitable choices as not all residents may be able to eat the same food due to medical conditions or their general health. A few residents choose to have meals in their own rooms and this is respected by the staff. A number of residents said that they have food brought in and comments included, It is OK, You get what youre given, I did not know what lunch was going to be, I have food brought in and I would like some cakes. Lunch was served in the dining room. There were no tablecloths and the tables had plastic mats. The surfaces were sticky to touch prior and following lunch. An environmental health inspection took place earlier this month and good practice recommendations were made to improve hygiene and kitchen standards. This includes the replacement of fly screens covering windows in the kitchen. These were found to be ripped and dirty at the time of the inspection. A staff member said this is an ongoing problem and the owner is aware. Care staff assist with serving meals and general kitchen duties. There is no dishwasher and a member of the care staff is taken off the floor to undertake cleaning dishes. This therefore takes her away from care duties and reduces the number of staff to assist residents with their care. It was noted that a number of utensils in the kitchen were worn and new ones should be purchased to assist with food preparation. This has been raised with the owner and they have yet to be replaced. Staff said the kitchen was cleaned each month however there was no evidence of an in depth cleaning rota to demonstrate this. A staff member confirmed that certain areas of the kitchen required cleaning as they were dirty at low and high levels. Care Homes for Older People Page 19 of 40 Evidence: Discussion with staff confirmed that problems are encountered with the food suppliers and that certain foods cannot be obtained which residents enjoy and have requested. Alternatives are provided where possible however this raises a concern regarding lack of choice for them. A review of the quality and the choice of the meals should take place, which should include input from residents. This is to ensure residents are served meals and snacks whick they prefer and enjoy. Care Homes for Older People Page 20 of 40 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of knowledge regarding safeguarding people and poor recruitment practices may result in residents not receiving support in a manner that focuses on their protection and well being. Evidence: The AQAA reported that the statement of purpose and welcome pack contains the complaints procedure. The complaint procedure could not be located in the service user guide and statement of purpose at the time of the inspection. It was also not on display for residents and their families to view. A copy of this document and the complaint policy was later located in the policy folder. It would be beneficial to display the complaint procedure so that residents have easy access to the information they need should they wish to raise a concern. This will also provide details of how the complaint is investigated with the timescale stated. Current arrangements make it difficult to find the information they require. Details of the complaint procedure must also be recorded in the service user guide so that residents and their families have the information they need to raise a complaint. Residents spoken with said they did not have any complaints however through discussion comments were made regarding improving the choice of food and also social arrangements in the home. Staff spoken with said they would report concerns to the manager and the AQAA reported no complaints have been received by the home. The complaint log evidenced complaints up to 2006. It was unclear if concerns had been raised since this time. Care Homes for Older People Page 21 of 40 Evidence: The AQAA reported that there has been no safeguarding referrals and none have been received by the Commission. There was an abuse policy and local guidelines on how to report an alleged incident. There has been previous safeguarding training though none has been accessed by the staff this year. Staff interviewed were unsure of the correct procedures to follow should they witness an alleged incident. This has the potential to place people at risk. Further safeguarding training must be sought to ensure they are aware of how to report an alleged incident to the safeguarding agencies and how the investigation is conducted. With regards to the Mental Capacity Act 2005 there has been no staff training around the Deprivation of Liberty safeguards. These have been introduced for people who lack capacity and need extra protection. This ensures people are looked after safely. Deprivation of Liberty training should be incorporated with the safeguarding training for all staff to ensure they have the knowledge and skills regarding the safeguards. The AQAA reported that residents rights are protected however existing practices may place people at risk. Recruitment practices were found to be unsafe as there was a lack of police clearance for the staff. The requirement for this is stated under the Standard 29 of this report. Care Homes for Older People Page 22 of 40 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Hawthorne Lodge is poorly maintained and does not provide homely, comfortable, clean and safe accommodation for people accommodated. Evidence: Hawthorne Lodge is registered for twenty five older people. At the time of the inspection eighteen people were accommodated. A tour of the building took place with the manager and it was noted that a number of areas require attention to improve the accommodation for the residents. There was no maintenance book available which showed worked completed or jobs that needed attention. There was no record of rooms decorated or furnished over the last year. The AQAA did not provide any detail as to the general maintenance, refurbishment and decoration programme for the home. The following was observed: A number of bedrooms viewed required decoration, new furniture, repair of window restrictors, control of damp, general cleaning for odorous smells and screens for a double room to ensure privacy for the residents. A number of bedrooms were also being used for general storage, for example mattresses. Hot water was not available in one bedroom sink and a number of top opening bedroom windows did not open. Secondary double glazing in two bedrooms was held open by a box. Some bedroom Care Homes for Older People Page 23 of 40 Evidence: windows were covered by external climbing plants thus blocking light and providing an unpleasant outlook. Trailing electric leads were seen for some electrical appliances and exposed wires for a call bell. It was noted that some of the larger bedrooms had pleasant decor but this was not found throughout the home. Not all rooms were personalised with individual items from residents homes. Bed linen seen appeared washed out due to general wear and bed linen was turned back rather than being attractively made with a bed spread. Some pillows did not have pillowcases. Bathrooms were bare and institutional in design. There were bath hoists and a special bath which would be beneficial for residents with limited mobility. The manager said that it does not appear to be used at present. The walk in shower on the ground floor was being used for general storage. The AQAA reported that the control of infection standards were met. This was found to be lacking in some areas; not all bathrooms had paper hand towels or liquid soap to reduce the risk of cross infection. A number of bathrooms had bath mats and nail brushes for communal use. The manager was advised to remove them as they are a source of cross infection. There were no thermometers for staff to check the temperature of the hot water prior to bathing residents. Records are kept however when the hot water is checked by the maintenance person once a month. Prescribed lotions for a resident were left out in one bathroom. These must be locked away when not in use. The window restrictor in a bathroom was broken. There are two lounges. One situated on the ground floor and one on the first floor. The first floor lounge television picture was poor at the time of the inspection. The room had a new carpet and comfortable sofas and chairs. The ground floor lounge was being used by the majority of the residents. The wall lights in this room were not working and the armchairs were placed along the walls rather than in small groups to promote communication and a more friendly atmosphere. Several chairs were dirty and in need of cleaning or replacement. The curtains were not hanging correctly as curtain hooks were missing. There is a dining room and the tables were laid with plastic mats for lunch. There were no table cloths. The dining room chairs did not match all of the tables and there were not enough dining room chairs for places set. This was however later observed to accommodate wheelchairs. There is new flooring through the dining room and hall which has brightened up the home. The porch and hall had no information displayed regarding the service. The office was Care Homes for Older People Page 24 of 40 Evidence: locked when not in use and CCTV cameras were in operation to ensure security of the home. There is a very small smoking lounge for residents who wish to smoke. This however was also being used by the staff. The wall paper and hand sink were dirty, the armchairs and carpets had numerous cigarette burns and the ash tray was full. The room had a window but there was no extra ventilation and the smoke permeates into the dining room. Confidential information regarding the residents was on display in this room and removed when requested by the inspector. The laundry room had baskets for the return of clothes to the residents.Clothes and bedlinen are laundered by the staff. There were no hand towels in the laundry for staff to wash their hands to help reduce the risk of cross infection. Residents interviewed said the laundry service was good. Environmental health were advised of the concerns regading the environment following the inspection. Residents are currently not living in comfortable accommodation and the lack of maintenance in relation to health and safety has the potential to place them at risk. Access to the home is via the main front door or side entrance leading into the dining room. The garden has a small number of garden chairs and a gazebo. The garden is not landscaped. Residents interviewed said they did not often sit out in the garden and staff did not ask residents if they would like to use the garden during the inspection. Requirements for maintaining fire prevention are discussed under Standard 38 of this report. The fire risk assessment of the building could not located at the time of the inspection. Care Homes for Older People Page 25 of 40 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are not supported by staff who are recruited safely or who have had training to ensure they have the skills and knowledge to undertake their work. Evidence: The staffing rota was seen and this showed the number of staff on duty. Discussion with staff showed that a change had been made to the rota and a staff member was working excessive hours. As the manager is new in post she was unaware of this change. The staffing rota should record names of staff working each shift so that an accurate record is maintained. Guidance should be sought regarding employment law and hours worked as if staff work excessive hours this may affect the health and safety of people in the home. The AQAA reported that of the thirteen staff employed, nine have achieved an National Vocational Qualification (NVQ) in Care at Level 2 and above. At the time of the inspection there were no details available of the current NVQ trainer and dates of NVQs being undertaken. NVQ certificates were not available in all staff files seen. The AQAA reported that all staff have CRBs (Criminal Record Bureau checks). These are police checks that are required prior to starting employment. Two staff files were looked at and these did not evidence police clearance or references. These checks are Care Homes for Older People Page 26 of 40 Evidence: required prior to commencing employment. The new managers file was also not available to look at and discussion confirmed that the owner has not sought police clearance for her to work at Hawthorne Lodge. The recruitment practices place residents at risk. The AQAA reported that staff have receiving training. Staff training files and discussion with staff showed that staff had received previous training. A number of certificates in safe working practice have now expired. A staff member also had not undertaken any training since starting. The requirement for this is stated under Standard 38 of this report. There was no evidence to support a current training plan. A training plan should be implemented with dates of courses undertaken and those planned. This will help to identify individual training needs. Person centred care may be compromised as the staff do not have the necessary skills and knowledge to undertake their work. This will result in poor outcomes for them. A member of the staff team said they would like to go on training as soon as possible as they have had to learn from other staff. The induction process was found to be limited and there was no evidence of the Skills for Care Induction Standards which provide staff with a formal introduction into care. A review of the induction programme would be beneficial so that new staff are fully supported in their job role in accordance with Skills for Care. The manager has commenced employment without an induction. This must be provided to support her in her new job role, meets the needs of the residents and manage the home effectively. Residents made the following comments regarding the care and staff, Very good, Its OK, The staff are around and I dont have much to do all day. Care Homes for Older People Page 27 of 40 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management systems and procedures do not support people in the home and this results in residents receiving inappropriate care and support in an unsafe environment. Evidence: There is a new manager in post and she commenced employment the week of the inspection. Ms Joanne Gledhill has past experience caring for older people, has completed NVQ Level 3 in Care and is a trainer for moving and handling. Ms Gledhill confirmed that she will commence NVQ Level 4 as part of her managerial development. She will also need to apply to the Commission to become the registered manager of the service. This application should be presented to the Commission as soon as possible. As previously stated under Standard 29 of this report, the managers file was not available to check recruitment procedures and past qualifications. As the manager is very new in post her management skills were not assessed. There were no details in the AQAA regarding the quality of the service, how residents Care Homes for Older People Page 28 of 40 Evidence: are involved or how their opinions are sought. This helps to provide information as to whether the residents and their families are happy with the care or feel improvements can be made. Quality assurance does not appear to be a core management tool. A review of the service is needed to ensure the home is being run in the best interests of the residents and to help monitor compliance and practice with care plans, policies and procedures in the home. Monthly reports were on file to show that work was needed in relation to decoration in different parts of the home. The AQAA was brief and gave limited information about the service. There was little evidence to support any claims made within it thus giving an unreliable picture of the service. This shows a lack of understanding and purpose of the AQAA. Insurance cover for the home was displayed however the certificate was out of date. The manager sought confirmation that this had been renewed. This was found to be the case and the current certificate should be displayed to evidence efficient management of the business. A copy of the latest insurance certificate should be forwarded to the Commission. The Certificate of Registration by the Commission could not located. It is an offence under the Care Standards Act 2000 not to display this certificate. The manager was advised of this at the time of the inspection. A sample of residents financial records were seen and these were found to be adequately maintained. It is good practice to evidence two staff signatures for transactions made on behalf of the residents to ensure accuracy of records held. Staff have received supervision in the past however there are no recent dates of supervision sessions held. This should be arranged and staff meetings held so that staff feel supported in their job role and their training needs are identified. A member of staff said this would be beneficial. Looking at training records and discussion with staff showed that training is needed in safe working practices areas to enable the staff team to provide safe care and support to the residents. Courses such as moving and handling, food hygiene, infection control and first aid must be given to staff to ensure they have the skills and knowledge to care for the residents. The AQAA stated that staff training is provided but there was no evidence to support an ongoing training plan for the staff. The AQAA reported that safety and welfare of service users (residents) and staff are protected. This was found not to be the case in some areas. A sample of health and Care Homes for Older People Page 29 of 40 Evidence: safety records were viewed, such as certificates for fire safety, gas, electric and bath hoists. There was no up to date annual certificate for checking fire alarms and emergency lighting to ensue they were working effectively. The manager contacted the homes engineer to arrange a visit to the home to carry out the necessary safety checks. The fire risk assessment for the home was not available and staff had not received fire prevention training since 2008. A staff member said they had not received any formal fire prevention training since starting. We contacted a fire safety officer following the inspection to advise them of the lack of fire prevention and fire safety procedures which places people at risk. It was difficult to find all the necessary certificates to ensure equipment and services were maintained to a safe standard. There was no certificate for testing the safety of the hoisting equipment however examination of equipment showed a recent date when checked. Accidents that affected the health of the residents had been reported however there was limited information in the care records as to the action taken following the event. This is stated under Standard 8 of this report. Risk management was not assessed in detail as the manager is new in post. In light of the findings from this inspection a quality review of the home must include risk assessments to provide enough detail and guidance for staff to maintain the health and safety of the residents. Care Homes for Older People Page 30 of 40 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 13(2) Records of medicines 07/06/2008 received into the home must include evidence of staff signature for their receipt and date of receipt to provide a clear audit trail. This will help ensure medicines are being administered correctly. Care Homes for Older People Page 31 of 40 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 22 The service user guide must have details of the homes complaint procedure. This will ensure residents and their families have the information they need to make a complaint and have confidence it will be investigated within the timescale stated. 30/09/2009 2 3 14 Residents care needs must be assessed in full. This is so that the provider is able to ensure the staff team posses the skills and experience to support them with their individual needs. 30/09/2009 3 7 15 Residents care plans must 30/09/2009 accurately reflect their curent health and social care needs. Staff must be provided with the information they require to support them effectively and safely. Page 32 of 40 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure the residents needs are met in a safe and supportive manner. 4 8 12 Residents health care needs 30/09/2009 must be effectively monitored and supported by staff and by external health professionals. This includes the completion of risk assessments where a risk has been identified that affects the residents health. This will ensure residents health and well being is promoted and maintained by the staff. 5 9 12 Medicines must be given as prescribed. This helps to make sure their health and well being is protected. 6 9 12 Medicines must be stored securely. This helps to ensure the protection of the residents. 7 10 12 Residents health and 30/09/2009 welfare must be promoted in a respectful manner. For example, meals served. This will ensure their dignity and privacy is respected. 30/09/2009 30/09/2009 Care Homes for Older People Page 33 of 40 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 8 12 16 Residents must be offered a varied programme of events and activities according to assessed need. This is to ensure residents are able to join in with meaningful social events according to wish and preference as part of their chosen lifestyle. 30/09/2009 9 15 12 Residents must be provided with a written menu so that they are aware of meals prepared and the choices available to them. This will ensure they receive nutritious meals according to dietary need and preference. 30/09/2009 10 15 13 Standards of cleanliness must be improved in the kitchen. This will ensure the ongoing health and safety of the residents. 30/09/2009 11 18 13 Staff must have safeguarding training. This will help to ensure staff are familiar with the forms of abuse and how to report an alleged incident. It will ensure residents receive support in a manner that 30/09/2009 Care Homes for Older People Page 34 of 40 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action focuses on their protection and well being. 12 19 23 A programme of maintenance and decoration of the home is needed as areas are in need of repair and attention. This will evidence work undertaken and planned to improve the environment for the residents. 13 19 13 A risk assessment must address all risks within the environment. For example, trip hazards, window restrictors, damp and general maintenance. This will ensure residents have safe, well maintained accommodation. 14 20 23 Suitable furnishings and fittings are required in the communal areas. This is required for the comfort and safety of the residents. 15 22 23 All bathrooms must be available for residents to use. This is to ensure residents have a choice of aids to assist them with bathing safely. 30/09/2009 30/09/2009 30/09/2009 30/09/2009 Care Homes for Older People Page 35 of 40 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 16 24 16 Residents require new furniture and fittings for their private rooms. This is to ensure they can live in private accommodation to assure their comfort and privacy. 19/10/2009 17 26 13 All areas of the home must be kept clean. This will ensure residents live in a clean environment where the risk of cross infection is minimised. 30/09/2009 18 29 17 Staff must be recruited safely. This will ensure the ongoing protection of people who use the service. 19/10/2009 19 30 18 All staff must have an induction when they commence employment. This is required for the manager. This will ensure the manager is supported in her job role, meets the needs of the residents and manages the home effectively. 19/10/2009 20 33 24 A review of the quality of the service must be conducted. The views of the residents, 30/09/2009 Care Homes for Older People Page 36 of 40 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action their families and other stakeholders must be sought to ensure the service is run in their best interests. 21 38 18 Staff require training in safe working practice areas. This will ensure they have the skills and knowledge to undertake their work safely. 22 38 12 Safe working practices must be evident at all times. This is required in relation to fire safety records and fire training for staff. This is to ensure residents health and safety is protected and maintained at all times. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 19/10/2009 30/09/2009 1 1 The service user guide and statement of purpose should be displayed for residents and their families to view as this provides information regarding the home. Previous inspection reports should be displayed so that residents and their families have details of the standard of care, facilities and management of the home. 2 7 Care plan reviews should give a summary of care needs over a period of time rather than stating no change. This helps to help evidence the residents current state of health. Care Homes for Older People Page 37 of 40 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Resident and/or relative involvement should be sought to ensure everyone is familiar with their plan of care and are in agreement to changes made. 3 12 An up to date record should be kept of activities undertaken by residents. This will help plan future events and evidence their participation and enjoyment. A dishwasher should be purchased to assist the staff with general kitchen duties. A review of the quality and the choice of meals should take place to ensure meals and snacks are to residents liking. New kitchen utensils should be purchased to assist with food preparation. 5 16 The complaints procedure should be displayed so that residents can easily access the information they need to make a complaint. Any concerns or complaints should be recorded in the complaint log. This will help evidence the nature of the complaint, investigation and any action taken to resolve the issue. 6 18 Deprivation of Liberty training should be provided for all staff to ensure they are aware of the safeguards to protect people. A maintenance record of day to day jobs completed and work to be carried out should be kept at the home. This should include a check of ensuring bedrooms are homely in appearance and purchase of new bed linen. A risk assessment should be completed for the use of the smoking lounge as the carpet and furniture has burn marks and the smell of smoke can permeate from this room into the dining area. A cleaning schedule should be drawn up to ensure all areas of the home are kept clean. Emphasis should be placed with regard to the dining room furniture prior to and following meals and the kitchen. The staffing rota should record names of staff working each shift so that an accurate record is maintained. Guidance 4 15 7 19 8 20 9 26 10 27 Care Homes for Older People Page 38 of 40 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations should be sought regarding employment law and hours worked as if staff work excessive hours this may affect the health and safety of people in the home. 11 12 28 30 NVQ certificates should be kept on file to evidence NVQ courses undertaken. A training plan should be implemented to record courses undertaken by the staff and those planned. This will help to identify their training needs. The Skills for Care Induction Standards should be implemented for new staff as this provides a formal introduction into care. A review of the induction programme would be beneficial so that new staff are fully supported in their job role. 13 14 31 33 The manager should apply to the Commission for Quality Care for the position of registered manager. The AQAA should provide informtion that is fully supported by evidence to reflect the current service. Residents should be asked to complete satisfaction surveys and meetings should be arranged to enable them to give their opinions of the service. Staff meeting should also be held to ensure staff are supported in their job role. 15 16 33 34 The AQAA should be completed in sufficient detail to evidence the service provision. A current insurance certificate should be displayed in the home to evidence management of the business. A copy of the current certificate should be forwarded to the Commission for Quality Care. Residents financial records should evidence two staff signatures to ensure accuracy of the records held. Staff supervision should be held regularly to support staff in their job role and identify their training neeeds. 17 18 35 36 Care Homes for Older People Page 39 of 40 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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