Random inspection report
Care homes for older people
Name: Address: Hawthorne Lodge 164/166 Hawthorne Road Bootle Liverpool Merseyside L20 3AR one star adequate service 17/02/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Claire Lee Date: 0 8 0 6 2 0 1 0 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: Lea@hawthornelodge.co.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs Pauline Lynes Type of registration: Number of places registered: Conditions of registration: Category(ies) : Stirrupview Limited Property & Estates care home 25 Number of places (if applicable): Under 65 Over 65 25 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is: 25 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 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 owned by Mr Hornby. The manager is Ms Pauline Lynes. The
Care Homes for Older People Page 2 of 11 1 7 0 2 2 0 1 0 Brief description of the care home accommodation 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. Bathrooms have equipment to help residents with bathing arrangements. Residents have the use of a call bell with an alarm facility. CCTV cameras view certain areas in the home. 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 3 of 11 What we found:
The random inspection for Hawthorne Lodge was conducted on 8th June 2010 by two inspectors. A site visit took place with the homes manager and it lasted approximately three hours. The purpose of the inspection was to follow up on a number of requirements from the last key inspection, which was conducted 17th February 2010. People accommodated at the home like to be called residents and this term is used in this report, as a mark of respect to them. During the visit we case tracked a resident who had recently been admitted to the home. This involved looking at their care file to to ensure the staff had sufficient information to provide the care and support the person needed. We looked at the staff files for two new employees to check they had been recruited correctly and a number of documents relevant to the service. We looked at different parts of the home to evidence recent decoration and general maintenance and we met with some residents to gain their views of the home. There were sixteen people accommodated and the home was well staffed on the day of the site visit. Overall we found that out of nine outstanding requirements, six had been met. We did not review the requirements [2 in total] around medication, as these will be the focus of a separate inspection by a pharmacy inspector. We have also previously issued a Statutory Requirement Notice to improve the way in which medicines are recorded, kept safe, safely administered and disposed of to help protect people. The date for compliance was 15th June 2010. Under the heading what the service does well [below] we have listed the requirements that have been met and the supporting evidence for this. Under what the service could do better we have listed the outstanding requirements still to be fully met, as well as one further requirement and some good practice recommendations. What the care home does well:
We saw the information supplied by the home when people are admitted. This is called the service user guide. We had previously required that information is made available about the use of CCTV cameras in the home. This has now been added to the document. This requirement has been met. We reviewed the care of one person admitted since the last visit. We looked at the care records and spoke with the person and staff who supported them. The person told us that the staff were providing good support. The resident required support with social care needs and physical/medical care needs. These were being addressed with very good liaison with external health and social care professionals. For example, district nurses had been involved to provide support around pressure area care. An advocate had also been involved to assist the person with trying to sort out future accommodation and there had been appropriate liaison with the social worker involved. The person told us, The staff are great and I get along with them very well. The manager has been very good at sorting me out. Care Homes for Older People Page 4 of 11 When we looked at the care file for this person, we found that it lacked the necessary supporting detail. This is evidenced below under what the service could do better. We had made a previous requirement to ensure the homes procedures included health and safety checks, which looked at all hazards in the home. This included the risk to residents of trailing electrical wires. We toured some areas of the home that we had found previously to be hazardous and saw that this has been addressed. We also saw the documentation recording the routine checks made of the environment, which included this area, so that any hazards can be better monitored. This helps to provide a safe environment for people to live in. This requirement has been met. We made a previous requirement to ensure staff are recruited safely to help protect people in the home. This includes ensuring staff files are available for inspection. At the last key inspection, the managers staff file was not available for us to look at. At this inspection we viewed this file and also the staff files for two new employees. This showed us that satisfactory recruitment checks had been carried out; this included obtaining references and a police check. This helps to keep people safe. This requirement has been met. Following the inspection we were provided with evidence that a privacy impact assessment had been completed for the use of CCTV cameras in the home. This was a previous requirement that has now been met. A privacy impact assessment helps to assess the use of these cameras on peoples lives. We have also been provided with an annual development plan for the home. This outlines improvements made and those planned to help maintain good outcomes for people. This was a previous requirement that has now been met. What they could do better:
We looked at a care file for a person admitted to the home since our last visit. The person had been admitted as an emergency following a social worker referral. An assessment of care needs had been undertaken by the manager on the day of admission. This covered the immediate needs of the the person. The assessments did not cover peoples mental capacity in terms of their ability to make a decision to come into the home. This is particularly important given the advent of legislation in the Mental Capacity Act [MCA]. This requires such assessments to be carried out, so that a basis can be established for decision making around care needs on a daily basis, as well as other life decisions. This was discussed with the manager and we would recommend that an assessment of mental capacity is built into the homes pre admission assessment documentation. When we looked at the care file for the person admitted recently we found that much of the information we gained speaking to the person and care staff had not been recorded in any depth and there were contradictory assessments made. The care plan, which provides the basis for carrying out the care in the home, lacked detail and was not easy to follow. For example two assessments made around nutrition were contradictory with one saying low care needs and the other high care needs. The latter was not signed or dated, so it was impossible to say when the assessment had been made and by whom. There was no reference to nutritional needs on the care plan. The carer spoken with said, Things had improved regarding dietary intake indicating there had been issues but this had not been recorded sufficiently. We found the lack of detail and contradictions
Care Homes for Older People Page 5 of 11 confusing and therefore a poor base for establishing care. Another example was the fact that the person concerned had obvious issues around mobility [use of a wheelchair] but there was a lack of assessment and planning around this, to properly record and establish the care needs; there was no moving and handling assessment for example. The manager advised us of some very good care and follow up regarding the persons mobility but none of this was recorded in the care file. The care plan is a document that should be shared, as much as possible, with the person concerned, so that they can feel included in all aspects of their care. The person said that the manager had spent some time initially asking a lot of questions but that they were not aware of the care plan. We saw a signed document the care plan consent with the persons signature on. We would recommend that the person [or advocate] sign the actual care plan, as this would provide a more direct evidence base for inclusion. The care plan was dated a month following admission to the home. We would question whether a person admitted can go a full month without a plan of care being established and would strongly recommend that a standard is set by the manager. This is so that a care plan is established more quickly following admission. The reviews of the care plan, although carried out regularly, were also very brief and did not provide enough commentary for us to follow the progress of care. Again there was no evidence that the person concerned had been involved in any of the reviews. Overall we found evidence that the actual care provided did meet the persons immediate needs but the lack of proper care planning could mean that some care needs may be missed and the person put at risk. We have made a requirement that the manager reviews the care planning in the home and establishes a consistent standard. We have made a previous requirement to ensure that the windows in the home are maintained in a state of good repair, so that residents are living in a well maintained home. This requirement has a due date in August 2010 but we were able to review the progress to date. The manager informed us that Some work has been completed. We saw the homes workbook, which included dates for work on the windows. In the absence of the maintenance person however, we were not able to establish the specifics of any work completed. Following the inspection, we were advised by Mr Hornby, Responsible Individual for the home, that some of the existing windows will be replaced. We have left this requirement for ongoing review. At the previous inspection in February 2010 we noted that a shower room on the ground floor was not in use as work was needed to provide easy access for the residents. We found that this work remains outstanding and there are still no bathing facilities on the ground floor. We have been advised that there are problems with the drainage system. Work should be carried out as soon possible, so that people have access to a bathing facility on the ground floor. It would also provide a choice of bathing arrangements, as there are no other walk in shower rooms in the home. When looking at the staff files we noted that there was no record of each persons identity. For example, a copy of their birth certificate, passport, or a photograph. The manager told us that this information had been sent to the relevant body who send off for the police checks for the staff at the home. We advised the manager of Schedule 2 of the Care Homes Regulations for Care Homes for Older People, which gives details of the information that must be kept on a person working in a care home. We would strongly
Care Homes for Older People Page 6 of 11 recommend that the manager keeps this information in each persons file. This is needed for proof of identity and also for the inspectors to view to help ensure records are up to date. The manager agreed to contact the relevant body to have this information returned. In respect of the use of the CCTV cameras we were advised that a questionnaire is being compiled and this will be sent out to residents, their relatives and the staff to gain their views of their use. As this document is not available yet, we could not assess this. 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 set out on page 2. Care Homes for Older People Page 7 of 11 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 19 23 Externally all windows must be kept in a good state of repair. This ensures the home is maintained appropriately and fit for people to live in. 23/08/2010 2 29 23 All bedrooms must be 17/12/2009 checked to ensure that windows provide for easy and safe ventilation of the home and can be opened and closed when necessary. This is with particular reference to those rooms identified on the inspection visit This will help to ensure people living in the home can moderate the temperature in their rooms Care Homes for Older People Page 8 of 11 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, 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 7 15 All care plans must be drawn 10/02/2011 up with the involvement of the person concerned [or their advocate] and must contain enough detail of the care needs so that care can be monitored and evaluated adequately. All care needs must be included. This provides a basis for the inclusion, monitoring, planning and evaluation of care. It helps to ensure that a clear pathway can be established and the person concerned is more active and involved. 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 1 3 The need to assess peoples mental capacity at the point of admission to the home should be incorporated in the admission and ongoing assessment process. This helps to ensure that peoples ability to make a judgment about
Page 9 of 11 Care Homes for Older People 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 moving in to the home is recorded. It also assists with daily care decisions once admitted to the home. 2 7 All residents care documentation should be signed and dated accordingly. Residents care evaluations should be more detailed and provide a commentary on the progress of care set against the planned outcomes. It is also a good opportunity to include the views of the person concerned. 3 19 Work should be undertaken to make the ground floor shower room fit for use. This is to ensure people have access to a bathing facility on the ground floor. It would also provide a choice of bathing arrangements, as there are no other walk in shower rooms in the home. When looking at the staff files we noted that there was no record of each persons identity. For example, a copy of their birth certificate, passport, or a photograph. We would strongly recommend that the manager keeps this information in each persons file. This is required for proof of identity and also for the inspectors to view to help ensure records are up to date. 4 27 Care Homes for Older People Page 10 of 11 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 11 of 11 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
