This inspection was carried out on 10th October 2008.
CSCI found this care home to be providing an Excellent service.
The inspector found no outstanding requirements from the previous inspection report,
but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.
Inspecting for better lives Random inspection report
Care homes for older people
Name: Address: Hawthorns (EVESHAM), The Church Street Evesham Worcestershire WR11 1EP The quality rating for this care home is: The rating was made on: three star excellent service 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 assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. 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: Denise Reynolds Date: 1 0 1 0 2 0 0 8 Information about the care home
Name of care home: Address: Hawthorns (EVESHAM), The Church Street Evesham Worcestershire WR11 1EP 01386444330 01386444331 The-Hawthorns@shaw-homes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Shaw healthcare Ltd care home 47 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia physical disability 47 7 Over 65 0 0 Conditions of registration: 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: Dementia (DE) 40 Physical Disability (PD) 7 The maximum number of service users to be ccommodated is 47. Date of last inspection Brief description of the care home The Hawthorns is a purpose built care home which provides nursing care for up to 47 people. Forty of the places are for older people who need nursing care due to physical difficulties or because they have a dementia type illness. The other seven places are in the aqquired brain injury unit on the second floor which caters for younger adults. The home is a short distance from the centre of Evesham, convenient for local facilities and for people wanting to visit the home. There are car parking spaces for visitors and Care Homes for Older People Page 2 of 10 staff. The home is spacious with accommodation provided on three floors. The home is arranged in five self contained units, four have ten rooms and the aquired brain injury unit on the second floor has seven. This means that people live in relatively small groups with staff that usually work in the same unit when they are on duty. Each unit has a sitting room and a kitchen/diner; the size and layout of these has a domestic feel and means that visitors can make a drink when they come to visit. All of the bedrooms are singles and have an en-suite toilet and shower. In addition the home provides lounges, dining rooms and bathrooms with specialist equipment for people who need assistance with bathing. There is a garden for people to use when the weather is fine. Care Homes for Older People Page 3 of 10 What we found:
We did an unannounced random inspection at the Hawthorns because when we did our Annual Service Review in June 2008 we were not confident that the Home was still providing good outcomes for people living there. This was due to the number of notifications sent to us by the service about falls where people had needed medical attention and/or admission to hospital. In addition to this the Annual Quality Assurance Assessment (AQAA) sent to us by the service did not contain enough information to demonstrate what the home does well, what they need to improve and what their plans for improvement are. We did not inspect the part of the accommodation which provides seven places for people with acquired brain injury. We will be liaising with the organisation and our Regional Registration Team regarding how this part of the service is registered and managed and will inspect it separately in due course. As a result of this random inspection we have decided to bring forward the next unannounced key inspection of the home. Please note that the information on page 2 under conditions of registration is incorrect. the service is registered as a care Home with Nursing, not as one providing Personal Care only. What the care home does well:
The building was clean and warm on the day we did our inspection. The atmosphere was friendly and relaxed and the staff we met showed an interest in their work. It was the last day at the home for the registered manager who has been promoted within the organisation to their new Quality Assurance Team. During the day we overheard lots of staff and visitors wishing her well and thanking her for her hard work at The Hawthorns. We met the new manager who had started work at the home a few weeks earlier to enable a smooth handover and avoid a period without there being a manager in post. The new manager has submitted her application to be registered to us and is waiting for details of her interview with our Regional Registration Team. Care records at the home have been streamlined to make them easier to use for staff. this had involved splitting them into three files for assessment, care planning and risk assessment and daily records. The care staff understand the importance of people having enough to drink and one showed us the records they keep to show how much and how often people have drunk during each day. This care was also able to tell us about people having Fortisip drinks if they need additional nutrition. We saw that staff knocked on doors before they went into bedrooms and spoke to people politely. Staff training posters for medication and safeguarding (adult protection) training were Care Homes for Older People
Page 4 of 10 displayed showing that a large number of staff had been booked to attend these. What they could do better:
We found that some information in the care records was contradictory; for example, one person had different risk assessment forms about the risk that she may fall over. In one of these the risk was described as medium but in the other the risk was rated as very high. The service needs to make sure that the records provide consistent information to staff to help them to provide each person with the correct care. Information regarding continence management needs to be improved. In one care record we looked at reference was made to making sure a person had the correct incontinence pads but we could find no explicit information about which type this was. Staff had noted that one person was developing pressure area damage and had recorded this but there was no further information about how this was progressing. The area had not been added to the body map used to chart any wounds. The nurse on duty was able to assure us that on that morning she had checked this herself and found the area to have healed. It is essential that records about pressure area damage are updated at least daily and that they include information about the size and appearance of any wound so that staff can monitor and reassess the care needed. The records about accidents that people in the home have had are reviewed by the manager and collated into regular reports. We noted that the entries made by the manager when signing off the accident forms were very brief, for example many just said the a care plan and risk assessment was in place. We recommend that this process is used more pro actively to make sure the care plans and risk assessments reflect any change in need or risk. We did note that this had been done in a small number of examples. We found an example of staff having different perceptions and views regarding how to keep one resident safe at night. Some entries in the records showed that some staff were placing a mattress on the floor by the persons bed while other staff were saying that this was increasing the risk to the person. It is important for the care records and risk assessments to be checked to make sure the best strategies for each person are agreed and that all staff work consistently to minimise the risk to residents. We also noted that following falls and accidents the risk rating had still been scored as low. In one example the risk rating stayed at 0 even though the incident had involved a person climbing out of her bed over the top of their bed rails. This would have placed them at significant risk of injury and should have lead to a full review of the use of bed rails for that person. The organisations documentation regarding the safe use of bed rails is not being properly used. We found one example where the only record was a handwritten note on the bed rail guidance sheet that rails were not required. The service has a form which includes space to record indications for not using bed rails and space for alternative solutions where use of rails is not appropriate but both these sections were blank. The only writing on the form was the residents name. The form was not dated or signed Care Homes for Older People Page 5 of 10 The care records about peoples nutritional requirements need to be improved. We saw an example of a person whose care information (weight loss and a high score for being at risk of pressure sores) indicated the need for a fortified diet. This was not clearly highlighted on the diet information sheet which said they have a normal diet. This is an area that has already been identified in the monthly visit reports by the Area Manager. We saw staff using inappropriate moving and handling methods ie they were walking a person across a room holding them under their armpits. This technique is uncomfortable and potentially painful for a person being moved and viewed nationally for many years as poor practice. Storage facilities are very limited in the home. This means that wheelchairs and hoists are being kept in bathrooms when not in use. The bathrooms are therefore cluttered and not the relaxing and pleasant rooms they should be. The staffing levels at the home provide one registered nurse on each floor (two separate units for ten people) and two carers for each unit of ten. We questioned whether this is adequate. Some of the people who live in the home need two staff for moving and handling and a high proportion need one to one help with eating their meals. If two staff are with someone in a bedroom it means the other nine people are unattended for however long this takes. In one of the units we learned that eight of the people need help with eating. This is a time consuming task if done properly and we would question how two carers can manage to do this without rushing. 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 6 of 10 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 10 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 13 Regulation 13(4)(b) and (c) 31/10/2008 When a person has been identified as being at risk of falling from bed, decisions about using bedrails or not must be thoroughly recorded in accordance with guildelines from the Medicines and Healthcare Products Regulatory Agency. This is to make sure that decisions about the use of bedrails are made in the light of best practice guidance and to minimise the risk of injury to a person due to their incorrect use. 2 8 13 Regulation 13(4)(b) and (c) 31/10/2008 When a person has been identified as being at risk of falls the care records and risk assessments must provide clear information for staff about agreed strategies for assisting them. This is so that staff work consistently to minimise the risk to the individual concerned. Care Homes for Older People Page 8 of 10 3 8 17 Regulation 17(1)(a), 31/10/2008 Schedule 3 section 3(n) When people have developed pressure area damage the records of this must be kept up to date and clearly describe the progress or deterioration of any wound. To ensure that pressure area damage is monitored and staff have the information they need to make decisions about the care needed. 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 7 You should ensure that the information in the care plans and risk assessments does not contain contradictory information to avoid the risk of staff following the wrong information. Work on improving information in the care records about nutritional assessment needs to be developed further as already highlighted in the Area Managers Regulation 26 reports. You should ensure that the detail in the care plans is sufficient to ensure that staff have all the information they need to support people with their continence needs. Consideration needs to be given to ways of improving storage arrangements in the home. Staffing arrangements should be reviewed with particular attention paid to staffing levels at mealtimes and the number of people living in the home needing two carers for moving and handling and personal care. Staff competence in moving and handling should be monitored and where necessary poor practice should be addressed with staff concerned. The process of monitoring accidents needs to be more robust to ensure that care plans and risk assessments are updated and accident trends are identified. 2 8 3 8 4 5 22 27 6 38 7 38 Care Homes for Older People Page 9 of 10 Reader Information
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