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Inspection on 12/05/05 for Hawthorns Nursing Home

Also see our care home review for Hawthorns Nursing Home for more information

This inspection was carried out on 12th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The premises look well maintained and homely. The staff continue to strive to achieve good levels of care and offer individual support to the service user. They are also developing a growing knowledge and skill in palliative care and meeting the special needs of residents. The staff also involve themselves in social activities and fund raising events at the home.

What has improved since the last inspection?

A new manager has been appointed, and this will help to improve the managerial structure and day to day supervision of the staff. The quality assurance process for the care group and the home is now in place and assisting the management to measure standards of service. This has been a positive achievement this year.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Hawthorns Nursing Home 270 Unthank Road Norwich Norfolk NR2 2AJ Lead Inspector Susan Golphin Announced 12 May 2005 09:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hawthorns Nursing Home I55 s44394 Hawthorns v218420 (an) 120505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hawthorns Nursing Home Address 270 Unthank Road Norwich Norfolk NR2 2AJ 01603 452302 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Alphacare Services (UK) Ltd Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Hawthorns Nursing Home I55 s44394 Hawthorns v218420 (an) 120505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Twenty-eight (28) Older People may be accommodated. Date of last inspection 15 December 2004 Brief Description of the Service: The Hawthorns Nursing Home is situated on the city boundary of Norwich. It is a converted Victorian house with a large extension to the rear of the premises. The home can accommodate 28 older people with nursing or/and care needs. The accommodation is on two floors and offers 5 double rooms and 18 single rooms some with en-suite facilities. The communal areas are on the ground floor, and there is a passenger lift to the first floor. There are garden areas to the front and rear of the property and off street parking to the side and front of the home. Hawthorns Nursing Home I55 s44394 Hawthorns v218420 (an) 120505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection took place between 9am-3.30pm. There was the opportunity to talk to three service users and two relatives/visitors during the day. Overall the service users are satisfied with the care support they receive. Eleven out of thirteen comment cards from relatives and residents said they were satisfied with the care service provided. Two expressed concern about staffing levels at crucial times of the day, especially mealtimes. A new manager has recently been appointed. What the service does well: What has improved since the last inspection? A new manager has been appointed, and this will help to improve the managerial structure and day to day supervision of the staff. The quality assurance process for the care group and the home is now in place and assisting the management to measure standards of service. This has been a positive achievement this year. Hawthorns Nursing Home I55 s44394 Hawthorns v218420 (an) 120505 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hawthorns Nursing Home I55 s44394 Hawthorns v218420 (an) 120505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Hawthorns Nursing Home I55 s44394 Hawthorns v218420 (an) 120505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,5 The information available about the home is sufficient to enable prospective residents to make an informed decision. There is a satisfactory assessment process in place. EVIDENCE: There is a statement of purpose and service users guide for the home and available to all prospective service users and their representatives, and can assist them in deciding whether they wish to live in the home. The assessment process has been reviewed and additional questions have been added to provide more details about the possible mental health status or behavioural needs of prospective service users. Prospective service users and their representatives or families can visit the home prior to admission and information about the service provision is available. The new manager will be reviewing the service users guide and statement of purpose and other information as part of her own induction to ensure the information it is easily accessed and up to date. (see recommendation) Hawthorns Nursing Home I55 s44394 Hawthorns v218420 (an) 120505 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10 There is a care plan in place for each person, which provides staff with the information they need to meet service users’ basic health care needs. Individual care and support in the home is offered in a respectful and dignified way. EVIDENCE: The care plans seen on the day provide appropriate details about service users healthcare needs. Within the AlphaCare Services group work is in progress to review the care planning process to promote a more person centred approach and clearer staff accountability. The format and practice in use in this home would also benefit from a review to ensure service user involvement and contribution to their own care is recorded and any risk assessments that relate to special needs are in place. Visitors seen on the day said they would welcome updated information about their relatives care as a matter of routine rather than having to seek out staff for comment. ( see recommendation) Staff were observed during the course of the day meeting service users needs in a personal and caring way. Staff seen on the day acknowledged that the healthcare needs of the service users is high and most need two carers to meet personal and intimate care as well as assist with feeding and eating. Hawthorns Nursing Home I55 s44394 Hawthorns v218420 (an) 120505 Stage 4.doc Version 1.30 Page 10 The manager will review clinical practice and care routines with senior staff and re assess the care needs of the service users, but also based on the discussions and feedback from the staff group. ( see requirements) Hawthorns Nursing Home I55 s44394 Hawthorns v218420 (an) 120505 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,15 The home has an activities programme in place to meet the group social and recreational needs. The meal arrangements in place offer basic menu options and dishes to meet service users’ dietary needs. EVIDENCE: Group activities take place on a regular basis but can depend on the availability of staff to lead the activity, other than when outside entertainers visit each Thursday. The manager will review the weekly programme and time allocated to this provision to develop personal activities for service users in addition to the group ones. ( see recommendation) The service users spoken to on the day of the inspection could not recall their choice of meal for the day, and whilst the personal likes and dislikes of the service users are known and respected, the management need to find ways in which information about the menu can be shared with the service users so that they can easily recall their choices or special dietary needs. The management is setting up a food diary to help one service user make personal meal choices and maintain their interest.( see recommendation) Hawthorns Nursing Home I55 s44394 Hawthorns v218420 (an) 120505 Stage 4.doc Version 1.30 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The home has a satisfactory complaints system in place Information can be accessed by service users or their representatives. The arrangements for the protection of vulnerable adults is in place and there is improved staff knowledge and understanding of adult protection issues. EVIDENCE: The home have dealt with one complaint since the last inspection. The complaint details have been documented. The outcome recorded. Complaints are audited monthly and three monthly through the company quality assurance process. There have been no formal complaints through the CSCI, although the comment cards raise concerns about some of the routines and care practices and have been passed on to the management for their attention and review. Training sessions on the protection of vulnerable adults and adult abuse awareness are in place and staff confirmed that they have completed the sessions. Hawthorns Nursing Home I55 s44394 Hawthorns v218420 (an) 120505 Stage 4.doc Version 1.30 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20,22,23 The standard of the environment within this home is satisfactory, and continuing investment in the external and internal décor will improve the overall premises. The communal facilities are in place and accessible. EVIDENCE: A short tour of the premises was undertaken, and sample of rooms seen. All were in good order. Some of the individual bed tables in use are worn and need to be replaced The radiator covers also have signs of damage and need to be repaired or replaced. There is a decoration programme in place and rooms are re-decorated when vacated. Storage of aids and hoists is a problem because they require electrical sockets for re charging and the conservatory area is being used to house them. ( see requirement) The management will review the communal facilities and look at ways in which changes can be made to improve the space available and the overall layout. Progress is being made in the garden and there are plans to improve the laundry layout and facilities. Decoration work on the external window frames has yet to be completed. Currently the home requires an additional Hawthorns Nursing Home I55 s44394 Hawthorns v218420 (an) 120505 Stage 4.doc Version 1.30 Page 14 hoist to meet client need on the first floor of the premises and the management confirmed that the equipment is on order. Hawthorns Nursing Home I55 s44394 Hawthorns v218420 (an) 120505 Stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Progress is being made to promote the stability and skill mix and training of the staff group to maintain a consistency of care in the home. EVIDENCE: From the discussions with staff and from observations on the day the dependency levels of the service users is medium to high. Therefore it is sometimes difficult for the staff to meet all the residents healthcare needs in a balanced and practiced way. The newly appointed manager will be meeting with the senior staff to re-evaluate the current care needs, work load, care practice and routines; to improve ways in which staff can devote sufficient time to residents and meet their intimate care needs including bathing and assisting them to eat. ( see requirement) Hawthorns Nursing Home I55 s44394 Hawthorns v218420 (an) 120505 Stage 4.doc Version 1.30 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32 33, 38 The newly appointed manager needs to develop a clear plan for the immediate future for the home, which should be shared with staff and service users and their representatives. EVIDENCE: The newly appointed manager is a trained nurse with previous managerial experience in the care of older people. The home has been without direct leadership for some time and the manager will need to establish a supportive managerial style that will promote a sound working relationship with the staff teams and the service users and their representatives.( see requirement). There is evidence in place that the health and safety and well being of service users and staff is promoted. Problems with some areas of the plumbing and the hot water storage tank have now been remedied and the system is fully functional. A recent Environmental Health officer’s visit to the home in January 2005 identified areas of improvements and recommendations were made Hawthorns Nursing Home I55 s44394 Hawthorns v218420 (an) 120505 Stage 4.doc Version 1.30 Page 17 which have been met in part . There is still some outstanding work to be completed in the new storage room and all would benefit from a major clean and re-organisation of the storage facilities to make best use of the allocated space. ( see requirement) The AlphaCare Services (UK) Ltd quality assurance process has now been implemented and the first results of the three monthly audit are being collated The Nurse Care Co-ordinator is able to measure progress and achievements as well as identify areas needing improvements and review with better accuracy and clearer outcomes. Mandatory training is in place and ongoing, including fire training ; moving and handling and health and safety at work . Staff engaged in the preparation of food have yet to undertake basic food hygiene training, with the opportunity to undertake additional training in general catering and kitchen management and in meeting the nutritional and dietary needs of service users . ( see requirement) Hawthorns Nursing Home I55 s44394 Hawthorns v218420 (an) 120505 Stage 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 2 2 x x x x x STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 2 3 x x x x 2 Hawthorns Nursing Home I55 s44394 Hawthorns v218420 (an) 120505 Stage 4.doc Version 1.30 Page 19 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 19 Regulation 20 Requirement The registered providers and management must review the storage of aids and hoists away from the communal space to ensure the facilities offer a comfortable and homely environment The registered providers and management must provide appropriate hoists and equipment for their rooms to meet service users needs. The registered providers must continue to complete the re decoration and upgrade areas showing signs of wear or damage. The registered providers and management must review the current staffing levels to reflect the assessed needs of the service users . The registered providers must review the food preparation areas to ensure well maintained areas for food storage and preparation The registered providers must promote and provide basic food hygiene training for those involved in the preparation and Timescale for action immediate and ongoing. 2. 20 23 immediate and by June 30th 2005 immediate and by August 31st 2005 immediate and by 30th June 2005 immediate and ongoing immediate and by 31 August 2005 Page 20 3. 22 23 4. 27 13,18 5. 38 23 6. 38 16j Hawthorns Nursing Home I55 s44394 Hawthorns v218420 (an) 120505 Stage 4.doc Version 1.30 7. 8 13 8. 32 4 serving of food and in the management and maintenace of the kitchen in keeping with EHO advice and recommendations. The registered providers and the management must re-evaluate the current healthcare needs of the service users to ensure that they are being met The registered providers and the management must promote a clear sense of direction and leadership which staff and service users and their representatives can understand and follow, with startegies for enabling staff and service users to affect the way in which the service is delivered. immediate and by June 30th 2005. immediate and ongoing RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 1 Good Practice Recommendations It is recommended that the manager review all current information about the home to ensure that it is up to date and gives information about the recent changes in management and personnel. It is recommended that the care planning process is reviewed and revised and to reflect a more resident centred plan with which they or their relatives can be involved. It is recommeded that the management review the activities and social and recreational facilities to promote both individual interests as well as group activities. It is recommended that the management review ways in which details about the daily menu and choices can be shared with service users and the information retained . 2. 7 3. 4. 5. 12 15 Hawthorns Nursing Home I55 s44394 Hawthorns v218420 (an) 120505 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection 3rd Floor - Cavell House St Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hawthorns Nursing Home I55 s44394 Hawthorns v218420 (an) 120505 Stage 4.doc Version 1.30 Page 22 - 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!