Inspection on 18/04/08 for Hawthorns Nursing Home

This inspection was carried out on 18th April 2008.

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

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

Other inspections for this house

Hawthorns Nursing Home 15/05/07

Hawthorns Nursing Home 14/06/06

Hawthorns Nursing Home 06/12/05

Hawthorns Nursing Home 12/05/05

Hawthorns Nursing Home 15/12/04

Hawthorns Nursing Home 27/04/04

Similar services:

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Hawthorns Nursing Home 270 Unthank Road Norwich Norfolk NR2 2AJ Lead Inspector Mr Jerry Crehan Unannounced Inspection 18th April 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hawthorns Nursing Home DS0000044394.V362846.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hawthorns Nursing Home DS0000044394.V362846.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hawthorns Nursing Home Address 270 Unthank Road Norwich Norfolk NR2 2AJ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01603 452302 01603 507523 thehawthorns@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Care Services Ltd Application pending Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Hawthorns Nursing Home DS0000044394.V362846.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Twenty-eight (28) Older People may be accommodated. Date of last inspection 15th May 2007 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 and/or care needs. The accommodation is on two floors and consists of 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. The home provides information about the services it provides and a copy of the most recent inspection report in the entrance foyer. Hawthorns is one of several homes in Norfolk owned by the proprietors. The range of weekly fees is £462 to £637 per week. Hawthorns Nursing Home DS0000044394.V362846.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use the service experience adequate quality outcomes. Care services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. This report gives a brief overview of the service and current judgements for each outcome group. Before the inspection the manager of the service completed a lengthy questionnaire about the service referred to within the report as the AQAA. Five comment cards were received from people who live at the service. Three comment cards were received from relatives of people who use the service; three comment cards were received from staff who work at the service. These and comments from people spoken with during the inspection visit reflected some positive views about the home and care provided there, such as ‘Staff members I have been in contact with, have treated my relative with care and kindness, and are friendly and efficient’. However some comments and responses contain a negative theme concerning an absence of management consistency and leadership, which has lead to declining nursing and care standards. Records held by the Commission and previous inspection reports were checked. This key inspection comprised an unannounced visit to the home that took place over 9.25 hours on 18th April 2008. Opportunity was taken to tour the premises, look at care records and policies, and communicate with residents, visitors, nursing and care staff, and the acting manager. The inspection report reflects regulatory activity since the last inspection and evidence from inspection of Key Standards. What the service does well: • Relatives and residents surveyed confirmed that they felt that they were given the information they needed about the home in order to make a decision about whether their needs would be met there. Residents care files contained care and health assessments that provided staff with clear guidance as to how people’s assessed needs. Risk assessments were also written, reviewed and individualised. People who use the service have access to a good diet and meals that are well prepared. Meals were well presented and looked appetising. DS0000044394.V362846.R01.S.doc Version 5.2 Page 6 • • Hawthorns Nursing Home • • Residents are aware of how to make a complaint. A relative indicated that ‘my relative feels they are living in a safe and friendly place’. There are systems in place for monitoring the quality of the service provided including taking the views of residents, relatives and other stakeholders. What has improved since the last inspection? • The acting manager has been working with staff, residents and relatives to collate ‘life histories’ for people to better support their individual and social care needs. Some parts of the environment at the home have been improved since the last inspection, most notably the reception area and main lounge that have been re-carpeted. There have also been a number of new beds provided. • What they could do better: • • • People who use the service must be better supported by staff to make decisions with respect to the care they are to receive. People who use the service must be provided with the facility and support to satisfy their social and recreational needs. A significant number of environmental improvements are necessary to ensure the comfort, safety, privacy and dignity of residents. These include: satisfactory ventilation and heating in communal areas, adequate bathing and toilet facilities that are suitable to the needs of residents (the home has one useable bathroom), and improved maintenance of the premises to ensure the health and safety of everyone who uses or visits the home. The privacy and dignity of residents must be better supported by the environmental improvements needed at the home. This includes the provision of lockable private accommodation and communal space in which residents can meet their visitors privately. • Hawthorns Nursing Home DS0000044394.V362846.R01.S.doc Version 5.2 Page 7 • • There should be a staff complement and a deployment of staff in sufficient numbers to support the needs of people who use the service. The home needs continuity of management, stability and leadership. This need has been emphasised by residents’ relatives and staff, (and in the outcomes from this inspection). They have been expressing an increasing disquiet about the impact of an absence of leadership affecting care standards and morale at the home. Staff must receive and complete induction training to ensure that the care needs of people using the service are met. All staff at the home must be formally supervised. This will help to ensure that care provided meets the needs of people who use the service and the philosophy of care in the home. • • Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hawthorns Nursing Home DS0000044394.V362846.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hawthorns Nursing Home DS0000044394.V362846.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 & 3 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have their needs assessed and access to all of the information they need about the service they may choose so they can make an informed choice. EVIDENCE: The provider has a ‘Statement of Purpose’ and ‘Service User Guide’ to reflect the services provided at the home. These documents contain sufficient information for anyone to make an informed choice about long-term care. The Service User Guide contains a summary of the home’s complaints procedure. There is a policy and procedure in place for assessing and admitting people to the home. Relatives and residents surveys confirmed that they felt that they were given adequate information about the home in order to make a decision about whether their needs would be met there. Hawthorns Nursing Home DS0000044394.V362846.R01.S.doc Version 5.2 Page 10 There is an assessment pro-forma (pre-admission assessment) used by the acting manager when collecting information to ascertain the level of support required by prospective residents. There was evidence of physical, social and nursing needs assessment for these residents seen in files inspected that could form the basis of individual care planning and risk assessment. The acting manager stated that she seeks to visit prospective residents prior to admission. A dependency assessment seen indicated that a resident was of ‘medium dependency’. From observation of the level of care and support provided by staff it was evident that the assessment needed to be reviewed. Hawthorns Nursing Home DS0000044394.V362846.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 & 10 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The majority of the health and personal care support that people receive is based on their individual needs. However, not all of the people who use the service feel they are treated with dignity and respect. EVIDENCE: Residents care plans were found in place in each of the three sample files inspected. These records were complete and up to date and showed evidence of review as well as resident and family involvement and included comments such as; ‘I am very happy with the way that (resident’s name) is looked after and the staff are very good’. The acting manager provided evidence of work currently being undertaken to collate life histories for people to support their individual and social care needs. She indicated that relatives, residents and their ‘key workers’ have a role in this. The files examined contained care and health assessments that provided staff with clear guidance as to how people’s needs, such as mobility, pressure area Hawthorns Nursing Home DS0000044394.V362846.R01.S.doc Version 5.2 Page 12 care, nutrition and continence should be met. There was evidence that records had been reviewed and updated regularly. Risk assessments were also written and were individualised. Nursing and care staff were busy and attentive to the needs of residents during the inspection visit. They showed insight into the needs of a resident with agitation exploring appropriate options to address their needs while offering reassurance to them. All staff were courteous and sometimes formal in their form of address with some residents and less formal and more familiar with others. From observation this appeared to suit individual residents preferences. Residents spoken to during the inspection visit spoke favourably about the quality of the staff at the home. The files examined also contained ‘daily information records’ to monitor resident health and social wellbeing and as a form of communication for colleagues. Some of the recording in daily information records seen was not indicative of an individualised approach to residents and their wishes and feelings. For example one record seen describes a resident’s refusal to go to bed. The completed AQAA provided by the acting manager states that: ‘We work in close partnership with G.P, Dentist, Opticians, Occupational Therapist and Physiotherapist’. Files examined confirmed appropriate liaison with these community health professionals, and each of the residents comment cards received indicated a view that they always or usually receive the medical support they need. The home has a suitable policy for dealing with the control and administration of medicines that staff are aware of and work to. This includes supporting residents to look after and administer their own medicines where they have the capacity to do this. Medication records reviewed were up to date for each resident indicating medication received and administered or disposed of. The arrangements in place for the storage of most medicines are satisfactory. At the time of inspection the medicine refrigerator temperatures were being monitored and recorded. It was found that temperatures recorded were well below the accepted temperature range and within the frozen range. There are clear guidelines for nursing staff in the event of administration of ‘PRN’ (when required) medicines. The guidelines are also available for information to care staff in residents care plans. Residents are happy with the way that most staff deliver their care and respect their dignity. The views within the five residents surveys received by the Commission are mixed with regard to whether ‘The staff listen and act on what Hawthorns Nursing Home DS0000044394.V362846.R01.S.doc Version 5.2 Page 13 you say?’ Two people stated ‘yes’ to this question, two people stated ‘sometimes’ and one person said ‘no’ to the question. Additional comments were also made about this issue, such as: ‘Depends on which staff and when’ and ‘Don’t always have time’. Staff spoken with and observed demonstrated an awareness of the need to treat residents with respect and to consider dignity when delivering personal care. Residents spoken with stated that staff at the home respect their right to privacy. However, there are no suitable or assisted bathroom or shower facilities in working order on the first floor of the home. Residents whose private accommodation is located on the first floor are required to travel to and use ground floor bathing facilities. Doors to residents’ private accommodation are not lockable (see environment section of this report). Hawthorns Nursing Home DS0000044394.V362846.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to a good diet and meals that are well prepared and meet their nutritional needs. People who use the service are limited in what they can do to satisfy their social and recreational needs. EVIDENCE: There is information about planned entertainment at the home in the foyer area. This and information from senior staff provided evidence of musical entertainment, with sing-a-longs and old songs brought into the home approximately weekly and fortnightly visits from the ‘PAT’ dog service. Trips out of the home are also part of the programme of activities; trips to the local park, shops and pub were mentioned, and two church services at the home are held each month. A nominated member of the care staff on weekdays provides activities, though it was reported that this facility is not available at weekends. The kinds of activities described by staff are talking to residents, undertaking nail care and hand massages, and going for walks. These activities were not available at the Hawthorns Nursing Home DS0000044394.V362846.R01.S.doc Version 5.2 Page 15 time of the inspection visit due to a lack of staff. The views within the five residents surveys received by the Commission were generally negative. When asked ‘Are there activities arranged by the home that you can take part in?’ three people indicated ‘sometimes’, two people indicated ‘never’. The acting manager indicated in the home’s AQAA that part of the plan for the home over the next 12 months is ‘To get a new activities programme in place and promote each resident as an individual i.e. reading a book or reminiscing’. She also indicated that the home could do better by recruiting an activities organiser. This is a view supported by staff in their comments received by the Commission. Residents’ visitors are made welcome and there were visitors to the home at the time of the visit. A response within the relative surveys indicated: ‘Staff members I have been in contact with have treated my relative with care and kindness, and are friendly and efficient’. Environmental limitations restrict residents’ and visitors’ ability to meet privately other than in the residents’ bedrooms. Advocates are in place for residents who require someone to represent their interests. The home does not act as advocate for residents but can provide information about where advocacy services may be available should they be required. The majority of residents who commented on the meals on offer at the home indicated a view that they usually liked them. Breakfast was available to residents through the morning and this included tea and coffee with a choice of toast, cereals, porridge and grapefruit. The lunch on offer on the day of the inspection visit was fish and chips. The meal looked appetising, was well presented and taken by residents in either communal or private setting depending on their preference. Residents evidently enjoyed their meals and commented that lunches are usually good with choices on offer. There was evidence in residents’ care plans of nutritional screening using the ‘MUST’ system of nutritional assessment to help to ensure that the dietary needs of residents are met. Hawthorns Nursing Home DS0000044394.V362846.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for responding to the concerns and complaints of people who use the service are good and this helps ensure people who use the service are protected from abuse. EVIDENCE: The acting manager keeps a record of all complaints. The manager has dealt with two written complaints since the previous inspection, which were investigated and managed appropriately. The home has a detailed complaints procedure and information on how to make complaints is detailed in the home’s guide for residents issued at the point of admission to the home. Residents spoken with during the inspection visit stated that they would be happy to speak with nursing or care staff if they had a concern or complaint. A relative indicated that ‘my relative feels they are living in a safe and friendly place’. Four of the five resident comment cards indicate that they know how to make a complaint. There is an adult protection policy in place at the home. The staff spoken with during the inspection visit were clear about the action they would take if concerned about the possibility of abuse taking place at the home and were Hawthorns Nursing Home DS0000044394.V362846.R01.S.doc Version 5.2 Page 17 confident that they could deal with this appropriately. They were sufficiently aware of the home’s ‘Whistle-blowing’ procedure and its function, and records show that almost all staff have completed relevant training in ‘Safeguarding’ vulnerable adults from abuse. The home’s management has made appropriate referrals through the Norfolk adult protection protocol since the last inspection, and carried out investigations satisfactorily. Hawthorns Nursing Home DS0000044394.V362846.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 22, 24, 26 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some parts of the environment at the home have been improved since the last inspection. The premises and equipment at the home does not adequately meet the needs of residents and ensure their privacy and dignity. EVIDENCE: A tour of the premises was completed. Since the last inspection a number of improvements have been made including the fitting of a new carpet for the main lounge and re-design of the reception area, and the provision of some new ‘profile’ type beds. The service provides a generally homely environment. It has a rolling programme to improve the decoration, fixtures and fittings. However, there are overdue timescales for environmental maintenance such as the continuing Hawthorns Nursing Home DS0000044394.V362846.R01.S.doc Version 5.2 Page 19 absence of an extractor fan in the kitchen and a satisfactory system for maintaining a comfortable temperature in the conservatory. Some external window frames at the front of the building have flaking paint and a rainwater leak into the wall at the front of the home has caused damp in the office shared by the manager and administrator. Obstructions and potential hazards from the first floor fire exit were noted, such as a dried bag of concrete on the pathway. The side gate was difficult to open as the post securing it was not properly fixed and plants/shrubs are encroaching over the exit pathway. These matters were brought to the notice of senior staff for attention at the time of the inspection visit. All of the communal areas and some of the bedrooms were seen. The views within the five residents surveys received by the Commission were positive with each respondent indicating a view that the home is always or usually ‘fresh and clean’. The grounds and garden are accessible with patio areas and seating for residents. Many of the bedrooms seen were personalised and furnished to a satisfactory or good standard. Some residents occupying the home for periods of respite care used those bedrooms that were not to this standard. There is currently no dedicated communal space in which residents can meet their visitors privately. Doors to residents’ private accommodation are not lockable. The home has satisfactory portable equipment to assist residents’ transfers and mobility, including three stand aids and three hoists. There is a single assisted bath at the home, which is located on the ground floor. There is a non-assisted bath and a shower room on the ground floor, both of which were out of use or not suitable for residents. There is a nonassisted bathroom with a toilet on the first floor that was out of use and not suitable for residents to use. This room had become inaccessible and unsafe due to storage of equipment, some of which is used by staff. There is no other communal toilet available for the (up to ten) residents whose private accommodation is on the first floor of the home. A staff member commented ‘The home should have more than one useable bathroom’. Hawthorns Nursing Home DS0000044394.V362846.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff at the home are not deployed in sufficient numbers to support the needs of people who use the service. The home’s recruitment practices help ensure people who use the service are protected from unsuitable staff. EVIDENCE: The Commission had recently been informed by the proprietor that the staffing allocation for the home would be five carers per morning and afternoon shift, subject to matters such as occupancy levels and the changing needs of residents. There were 23 residents accommodated at the home at the time of the visit. There is a total nursing and care staff complement of 17 in addition to administrative, ancillary staff and the manager. From observation and from information provided by the acting manager there was 1 nurse and 4 carers on duty during the morning of the inspection visit. From 2pm till 4pm on the day of the inspection visit the number of care staff was due to drop to 2. However, senior staff covered this period. From 4pm till 8pm there were 3 carers and 1 nurse on duty. Observations showed this staffing allocation is not sufficient to adequately meet the needs of residents. Hawthorns Nursing Home DS0000044394.V362846.R01.S.doc Version 5.2 Page 21 Comments received from staff indicate a view that there have been other occasions when 1 nurse and 2 carers have been on duty for periods during the day. They indicate that with 1 nurse and 3 carers on duty they find it very difficult to support residents care needs such as managing transfers with the hoist, managing residents mobility, bathing and activities. One comment received from staff indicates ‘Staff stick to a routine so the work gets done, but there’s no time for extras’. The views within the five residents surveys received by the Commission were mixed. When asked ‘Do you receive the care and support you need?’ three people indicated ‘sometimes’, one person indicated ‘usually’ and one person indicated ‘always’. One additional comment offered indicated ‘staff don’t come when I call sometimes’. Some comments received indicate a view that language and cultural differences of nursing staff can creates difficulties in communication especially on the phone. Other comments received include ‘I find the general standard of carers to be good’ and ‘Some good carers but they lack support of the management’. From two of the staff files seen, there was evidence to show that the recruitment and selection processes had been followed including obtaining references and checking on identity, criminal records disclosure and previous employment. Training records demonstrated that there is a very low percentage (15 ) of care staff that have gained their NVQ level 2 in care or above. Induction training for more recently recruited staff has evidently begun, but has not been completed. The acting manager acknowledged some difficulty for mentors being able to commit time to spend with staff working through their induction training. Information from other training records and discussion with staff provided evidence of a good approach to further training with all staff having achieved mandatory training and other training courses. One carer comment received indicated ‘Our trainer is very good and the courses are excellent’. There is a rolling cycle of staff training that addresses mandatory and other requirements provided by the proprietor. Hawthorns Nursing Home DS0000044394.V362846.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36, 38 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and staff at the home promote the health and care of people who use the service within their abilities, but people using the service are being put at potential risk through an absence of formal supervision of staff practice. EVIDENCE: The home does not have a registered manager. The manager’s post had been recruited to at the time of the inspection visit; however, the appointee was not yet in post. There has been an absence of continuity of management, stability and leadership of the home for several years, a point which was made by staff and Hawthorns Nursing Home DS0000044394.V362846.R01.S.doc Version 5.2 Page 23 relatives in their comments such as; ‘We have had 7 managers in 5½ years’ and ‘Stronger management needed’. The acting manager has significant experience at the home, is a registered nurse and described as approachable and fair by staff. The acting manager stated that she operates a weekly manager’s surgery each Tuesday afternoon where people can bring their issues or concerns to her notice. Other quality assurance processes have included recent opinion surveys for relatives and the same process will be undertaken for residents. Staff have also recently been surveyed for their views. Staff meetings take place every other month, and the acting manager leads these. She also undertakes a variety of internal audits, which are validated by the proprietor’s senior managers. There is an on-call system for unsocial hours and for weekends when senior staff are in charge of the home. The system provides access to the acting manager or deputy, and to an area on call support system operated by the proprietor. There is a ‘Friends’ of the home group who take an active role in supporting the home and in fundraising. Relatives or appointees manage most residents’ financial affairs. Financial records reviewed were satisfactory and are evidently audited periodically for the protection of residents and staff. There is an established system for providing care staff supervision through observation of their practice by nursing staff or the acting manager. However, there is not yet a system for formal recorded supervision established at the home for all nursing and care. The acting manager stated that a system was in the process of being set up. Training records demonstrated that staff are given mandatory training in general health and safety matters. Records demonstrating up to date compliance with health and safety regulations were seen. Some aspects of daily health and safety need to be addressed as stated elsewhere in this report. Risk assessments were seen in people’s files. The acting manager has systems in place that monitor some aspects of practice and compliance with the homes plans, policies and procedures. Hawthorns Nursing Home DS0000044394.V362846.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 1 1 X 2 X 3 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 2 Hawthorns Nursing Home DS0000044394.V362846.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12 (2) Requirement People who use the service must be supported (as far as practical) to make decisions with respect to the care they are to receive. This will help to ensure that they are treated with dignity and respect. Medicine refrigerator temperatures must be within the accepted temperature range at all times to ensure residents’ health and welfare. People who use the service must be provided with facilities for recreation to suit their individual needs. Ventilation and heating within all parts of the premises must be suitable for the assessed needs of residents. The premises must be in a good state of repair to ensure people live in a safe and suitable environment. Communal space must be provided which includes rooms in which residents can meet visitors in private. The premises and any specialist DS0000044394.V362846.R01.S.doc Timescale for action 18/04/08 2. OP9 13 (2) 18/04/08 3. OP12 16 (2)(n) 30/06/08 4. OP19 23 (2)(p) 30/06/08 5. OP19 23 (2)(b) 30/06/08 6. OP20 12 (4)(a) & 23 (2)(e) 23 (1)(a) 30/11/08 7. OP22 30/11/08 Page 26 Hawthorns Nursing Home Version 5.2 23 (2)(a,c,e) 8. OP24 12 (4)(a) 9. OP27 18 (1)(a) 10. OP30 18 (1)(c) 11. OP31 9 12. OP36 18(2) equipment used must be suitable for the assessed needs of the residents. Doors to residents’ private accommodation must be fitted with locks suited to residents’ capabilities to promote their privacy and dignity. People who use the service must be supported at all times by staff in such numbers as are appropriate for their health and welfare. Staff must receive suitable induction training to ensure that the care needs of people using the service are met. There must be an application for registered manager for the service. This Requirement Is Repeated Staff at the home must be formally supervised. 30/11/08 18/04/08 18/04/08 30/06/08 30/06/08 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 OP3 Good Practice Recommendations It is recommended that the dependency assessment tool used by the manager and senior staff be sufficiently weighted to take account of residents’ emotional wellbeing. It is recommended that a fundamental review of the standard and suitability of the accommodation and facilities provided on the first floor of the home should take place. It should consider the physical health care needs of residents as well as their privacy and dignity. 2. OP19 Hawthorns Nursing Home DS0000044394.V362846.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hawthorns Nursing Home DS0000044394.V362846.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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