Inspection on 06/12/05 for Hawthorns Nursing Home

This inspection was carried out on 6th December 2005.

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 18/04/08

Hawthorns Nursing Home 15/05/07

Hawthorns Nursing Home 14/06/06

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hawthorns Nursing Home 270 Unthank Road Norwich Norfolk NR2 2AJ Lead Inspector Mrs Susan Golphin Unannounced Inspection 6th December 2005 09:30 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.V270225.R01.S.doc Version 5.0 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.V270225.R01.S.doc Version 5.0 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 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 DS0000044394.V270225.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Twenty-eight (28) Older People may be accommodated. Date of last inspection 12th May 2005 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 DS0000044394.V270225.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine unannounced inspection was carried out between 9.30am and 3.30pm. The inspector was accompanied by the Pharmacist Inspector Mark Andrews. The manager Andrea Holloway and the Nurse Care Manager Yvonne Delf for Alpha Care Services (UK) (Ltd) were present throughout the day. Four residents, one visitor and two staff were spoken to and a small sample of care and staff records relating to those interviewed were also seen. All the comments have been incorporated into the report with the exception of specific or personal issues raised with the inspector, and these have been passed to the management for their immediate attention. The majority of comments expressed satisfaction with the service and care received. The inspector was pleased to be able to commend the management and staff for the way in which they are continuing to improve on the service to the residents. What the service does well: What has improved since the last inspection? There is one outstanding requirement and one recommendation from the last inspection. Since the last inspection improvements have been made in the following areas:• A review of both care and domestic routines and daily practice. The changes have meant that nursing and care staff with expertise and appropriate skills are directed to where they are most needed. • Improvements have been made to the layout to ensure that any unnecessary ‘clutter’ is removed. Hawthorns Nursing Home DS0000044394.V270225.R01.S.doc Version 5.0 Page 6 • • • • • Improvements have been made to the way in which aids and adaptations and wheelchairs are stored Improvements to the environment have included new bed tables and an additional hoist and stand aid have been purchased. A programme of redecoration is in place and the radiator covers have been repaired and repainted. The annual appraisals for all the staff have been completed. A ‘Friends of the Hawthorns’ has been established and the funding arrangements placed on a formal footing with named signatories. Arrangements have been made recently to provide the manager with some administrative support- to allow the manager more time to work directly with staff and carry out observational and clinical supervision on a more regular basis. What they could do better: • Improvements in the care practice and staffing levels and stability are continuing to be made and consolidated, and the manager is reviewing and monitoring the service and care practice to ensure standards are being maintained and initiatives adopted. Work is still needed on formalising the supervision process for staff. Staff appraisals have been completed but the regular supervision sessions are to be reviewed and revised in line with the appraisal process. Clinical practice and observational supervision is taking place but the records of the events and the outcomes need to be recorded in detail and any action plan for personal development or training given an agreed timescale. Review the current social activities and individual social stimulation available and seek the views and ideas of the residents to ensure their interests are promoted. Continue with the plan to upgrade and refurbish the kitchen and food storage areas, and following the EHO guidelines and recommendations. Continue to review the care planning process to ensure residents or their relatives can contribute to and also sign up to the agreed plan • • • • • 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 DS0000044394.V270225.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Hawthorns Nursing Home DS0000044394.V270225.R01.S.doc Version 5.0 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 the following standard(s): 2,4 There are appropriate procedures in place to provide residents or their relatives with a clear assessment of need, information about the service and facilities and contractual arrangements prior to admission. EVIDENCE: All prospective residents are provided with a written contract on admission to the home. A full assessment of need is completed prior to admission or before the placement is agreed. The information received reflects individual wishes and choices of the resident. Each of the files seen contained a completed assessment. Residents spoken to on the day of the inspection confirmed that they had visited the home prior to admission and those that had not had been happy for a representative to do so on their behalf. Hawthorns Nursing Home DS0000044394.V270225.R01.S.doc Version 5.0 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 the following standard(s): 7,8,9,10 There is a care planning process in place, which provides staff with the information they need to meet resident’s healthcare needs. Personal support in the home is offered in such a way as to promote resident’s privacy and dignity. Arrangements are in place for the management and administration of medication. EVIDENCE: The care plans for four residents were seen on the day. Each had an assessment of need, a plan of care which has been agreed and signed either by the resident or by their representative. Some of the care plans need to be reviewed to ensure resident involvement where possible and the dates of the next review should be indicated on each plan. The current plans offer appropriate information about residents and how their care is met. Residents spoken to on the day said that they are happy with the service they receive; one resident said that the staff are helpful and kind and can be relied on to help as needed. One resident said that she is happy living in the home and can do as she wishes. Residents gave examples of care and support they receive and confirmed that staff are respectful and kind. (see recommendation) Hawthorns Nursing Home DS0000044394.V270225.R01.S.doc Version 5.0 Page 10 The inspection of Standard 9 was conducted by Pharmacist Inspector Mr M Andrews. The inspector found overall the homes medication handling, administration and record-keeping practice to be of a satisfactory standard. The home has systems in place for monitoring and auditing medication practice on a regular basis. The inspector, however, was concerned to find that morning medicine rounds (scheduled for 07.00 and 08.00hrs) are commonly not completed until 11.00hrs. This may be of particular significance for medicines requiring early morning administration or medicines prescribed with daily multiple dosing, for example requiring further administration at 12.00hrs. In addition, since the non-involvement of community pharmacies in the removal of unwanted medicines for disposal from care homes with nursing care, the home has not made alternative arrangements for the disposal of medicines. Unwanted medicines have therefore not been removed for disposal from the treatment room for several months. The inspector also made several recommendations intended to assist the home enhance the safety of medicine administration and security of medicines. A copy of the full pharmacy inspection report has been sent to the provider and is available subject to request. (see requirement) Hawthorns Nursing Home DS0000044394.V270225.R01.S.doc Version 5.0 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 the following standard(s): 12,13,14,15 The dietary needs of the residents are catered for with a balanced varied selection of meals. Residents are able to socialise with others as they choose and maintain contact with family and friends. Residents are encouraged and expected to be involved in the process of daily living and decisions about their lifestyle. The arrangements in the home for meeting the residents cultural and social and recreational interests need to be reviewed to ensure individual lifestyle expectations are being met. EVIDENCE: Activities and social events are in place but depend either on the availability of staff to lead the activity or on volunteers. The Friends of Hawthorns has been re-established and the amenity fund reinstated with new signatories and a treasurer. Discussions are ongoing between the ‘Friends’ group and the management to find ways in which the resident’s social and recreational interests can be best promoted. (see recommendation) Residents are asked for their views and opinions about their care and encouraged to remain part of the planning process and decision-making about what they wish to do. During the discussions the staff said that if they have to Hawthorns Nursing Home DS0000044394.V270225.R01.S.doc Version 5.0 Page 12 act or make a decision for a resident because of their frailty they try to do so on an individual basis. Residents said that they are happy with the meals provided and the inspector was able to observe the chef seeking individual choice of food for the day and gave examples of some of the alternative dishes, provided. In the discussions with the chef on duty it was clear that the resident’s personal likes and dislikes are well known and catered for. One resident said that they are very happy with the menu and on the day of the inspection had asked for egg and bacon for lunch instead of the dish of the day. The menu is displayed and the chef and care staff said that they also remind residents about the menu and the options available on a daily basis. During the course of the day staff members were observed assisting people to eat and drink in a discreet and sensitive way. Hawthorns Nursing Home DS0000044394.V270225.R01.S.doc Version 5.0 Page 13 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 the following standard(s): Not inspected on this occasion EVIDENCE: Not inspected on this occasion Hawthorns Nursing Home DS0000044394.V270225.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 19,22,26 The standard of environment in this home has improved and provides the residents with a comfortable and homely place to live. Specialist equipment to aid and promote independence and mobility is in place and accessible to residents. There is an infection policy in place with clear clinical advice and guidance for staff to follow. EVIDENCE: A short tour of the premises was carried out whilst talking to residents and staff, and the inspector is pleased to note the improvements to the general environment. Arrangements have been made for better storage of aids and wheelchairs and some of the ‘clutter’ around the corridors and communal rooms has been removed. The layout of the sitting room has provided a better focal point for residents. Repairs and redecoration is ongoing and the first floor corridor will be redecorated as soon as possible. (see recommendation) A new hoist and stand aid have been purchased and adjustable bedside tables have been replaced both in resident’s rooms and sitting rooms. The kitchen and food storage areas are under review to improve current conditions. Condensation is proving to be a problem especially at crucial times Hawthorns Nursing Home DS0000044394.V270225.R01.S.doc Version 5.0 Page 15 of the day when the cooking processes are in full use. It was confirmed that suppliers have been contacted and initial assessments have been completed to find ways in which the problem can best be addressed. It is acknowledged that the situation needs to be dealt with as soon as possible to promote the best environment for food preparation and storage and work setting for the catering staff. (see requirement) The home was clean and well maintained on the day of the visit and residents rooms Hawthorns Nursing Home DS0000044394.V270225.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,30 Improvements to the staff group’s expertise and skills continue to be made and consolidated, to meet the healthcare needs of the residents. Arrangements are in place to offer relevant training and clinical guidance to all staff. EVIDENCE: The staffing situation has stabilised in the last six months. A review of both care and domestic routines has been carried out to ensure that trained staff and those with expertise are free to undertake the care and nursing tasks as needed. This process will continue to be monitored by the manager. Members of staff spoken to said that they are supported and supervised by the senior staff and management and feel that over the last few months have developed a better sense of purpose and direction. Standard 27 was not inspected in any detail other than to establish that the numbers of staff on duty for the day corresponded with the duty rota, and were meeting the healthcare needs of the residents. Extra hours or an additional member of staff will be appointed to undertake the social and recreational activities in the home, and promote residents interests. (see recommendation) Basic food hygiene training has been completed by two staff this year and one member of the catering staff is completing NVQ. Accredited First Aid training sessions need to be arranged for those whose current qualification is out of date. Staff spoken to on the day expressed a wish to undertake NVQ training as well as specialist and relevant courses for trained staff. The manager has Hawthorns Nursing Home DS0000044394.V270225.R01.S.doc Version 5.0 Page 17 recently completed the annual appraisal for the staff which has highlighted some of the personal and professional development and training requirements. Staff who have achieved NVQ 2 said they wish to continue their training and also expressed an interest in achieving NVQ 3 and also taking part in the senior care courses which offer some insight and learning into the managerial aspects of a home. There is a need for the management to establish an ongoing training programme to include mandatory and specialist training as well as NVQ opportunities for staff at all levels. (see requirements) Hawthorns Nursing Home DS0000044394.V270225.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 36 Staff supervision is in place but not all aspects of the sessions are recorded. EVIDENCE: Formal staff supervision is in place and some, but not all, have supervision contracts in place. The manager has completed the annual appraisal for all the staff using a new printed format. The appraisal outcomes will be used to assess training needs and personal and professional development and to establish the supervision process for the coming year. Some practical supervision is carried out on an observational basis but this is an ad hoc arrangement and not always recorded. Staff seen on the day said that they are supported and guided by the senior staff. The person responsible for the supervision of staff left recently and it is acknowledged that this will be an opportunity to review the process and reallocate the task to other senior staff. Senior staff delegated to carry out Hawthorns Nursing Home DS0000044394.V270225.R01.S.doc Version 5.0 Page 19 supervision sessions and supervisory responsibility should do so only after completing training themselves. Supervision sessions should always be arranged well in advance so that both the supervisor and the supervisee can allocate the time and prepare for the session. (see requirement) Hawthorns Nursing Home DS0000044394.V270225.R01.S.doc Version 5.0 Page 20 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 x 3 x 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 2 x x 3 x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x 2 x x Hawthorns Nursing Home DS0000044394.V270225.R01.S.doc Version 5.0 Page 21 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 OP9 Regulation Requirement Timescale for action 30/12/05 13.2, 13.4 The registered person must take steps to review morning medicine administration ensuring all medicines are administered at appropriate times. 13.2 The registered person must make arrangements to ensure medicines no longer in use are promptly removed and appropriately disposed of. The registered providers must continue to complete the re decoration and upgrade areas throughout showing signs of wear and tear. Repeat requirement The registered providers must ensure there is a training programme in place to promote the professional development of all the staff The registered providers and management must review the supervision process for the home and ensure it is up to date and in place. The registered providers must DS0000044394.V270225.R01.S.doc 2 OP9 30/12/05 3 OP19 23 31/03/06 4 OP30 18i 31/05/06 5 OP36 18 31/03/06 6 OP36 18 31/03/05 Page 22 Hawthorns Nursing Home Version 5.0 7 OP38OP19 23 ensure that those responsible for supervising staff should undertake appropriate training. The registered providers must review the food preparation areas to ensure they are safe and well maintained to a good standard and in line with the requirements and recommendations made by EHO Repeat requirement. 31/01/06 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 2 3 4 5 Refer to Standard OP9 OP9 OP9 OP9 OP7 Good Practice Recommendations It is recommended that copies of the care plans relating to medicine administration are copied and held alongside MAR charts to assist with medicine administration. It is recommended that improvements are made to the security of duplicate keys to the storage of medicines It is recommended that reviews are instigated for some medicines prescribed for regular administration, but administered only when required. It is recommended that the most recent medicine policy document is made available for reference. Old copies of BNF should also be replaced. 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.( repeated recommendation) It is recommended that the management review the activities and social and recreational facilities to promote both individual interests as well as group activities. ( repeated recommendation) 6. OP12 Hawthorns Nursing Home DS0000044394.V270225.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Norfolk Area Office 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 DS0000044394.V270225.R01.S.doc Version 5.0 Page 24 - 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. 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