Inspection on 12/06/08 for Hazel Bank Nursing Home

This inspection was carried out on 12th June 2008.

CSCI found this care home to be providing an Adequate service.

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

Hazel Bank Nursing Home 13/06/06

Hazel Bank Nursing Home 15/12/05

Hazel Bank Nursing Home 04/01/05

Hazel Bank Nursing Home 08/07/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Hazel Bank Nursing Home Daisy Hill Lane Daisy Hill Bradford West Yorkshire BD9 6BN Lead Inspector Nadia Jejna Key Unannounced Inspection 12th June 2008 09:50 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 Hazel Bank Nursing Home DS0000045223.V366826.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. Hazel Bank Nursing Home DS0000045223.V366826.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hazel Bank Nursing Home Address Daisy Hill Lane Daisy Hill Bradford West Yorkshire BD9 6BN 01274 547331 01274 484997 HazelBank@parkhomesuk.co.uk 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) Park Homes (UK) Ltd Mrs Kathleen Bailey Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39), Physical disability (2), Physical disability of places over 65 years of age (39), Terminally ill over 65 years of age (4) Hazel Bank Nursing Home DS0000045223.V366826.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The place for PD is specifically for the named service user The 2nd place for PD is specifically for the female service user named in the application for variation dated 1 August 2005 13th June 2006 Date of last inspection Brief Description of the Service: Hazel Bank Nursing Home is owned by the Park Care Homes UK group. It is situated about half a mile from Bradford Royal Infirmary and is a short walk from a busy road and local bus routes. It is a detached Victorian building that has been extended in keeping with the original features of the house. There is suitable wheelchair access at the rear of the building as well as ramped access to the front entrance. Adequate parking space is available. Accommodation is provided in single and double rooms, the majority of which have en suite facilities. A shaft lift provides access to the three floors. There are two communal lounges and a dining room on the ground floor that offer people lovely views of the front garden and the surrounding areas. There is a decked area outside the dining room where people can sit outside if the weather permits. The home offers nursing and personal care for people over the age 65. Currently the homes fees are between £434 and £578 per week. Information about services provided by the home is available in the Service User Guide. Copies are available in the home and can be posted out on request. Hazel Bank Nursing Home DS0000045223.V366826.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 the people who use this service experience adequate quality outcomes. Two visits were made on 12 and 16 June 2008. The purpose of this visit was to make sure that the home was being managed for the benefit and well being of the people using the service. During the visit people living in the home, their visitors and staff were spoken to. Records were looked at such as staff files, complaints and accidents records. Before the visit was planned the provider was asked to complete an annual quality assurance assessment (AQAA) of the service. This asks them to look at what they do well, what was in place to prove this, what improvements had been made over the last twelve months and what was planned for the year ahead. Other information asked for included what policies and procedures are in place, when they were last reviewed and when maintenance and safety checks were carried out. Information provided in the AQAA was used to inform the visit. It was sent to us in good time and the manager completed it well even though they had not been sent the correct document for their service. Questionnaires were sent to the home to be distributed to people living in the home, their relatives and healthcare professionals before the visit took place. At the time of the visit surveys had been returned by two relatives/visitors. The information from these was used to inform the visit and is referred to throughout the report. What the service does well: People and or their relatives can visit the home and look round and see if they think it will be suitable for them. People told us they had received enough information about the services provided to be able to make an informed decision whether or not it would suit them. Somebody from the home visits people before agreements are made about moving in so all can be sure the person’s needs can be met. Care and support is provided to people in a home that is kept clean and tidy. The atmosphere in the home is warm, welcoming and friendly. Visitors can call at any time and said they feel welcomed. Information from talking to people and returned surveys told us that: • Most people enjoyed the food served at the home. • They were generally satisfied with how things were in the home. Hazel Bank Nursing Home DS0000045223.V366826.R01.S.doc Version 5.2 Page 6 • • • • They were happy with their rooms and could bring in their own possessions to personalise and make them more homely. They can choose when to get up, go to bed, where to spend their time – either in one of the lounges or in their rooms – and where to eat their meals. The staff were ‘nice and kind’ and ‘willing and helpful’. They enjoyed the meals provided and would be offered an alternative if they did not like what was on the menu for that day. What has improved since the last inspection? What they could do better: The main area where changes will lead to making outcomes better for people living in the home is by making sure that there are enough staff available at all times to meet people’s needs. This will make sure that: • People’s health, safety and wellbeing are monitored and maintained • Their personal, social and psychological care and support needs are met. • People’s dignity will be promoted and respected by staff with the time to pay attention to these important details, such as nail care. • People get enough to eat and drink and regular intervals throughout the day and that accurate records will be kept to evidence it. Make sure that the care plans give staff detailed guidance about an individual’s needs, personal preferences, abilities and wishes, what to do to meet them, and how to keep people healthy and safe. Make sure that the complaints procedure is used and followed consistently and that accurate records are kept of how complaints are investigated, responded Hazel Bank Nursing Home DS0000045223.V366826.R01.S.doc Version 5.2 Page 7 to and if identified actions have been taken. This will help to make sure that improvements are made where shortfalls in the service provided have been identified and can be included as part of the home’s quality monitoring processes. Make sure that work on improving the appearance of the home and replacing fixtures and fittings takes place so that the home will be a more pleasant and comfortable place for people to live. 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. Hazel Bank Nursing Home DS0000045223.V366826.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 Hazel Bank Nursing Home DS0000045223.V366826.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): 3 and 5. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s needs are assessed before any arrangements are made for them to come live at the home, this helps all parties to decide if they can be met by the services provided. EVIDENCE: People and/or their relatives can visit the home and look round and see if they think it will be suitable for them. People told us that they had received enough information about the services provided to be able to make an informed decision whether or not it would suit them. Systems are in place to make sure that their needs are assessed and identified before they move into the home. We looked at the pre-admission information for somebody who had been living at the home for a few months. It had been carried out while they were still in hospital. There was enough information for Hazel Bank Nursing Home DS0000045223.V366826.R01.S.doc Version 5.2 Page 10 the home to be sure the person’s needs could be met and a provisional care plan put in place ready for when they arrived. A copy of the social services care needs assessment had been received as well. The person told us that their relatives had found the home for them and they remembered somebody from the home coming to see them. They told us that they had settled into the home well and were satisfied with the services provided to them. Hazel Bank Nursing Home DS0000045223.V366826.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): 7, 8, 9 and 10. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s health and personal care needs are set out in care plans, but the information is not detailed enough to make sure that people receive the individualised care they prefer and there are not always sufficient staff to make sure that people’s needs are met. EVIDENCE: We looked at five care plans during the visit. We found that care plans were in place for everyone but that the information and guidance they contained varied. They showed us that people have access to healthcare services through visits to the home by healthcare professionals such as the district nurses, their doctors, opticians, chiropodists etc. Hazel Bank Nursing Home DS0000045223.V366826.R01.S.doc Version 5.2 Page 12 However the information in some of the care plans was not detailed enough about the individual’s abilities, needs and preferences. This means that they are not person centred and do not provide staff with enough guidance about how to meet their health, physical, personal and social care needs. For example some of the care plans tried to cover too many separate areas of care in one document and there was not enough detail for staff to provide appropriate care and support to people. We saw that the heading of one care plan document for an individual covered hygiene, skin integrity, dignity, well being and use of bedrails, pressure area care and encouraging the person to come out of their room and mix with other people. The lack of detailed guidance supplied about meeting these needs means it would have been difficult for a new member of staff to read the plan and look after the person without asking them or other members of staff what they needed to do. This was discussed with the management team, they had already identified that there was a need for some training around person centred care planning and were looking for training providers. Two people whose care plans had been looked at were being nursed on specialist pressure relieving mattresses. When we visited them we found that the mattresses were faulty and the alarms were sounding. The nurse in charge was aware of one fault but not the other. One of the mattresses was set at the highest setting, which was not suitable for the weight of the person. The care plans did not tell us what the setting should be. Immediate action was taken to deal with these issues when we told the manager. Care record charts are kept for people who are at risk developing pressure sores about how often their position was changed and for people at risk of losing weight about how much they have been given to eat and drink. One person we looked at needed both of these records to be kept. The information on these charts would indicate that the care was not being given as set out in the care plan. They needed frequent changes of position – two to four hourly – but the records for the previous three days showed that they were often left in one position for more than five hours without a change of position. For example on 8 June 2008 the record said they were sat out in the chair at 09.15 am and the next entry was made at 10.05 pm when they were helped to go to bed. This person was also at risk of losing weight and their food/fluid intake was monitored, this record for the same day showed that they had had grapefruit and a cup of tea for breakfast and tea with some biscuits at 9.30 pm. There were no other entries. Staff told us that there were often not enough staff on duty but they did their best to make sure that people did get the care and food/fluid they needed but that they did not always have time to complete the charts because they needed to get to the next person. Hazel Bank Nursing Home DS0000045223.V366826.R01.S.doc Version 5.2 Page 13 The numbers of staff on duty and the need to ‘get to the next person’ also has an impact on people’s dignity and personal appearance. On both days of the visit we saw that some people who rely on staff for all of their personal care needs had long, dirty fingernails and some of the ladies looked as if their hair had not been combed or brushed. When we spoke to staff it was clear that they had a good understanding of people as individuals and what their needs and abilities where. However they told us they did not have enough time to read the care plans as often as they would like to and were kept up to date with changes through ‘shift handovers’ and information from each other. They were aware of the importance of privacy and we saw that they always knocked on bedroom doors before entering. Bedrails are used if a risk assessment identifies that they will promote safety for the individual. One person told us they liked to have the bedrails in place as they helped them to move in bed and they felt safer with them on. The assessments seen did not show if the person or their relatives had been involved in this decision making process. They also did not tell us who was responsible for checking that they were correctly fitted, in good working order, how often they would be checked and where the records would be kept. The management team told us that these checks are done weekly and records are kept elsewhere. The care plans used were being revised and this information would be included. We observed nurses giving people their medications. We saw that their practice and procedures were safe. For example they checked the medication administration records (MAR) before getting the tablets ready to give and did not sign the records until after the person had taken them. We looked at the MARs and saw that in most cases the sections for medications received into the home had been completed. There were some gaps where this information had not been added for new medications and for medications still in stock/carried forward from the previous month’s supply. Some of the handwritten entries for new supplies had not been signed by the person making them and medical ‘shorthand’ terms had been used that might not be easily understood by some people. There were also some ‘gaps’ on some of the MARs that would indicate the person had not been given their prescribed medication. Because there were no records of how many tablets were in stock at the beginning of the monthly cycle this could not be checked to see if the tablet had not been given or if the person giving them had forgotten to sign the MAR. The manager said that these issues would be dealt with straight away. The medication policies and procedures have not been revised against the new guidance ‘Safe Handling of Medications in Social care Settings’ issued by the Hazel Bank Nursing Home DS0000045223.V366826.R01.S.doc Version 5.2 Page 14 Royal Pharmaceutical Society yet. We were told that this is being done now by the company as part of their complete review of all policies and procedures. Hazel Bank Nursing Home DS0000045223.V366826.R01.S.doc Version 5.2 Page 15 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): 12, 13, 14 and 15. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People can maintain contact with family and friends and exercise some choice and control over how they spend their time. Most people enjoy the meals, but people who cannot communicate easily are not always getting additional snacks and drinks to supplement the regular meals and drinks they receive. EVIDENCE: The atmosphere in the home is warm, welcoming and friendly. People were calling in to visit their friends and relatives at all times of the day and told us that they were made to feel welcome. People living in the home told us that they were settled there and that the staff were kind and caring. They told us that they can choose when to get up, go to bed and where to spend their time during the day. Some people said Hazel Bank Nursing Home DS0000045223.V366826.R01.S.doc Version 5.2 Page 16 that they prefer to spend time in their own room. One person had got a private telephone and could keep in touch with family and friends. We were told that there are policies that provide staff with guidance about meeting the needs of people from different ethnic, cultural and religious backgrounds. The home is providing a service to people from Eastern European and Afro Caribbean backgrounds. We were told that if they wanted particular foods they would be provided on request and that rice based dishes are provided regularly for the Afro Caribbean people. Some people in the home are Roman Catholic and arrangements have been made for a local priest to visit the home regularly. There is also a weekly service for those people who want to attend. An activities organiser has been employed but they were on holiday when we visited. We were told that they have done a training course about activities for older people. There is usually a programme of regular activities when she is on duty but the manager had not been able to allocate anybody to this role while she was off. Individual records are kept of what the activities organiser has done with people. They showed that in addition to planned group activities like bingo, she also does 1 to 1 sessions with people talking to them or doing hand/foot massages. Some people told us that they enjoyed the massages. Some people told us that they did not do much and would like more to do, to occupy their time. When we talked to staff it was clear that they understood the need to support people with their daily social/leisure activities. They told us that on most days they did not have the time to do this as they need to concentrate on meeting people’s personal and healthcare needs. They said they would spend time with people when they had the opportunity. We saw this on the second day of the visit when some staff took a little time to sit and chat with some of the ladies while removing old nail polish. The most recent inspection of the kitchens by the Environmental Health officer was in April 2008 when they were give a 3 star rating out of a possible 5. A copy of the report has been sent to us, which identified where improvements needed to be made. The manager gave us a copy of the action plan that has been in place to rectify the shortfalls that were identified. We were told that all kitchen staff have been booked onto food safety training courses and that records and cleaning schedules are now up to date and in line with the recommendations made. The kitchen looked tidy and well organised. We were told that breakfast is served from 8 am until all people have had what they want. At 10.05 am on the first day two people in one of the lounges told us they had not had their breakfast even though they had been there a while. We told the kitchen staff who were not aware these people were in the lounge and gave them what they wanted. Hazel Bank Nursing Home DS0000045223.V366826.R01.S.doc Version 5.2 Page 17 People told us that they enjoyed the meals provided and that they were offered an alternative if they did not want or like what was on the menu for that day. We saw lunch being served on the first day of the visit. People could choose where they wanted to have their meal. Lunchtime in the dining room was relaxed and unhurried and people were enjoying their meal. A lot of people needed help and supervision to eat and staff did this in a kind and discreet way. Because there were so many people needing help with their meals in communal areas and in their own rooms it was quite late when staff were taking puddings out some people, but it was good that they were able to keep track of who had had what. The management team told us that the company was looking at changing the menus and this had been discussed at residents/relatives meetings. They had also been talking to the community dietician getting advice about good nutrition for the elderly and changing the main meal of the day from lunchtime to teatime. We were told that meals are ‘enriched’ where appropriate, using full fat milk, cream and butter. In addition to this nourishing snacks are provided mid morning, mid afternoon, at suppertime and on request. We saw that the afternoon tea trolley was stocked with cakes, biscuits, fruit and milkshakes. This is good practice but from looking at the food/fluid intake records for people who are at risk of losing weight it would appear that these people might not be getting regular meals or snacks. There is adequate provision of nourishing meals and snacks but steps must be taken to make sure that all people are given them, most especially those at risk of losing weight and who cannot ask for additional snacks. Hazel Bank Nursing Home DS0000045223.V366826.R01.S.doc Version 5.2 Page 18 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): 16 and 18. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are encouraged to raise any concerns they might have about the services provided. However there are not always records to show how complaints are dealt with or the outcome and identified remedial actions are not always carried out. This means that any improvements to service delivery that could be made do not always happen. People are protected from abuse. EVIDENCE: The complaints procedure is displayed in the hall/reception area along with forms for people to complete to give to the manager or send direct to head office. The company has got a clear process to follow when dealing with complaints/concerns. The records we looked at showed us that this might not be followed consistently. The AQAA told us that there have been six complaints received in the last twelve months and two concerns that were referred via the local authority adult protection unit. We have referred three concerns to the provider to Hazel Bank Nursing Home DS0000045223.V366826.R01.S.doc Version 5.2 Page 19 investigate over the last twelve months. The records and documents we looked at showed that: • Not all of the concerns we had received information about were recorded. For example a complaint from another provider with concerns about some medication that was sent with somebody moving into their home was not listed in the register or seen in the file and the management team could not provide us with an update on the outcome of their investigation. • There was not always a record of what action has been taken in response to the concerns raised. For example either the manager or a representative at head office had responded to some of them in writing. But for others there was no response, no details of the investigations carried out or of discussions/meetings held with people to resolve the concerns. • Where the outcome of an investigation showed that some action needed to be taken, such as providing nurses with training around care planning, it has not been followed up or provided. The concerns/complaints records seen in the home were about a variety of different issues. One person had written to the manager in January 2008 pointing out where things could be better for people listing personal hygiene, nail care, nutrition and hydration. A detailed response was sent and said that action would be taken to improve standards of care. However we have found some of the same areas of concern during this visit. These have been discussed with the management team. Policies are in place around abuse, adult protection and whistle blowing, these are being revised and we were told information about institutional abuse would be added. A copy of the local authority adult protection procedures was seen in the office. The manager is intending to go a two day training course for managers provided by the local authority adult protection unit. We were told that all staff have completed the company’s in house training around abuse and adult protection. The person providing the training has completed an appropriate ‘train the trainer course’. Staff told us that they had done this training and that they would not hesitate to report actual or suspected abuse to the person in charge. They knew that they could also approach other agencies such as social services. Hazel Bank Nursing Home DS0000045223.V366826.R01.S.doc Version 5.2 Page 20 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): 19, 20, 21, 24 and 26. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is clean and people are satisfied with the accommodation provided however many areas would benefit from redecoration and refurbishment. EVIDENCE: We looked around the building and visited some people in their own rooms. People we talked to were happy with their rooms and it was clear that they can bring in their own possessions to personalise them and make them more homely. The home was clean and tidy and there were no smells. But many areas of the home are showing signs of wear and tear. For example: • Some of the doors and walls need to repaired and redecorated where they have been damaged. Hazel Bank Nursing Home DS0000045223.V366826.R01.S.doc Version 5.2 Page 21 • • • • Some furniture in people’s rooms needs to be repaired or replaced. Some of the bedding and pillows used need to be replaced. Some of the pillows being used were very ‘lumpy’ as a result of frequent washing. Work has not been done yet to upgrade the bathrooms that do not have hand washing facilities. The manager said this is being looked at as the company is thinking about providing a wheel in/walk in shower. Some of the carpets are badly marked despite regular cleaning. We were told that the company is going to audit the home’s fixtures and fittings to find out where refurbishment and redecoration is needed. The company knows that is something that needs to start in the near future. New bedding, towels and face cloths have already been ordered. Some people have been provided with height adjustable beds. During the visit it was identified that some people would be far more comfortable and a little more independent if they had profiling beds that they could adjust themselves and provide more support for the upper body than pillows do; this type of bed was provided to one person and two more were going to be provided for people who need them. We saw that work was underway to provide ramped access to the ‘sunken’ front garden. We were told that this work was being done so that everyone would be able to go and sit in the garden rather than look at it from the decked area by the dining room. We saw staff using the same moving and handling slings for different people, which could be a cross infection risk. We were told that there should be enough in the home for them to be used for individuals but more had been ordered to make sure. The manager told us she has got a copy of the Department of Health guidance and assessment tool ‘Essential steps to infection control’ but has not used it yet. Completing this assessment should be done so that an infection control programme specific to the needs of the service can be put in place. Hazel Bank Nursing Home DS0000045223.V366826.R01.S.doc Version 5.2 Page 22 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): 27, 28, 29, 30 People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are not always enough staff on duty to meet people’s health, personal and social care needs, which means that people’s needs are not always being met. EVIDENCE: There were twenty-eight people living in the home when we visited. On the first day the staff team was one short because of sickness. Attempts had been made to replace the carer and we were told they were expecting a carer to come from another home in the group. The carer had arrived by 11 o’clock. We were told that if the home is going to be short staffed they look at the ‘bank staff’ list to find cover and then approach other homes owned by the provider to see if they can provide staff to cover. Staff were very busy helping people to get up, dressed and have breakfast and people were still getting up at 11 o’clock. We talked to staff and found that this was not by choice but because of the staff shortage. We were told that normally there are five staff in the morning, four in the afternoon/evening and three at night, one of them always being a qualified Hazel Bank Nursing Home DS0000045223.V366826.R01.S.doc Version 5.2 Page 23 nurse. These numbers have set by the provider using a ratio of people to staff for the three different shifts. This looks at numbers rather than people’s needs/abilities. Information we gathered through the inspection process showed that staffing levels must be reviewed to make sure that there are enough staff available at all times to meet people’s needs and take into account the size and layout of the home. Examples of why this is needed were given to the management team and included: • People’s personal care needs and appearance were not being maintained. We saw people on both visits with uncombed hair and dirty fingernails. • People and staff said they felt ‘rushed’ to get the job done. • There were no staff free to monitor/observe people in the lounges and communal areas whose care plans identified them as being at risk of falling and needing regular staff supervision to reduce the risk of accidents. • Staff did not have time to look at care plans and relied on verbal ‘handovers’ to keep up to date with changes in people’s conditions. We looked at three staff recruitment files. They showed us that appropriate pre employment checks are carried out before new staff start working in the home. When new staff start work they are enrolled on an induction training programme. However this has not been changed yet to match with the Skills for Care common induction standards. The manager told us that a new induction programme is being put in place. The AQAA told us that seven out of nineteen care staff had achieved an NVQ (National Vocational Qualification) at level 2 or higher. There are some gaps in the training provided to staff but they have been identified and are being dealt with. For example not all staff have done training in food hygiene, health and safety or infection control and only two staff have completed emergency first aid training. The manager said she is looking at getting training in pressure area care, diabetes and a ‘back to basics’ personal care refresher course. Hazel Bank Nursing Home DS0000045223.V366826.R01.S.doc Version 5.2 Page 24 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): 31, 33, 35 and 38. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is managed and run by somebody who is qualified and experienced to do so and does it in the best interests of the people who live there. There are areas where the provider can make changes and improve outcomes for people. EVIDENCE: The registered manager is suitably qualified and experienced to run a nursing home for older people. She has a clear understanding of the principles and Hazel Bank Nursing Home DS0000045223.V366826.R01.S.doc Version 5.2 Page 25 focus of the service. People living in the home and staff told us that the manager was approachable and supportive. Her aim is to provide as good a service as she can to people while working within the budgets and guidelines set by the provider. We have identified areas where outcomes for people could be improved in other sections of this report. For example: • Making sure that there are enough suitably trained and competent staff on duty at all times to meet peoples needs. • Making sure that staff have clear guidance about how to meet individuals needs and deliver care in accordance with their wishes. • Using the complaints procedure consistently. Keeping accurate records of all concerns/complaints dealt with that will help to identify where action can be taken to prevent further complaints being made and improve outcomes for people. The manager told us that systems are in place for carrying out internal quality audits and these are carried out at regular intervals. These include regular health and safety checks such as weekly fire alarm system checks, making sure wheelchairs and bedrails are in good working order and records are kept. We were told that each month service user quality assurance questionnaires are sent out to three people every month. They are returned directly to head office and the information from them is analysed and used to identify where changes need to be made. If people raise any specific issues they or their relatives are contacted. We were told that they would be introducing a system for collating the results of these that will be published in an annual report. We were told that the home does not look after people’s personal finances. If they cannot look after it themselves their relatives, solicitors or appointed advocates deal with them. The home will hold small amounts of money in safekeeping for people so that they can access it whenever they need it. We saw that records were kept of monies received from and returned to people. Information provided in the AQAA told us that safety and maintenance checks of gas and electrical appliances/installations were up to date. We were told that the home’s policies and procedures were all being revised to reflect changes in legislation and current good practice guidelines. The manager told us that the fire safety officer had called to arrange the next inspection in July 2008. She said that all works from the last visit had been completed and fire safety risk assessment was in place. Accident records are kept and the company has a system for auditing how many falls/accidents there have been in the home. We were told that they are going to add a section on the forms to show what time the person was last seen before the accident and by who. Hazel Bank Nursing Home DS0000045223.V366826.R01.S.doc Version 5.2 Page 26 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 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 3 2 3 X 3 X 3 X 3 STAFFING Standard No Score 27 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Hazel Bank Nursing Home DS0000045223.V366826.R01.S.doc Version 5.2 Page 27 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 15 Requirement Timescale for action 30/09/08 2. OP8 12 (1)(2) (3)(4) 13 (1)(b) The care plans must be more detailed and, where possible, be written with the involvement of the individual so that their personal preferences, abilities and wishes are recorded. This will make sure that staff have clear guidance about how to meet individual needs and deliver care in accordance with individual wishes. 10/08/08 Where risk assessments identify people as being at risk of falling, developing pressure sores or losing weight detailed care plans must be put in place. If assessments and care plans identify that there is a need to monitor food and fluid intake or care provided, appropriate, accurate records must be kept as these will help to identify when further input from other health care professionals may be needed. This will make sure that people’s healthcare needs are identified and met. Accurate records must be kept of DS0000045223.V366826.R01.S.doc 3. OP9 13 (2) 10/08/08 Page 28 Hazel Bank Nursing Home Version 5.2 4. OP15 16(2)(i) 5. OP16 22 all medications received into the home and when they have been given to people. This will make sure that people receive their medications correctly and safely and the treatment of their medical condition is not affected. Everyone living in the home 10/08/08 must be provided with adequate quantities of suitable, wholesome and nutritious food and drink in order to make sure that they are not at risk of losing weight or becoming dehydrated. All complaints/concerns must be 10/08/08 dealt with consistently following the requirements of this Regulation and the providers own procedures. Clear records must be kept of: * all complaints/concerns received, * what action was taken to deal with them, * any investigations carried out, * any meetings/discussions with people/relatives/staff etc. * what the outcome was and letters sent in response to people’s concerns, * any identified actions to be taken as a result and confirmation that they have been done. This will make sure that improvements are made where shortfalls in the service have been identified and can be included as part of the home’s quality monitoring processes. All areas of the home must be 30/10/08 decorated and maintained to a good standard. This must include making sure that: * worn and stained carpets are cleaned or replaced. DS0000045223.V366826.R01.S.doc Version 5.2 Page 29 6. OP19 23(2)(b) Hazel Bank Nursing Home * Hand-washing facilities are available in all communal bathrooms. Outstanding from the last inspection 13/06/06. There must be enough staff on duty at all times. People’s needs and dependency levels as well as the size and layout of the building must be taken into account when looking at staffing levels. This will make sure that people’s health, safety and well being is monitored and maintained and that their personal, social and psychological care and support needs are met. In order to demonstrate how the quality of services provided to people will be improved and how the requirements detailed in this report will be met the provider must forward an improvement plan to the CSCI. 7. OP27 18 (1)(a) (b)(3) 10/08/08 8. RQN 24 30/08/08 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 OP9 Good Practice Recommendations The policies for dealing with medications should be revised using the Royal Pharmaceutical Society guidance issued in October 2007 ‘Safe handling of medications in social care settings’. Steps should be taken to make sure that people’s dignity is recognised and maintained at all times. This should include attention to detail when providing help with personal care such as making sure fingernails are not overlong and dirty. DS0000045223.V366826.R01.S.doc Version 5.2 Page 30 2. OP10 Hazel Bank Nursing Home 3. 4. OP12 OP26 5. OP30 Consideration should be paid towards increasing the scope of social and recreational activities offered to people based on their personal preferences and abilities. The Department of Health guidance ‘essential steps to infection control’ should be used to assess the home’s infection control management systems and identify where any changes need to be made to improve the health, safety and well being of people who live in the home and staff. The induction training programme for new employees should be revised in line with the Skills for care common induction standards. Steps should be taken to make sure that all staff have received training that helps them to maintain the health, safety and well being of people living in the home and themselves. Hazel Bank Nursing Home DS0000045223.V366826.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Hazel Bank Nursing Home DS0000045223.V366826.R01.S.doc Version 5.2 Page 32 - 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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