CARE HOMES FOR OLDER PEOPLE
Hazel Bank Nursing Home Daisy Hill Lane Daisy Hill Bradford West Yorkshire BD9 6BN Lead Inspector
Pamela Cunningham Unannounced Inspection 15th 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 Hazel Bank Nursing Home DS0000045223.V271534.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. Hazel Bank Nursing Home DS0000045223.V271534.R01.S.doc Version 5.0 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 482824 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.V271534.R01.S.doc Version 5.0 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 4th July 2005 Date of last inspection Brief Description of the Service: Hazel Bank is part of the Park Care Homes UK group and is managed by them. It is situated about half a mile from Bradford Royal Infirmary and is an impressive stone building that has been extended in keeping with the original house. There is ramped access to the front of the building and adequate parking is available. Care is provided over three floors in single and double rooms, the majority of which have en suite facilities. The home offers nursing and personal care for people over 65 and is registered to provide care to people with terminal illness. A variation to registration has been applied for to allow the home to care for one person under sixty five who is disabled. The communal rooms are very comfortable, being furnished and decorated to a high standard. The home is well maintained and offers congenial accommodation where residents can sit and socialise. Hazel Bank Nursing Home DS0000045223.V271534.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection has to carry out at least two inspections of care homes every year. The inspection year runs from April to March and this was the second inspection visit for 2005/2006. Copies of previous inspection reports are available at the home or on the Internet at www.csci.org.uk. The last inspection of the home was on 4th July 2005. In addition to the time spent in the home, time was spent preparing for this inspection. This was an announced inspection carried out by one inspector who was at the home for one day. The main purpose of this inspection was to make sure that the home provides a good standard of care for the service users and to assess progress on meeting any requirements or recommendations made at the last visit. The inspection consisted of looking around the buildings, speaking with residents, management and staff. Looking at and case tracking residents’ records including care plans, looking at menus and staff rotas. Everyone at the home was helpful throughout the inspection and spoke with the inspector. What the service does well:
Each resident has a comprehensive care plan in place with their needs clearly identified along with the tasks needing to be done, in order for these needs to be met. Any allergies and specific instructions were clearly identifiable in the care plans. Regular staff meetings and supervision sessions are in place. Residents meetings are held on a regular basis and ideas from these have been used to improve care at the home. Residents spoken to confirmed that they are able to go to bed and get up at times convenient to them. They are able to have visitors with no restrictions and can go out with family. All of the residents spoken to said that they feel respected by staff and that they are well looked after. Everyone said that they would have no problem speaking to the manager or staff if they had any
Hazel Bank Nursing Home DS0000045223.V271534.R01.S.doc Version 5.0 Page 6 concerns. The residents are happy with the meals and a choice is always offered to them. The activity organiser plans activities that are suited to the residents’ abilities and take account of their preferences. Residents who smoke have been provided with an area specifically for their use. The home shows a firm commitment to training, and staff spoken to told me they have access to relevant courses. They also commented that they receive excellent support when they are taking part in training, and are well supported by the manager, on both professional, care, and personal issues. All staff have completed, are working on, or waiting to start an National Vocational Qualification (NVQ). Qualified staff are able to continue their PREP whilst working at the home. What has improved since the last inspection?
Although the present style and quality of recording of care is very good, the nursing director has developed a new style of care plan documentation, which is hoped will be fully implemented in the New Year. Included within this documentation is a very well put together risk assessment for the use of bed rails, which completely covers all possible risks, is very comprehensive yet easy to use. The documentation also includes an assessment tool to be used for all residents returning to the home following hospital admission. All complaints received by the home are now entered onto a central complaints database, and monitored monthly by the nursing director. The providers have employed a maintenance man specifically to work at Hazel Bank. The manager said that four bedroom carpets are cleaned each day, as are four mattresses. Through constantly monitoring care and other areas, one quality audit identified anomalies in one member of staff’s disclosure. This was rectified immediately and dealt with by the management. All communal areas, the laundry area and downstairs corridors have been redecorated. Hazel Bank Nursing Home DS0000045223.V271534.R01.S.doc Version 5.0 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hazel Bank Nursing Home DS0000045223.V271534.R01.S.doc Version 5.0 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.V271534.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5 and 6 All residents have their needs assessed before being admitted to the home. Service users are provided with information to enable them to make an informed choice about the home. The admission process is good and includes introductory visits. Service users needs are met at the home by well-informed and knowledgeable care staff. The home does not provide intermediate managed care. EVIDENCE: During discussions with residents they confirmed they had been assessed as to their nursing needs before they came to live at the home, and were also provided with a brochure which explained how the home was run, who runs and manages the home and what type of client the home is registered to admit. Hazel Bank Nursing Home DS0000045223.V271534.R01.S.doc Version 5.0 Page 10 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, and 11 The health care needs of residents are met and care plans provide clear and detailed instructions for staff to follow. Residents are treated with respect and their privacy is upheld. Death and dying is discussed if it is thought appropriate and handled sensitively with both residents and relatives. EVIDENCE: Although the present style and quality of recording of care is very good, the nursing director has developed a new style of care plan documentation, which is hoped will be fully implemented in the New Year. Included within this documentation is a very well put together risk assessment for the use of bed rails, which completely covers all possible risks, is very comprehensive yet easy to use. The documentation also includes an assessment tool to be used for all residents returning to the home following hospital admission.
Hazel Bank Nursing Home DS0000045223.V271534.R01.S.doc Version 5.0 Page 11 Three sets of care documentation were chosen for review and case tracking. All three were seen to contain all information required to enable needs to be identified and met. The care documentation of one resident with complex nursing needs who was admitted in an emergency, included an in depth admission assessment, with evidence of involvement of other healthcare professionals. All three were updated and reviewed monthly by the registered manager. There was evidence in all documentation of relative/next of kin involvement. Hazel Bank Nursing Home DS0000045223.V271534.R01.S.doc Version 5.0 Page 12 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): All standards were assessed. Residents are encouraged to be part of the decision making process and make choices about their lifestyle. They are supported to maintain contact with family and friends and visitors are welcomed at the home. A good, varied and nutritious diet taking into account individual choices is provided at the home. EVIDENCE: The home employs an activities organiser and she arranges events in consultation with the residents. A typical week’s programme was seen and contained various activities that could meet the needs of the residents. The programme contained films, games, quiz, hairdressing and one to one time with residents. Entertainers come into the home on a regular basis. Religious services take place on a weekly and monthly basis. The residents go out for meals and this something is that they enjoy. Visitors are welcomed at any time and one lady said that she likes to go to her room in the afternoon as her family visit then. Residents spoken to said that they can go to bed and get up at the time they chooses within reason. They are well looked after and said that the staff cannot do enough for them. The meals are very nice and one resident
Hazel Bank Nursing Home DS0000045223.V271534.R01.S.doc Version 5.0 Page 13 commented that there is always a choice of meat. The dining room is very pleasant with a good view over the outskirts of the city and offers plenty of space for people to sit comfortably and enjoy their meal. People are able to take meals in their own room if this is their preference. There is always a choice of meal and, although the company are due to introduce corporate menus across all of its homes. The manager said that she was confident they would be able to offer something different if it was appropriate at any particularly time, and that residents’ views would still be important to them. Breakfast and the evening meals are served over a period of time with lunch taken at the same time by everyone. Individual diets can be catered for at the home including diabetic Halal and Ukrainian foods. The meal served during the inspection was seen to be good, nutritious and nicely presented. Staff were seen to be offering support to residents where required to make sure that they could enjoy the meal. The Inspector sampled the meal and found it to be nicely presented and very tasty. Any post delivered to the residents is given to them and support offered to help deal with this if required. Staff were seen to knock on doors before going into residents’ rooms and to be polite when dealing with their needs. Hazel Bank Nursing Home DS0000045223.V271534.R01.S.doc Version 5.0 Page 14 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): All standards were assessed The home has an adequate complaints procedure that contains the timescales for the completion of the process. There have been three complaints made to the home since the last inspection, two of which are resolved, and one, which is on going. There have been no complaints made directly to the Commission. Residents and their relatives have their views listened to, taken seriously and action is taken to resolve issues. The residents have their rights protected and are protected from abuse. EVIDENCE: The appropriate policies and procedures were seen to be in place and the manager confirmed that staff have received Adult Protection training. She is confident that staff know what signs to look for and what action to take. All residents are given a copy of the complaints procedure and a copy of this is displayed in the reception area of the home. Residents spoken to confirmed that they feel able to approach the manager and staff if they have any worries or concerns. The manager makes herself available to relatives and stays late at the home one evening per week to ensure accessibility. There have been three complaints since the last inspection, one that is on going, and two, which
Hazel Bank Nursing Home DS0000045223.V271534.R01.S.doc Version 5.0 Page 15 have been resolved. The ones handled by the home were handled appropriately. The nursing director told me the company has a central database, which he monitors closely each month. Hazel Bank Nursing Home DS0000045223.V271534.R01.S.doc Version 5.0 Page 16 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, 20, 22, 25 and 26. The home offers a safe, well-maintained environment for the residents and provides appropriate bathing and toilet facilities. The home has robust infection control procedures. EVIDENCE: The home has a planned maintenance programme for the refurbishment and redecoration throughout the home. Since the last visit the lounges, laundry area and downstairs corridors have been redecorated. There is a decked area outside the dining room that is easily accessed by the residents and is furnished in a comfortable way for their use. There is a call system throughout the home and fire exits were seen to be free from any hazards with ramped access for the less mobile. Handrails are fitted to the corridors to enable people to walk around the home safely. Hazel Bank Nursing Home DS0000045223.V271534.R01.S.doc Version 5.0 Page 17 Four bedroom carpets and four mattresses are cleaned every day, in order to ensure there are no unpleasant odours. All bedrooms offer sufficient space for residents to follow their own lifestyle, and there was an abundance of personal memorabilia seen. The home has an effective laundry system with one person in charge of this area. The laundry was seen to be very clean and tidy, and it was apparent the person operating the laundry takes pride in her work. A control of infection policy is in place and staff are trained in this area. All areas are clean and tidy and there were no unpleasant smells present. The Inspector spoke to the Infection control nurse who was visiting the home at the time of the visit. She said there were no concerns regarding health and safety, and infection control. Hazel Bank Nursing Home DS0000045223.V271534.R01.S.doc Version 5.0 Page 18 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): All standards were assessed. Residents are supported and protected by robust recruitment procedures. Staffing numbers and skills ensure that residents needs can be met, however the manager is the only whole time registered nurse employed at Hazel bank. The home’s recruitment practices and training for new staff supports and protects residents. EVIDENCE: Staff spoken to during the inspection confirmed they have received training in the following subjects. Mandatory training, abuse awareness (16 care staff), Palliative care (6 staff.) The manager told me that the home is providing training on the Liverpool and care pathway training for the qualified staff, and that currently two of the staff have undertaken and completed the training. Training to NVQ qualifications is on going, and currently 12 out of the seventeen care staff have completed the training at various levels. Recruitment procedures are robust and protect the residents’ living in the home. Hazel Bank Nursing Home DS0000045223.V271534.R01.S.doc Version 5.0 Page 19 Bank nurses are used to supplement the numbers of permanently qualified staff at the home. Hazel Bank Nursing Home DS0000045223.V271534.R01.S.doc Version 5.0 Page 20 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): 31, 32, 33, 35, 36 and 37. The home is well managed and the manager is well able to discharge her responsibilities. She offers good leadership to the staff and ensures the residents are protected and cared for in a correct manner. She is very much part of the clinical team, and constantly audits the care provided. EVIDENCE: The manager has many years experience in working with this client group and is a qualified nurse. Good interaction was seen between her and staff and residents. All staff feel great respect for her and enjoy good support from her. Resident meetings are held every six to eight weeks where they are free to give views and comments. Minutes of the meetings are made and circulated to all residents and management within the organisation. Relatives are also invited to attend the meetings.
Hazel Bank Nursing Home DS0000045223.V271534.R01.S.doc Version 5.0 Page 21 Staff meetings are held on a regular basis and supervision sessions are held every eight weeks. The staff supervision sessions are recorded and evidence of this was seen in their files. Pre and post admission questionnaires are sent to prospective and permanent residents, however these are anonymised and returned directly to head office, therefore no results of the quality audits were available for perusal. Health and safety training is updated on a regular basis as is movement and handling, and there was evidence at the home to support this. Hazel Bank Nursing Home DS0000045223.V271534.R01.S.doc Version 5.0 Page 22 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 x 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 x 2 x x 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x 3 3 3 x Hazel Bank Nursing Home DS0000045223.V271534.R01.S.doc Version 5.0 Page 23 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 OP22 Regulation 14 Requirement The Registered Provider must make sure that that the needs of bedfast service users can be adequately assessed, and there is appropriate equipment in the home in order to ensure this, with special regard to the weighing of service users. (Previous timescale of 01.05.05. not met) The Registered Provider must ensure that all residents assessed as receiving nursing care are provided with a height adjustable bed. Timescale for action 28/04/06 2 OP22 14 30/06/06 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 Refer to Standard OP27 Good Practice Recommendations The Registered Provider must explore ways of increasing the numbers of permanently qualified staff employed on day duty.
DS0000045223.V271534.R01.S.doc Version 5.0 Page 24 Hazel Bank Nursing Home 2 OP33 Copies of quality audits are kept at the home for the purpose of Inspection. Hazel Bank Nursing Home DS0000045223.V271534.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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