Key inspection report
Care homes for older people
Name: Address: Hazel Bank Nursing Home Yanwath Penrith Cumbria CA10 2LF The quality rating for this care home is:
one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Marian Whittam
Date: 2 5 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People
Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home
Name of care home: Address: Hazel Bank Nursing Home Yanwath Penrith Cumbria CA10 2LF 01768840021 01768840031 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Number One Care Limited Name of registered manager (if applicable) Mrs Susan Dixon Type of registration: Number of places registered: care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following categories of service only. Care home only- code PC, to service users of the following gender:- Either. The registered person may provide the following categories of service only. Care home with nursing - code N, to service users of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: - Old age not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 21 Date of last inspection Brief description of the care home Hazel Bank is a care home registered to provide nursing care for older adults. Hazel Bank is a Victorian house that had been adapted and converted for its use as a care home but has kept many of the original features of the house. There is access to all floors in Hazelbank using the stairs and the passenger lift. The home is in the small rural hamlet of Yanwath about 5 miles from Penrith and has Care Homes for Older People Page 4 of 32 0 1 0 7 2 0 0 9 0 Over 65 21 Brief description of the care home large gardens with trees, a garden folly, lawn areas and a car parking area. Fees payable at the home are from four hundred and twenty two pounds a week plus the nursing contributions, as at the time of the site visit. There are additional charges for hairdressing, outings and personal transport, newspapers and magazines and personal toiletries. The home makes information about its services available through its service user guide and statement of purpose and these are available in the home and a copy of the last report. Care Homes for Older People Page 5 of 32 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means that the people who use this service experience Adequate quality outcomes. This site visit to Hazel Bank Nursing Home forms part of a key inspection. It took place on the 25.05.10 . We (CQC, The Care Quality Commission) were in the home for seven and a half hours. The CQC pharmacy inspector also visited and looked at the handling of medicines by checking relevant documents, storage and meeting with the manager Susan Dixon, the owner and other staff. The pharmacy inspection took five and a half hours. Feedback was given to the owner at the end of the inspection and to the manager, the pharmacist gave feedback to the manager by telephone two days later. We gathered information about the service in different ways: We sent an Annual Quality Assurance Assessment (AQAA) form to the home. The AQAA Care Homes for Older People
Page 6 of 32 is a self assessment and a dataset that must be completed annually by all providers of registered services. It is one of the ways we gather information from the providers about their service and how they believe they are meeting outcomes for the people living there and using their service. The AQAA also gives us statistical information about the individual service and trends and patterns in social care. This was returned to us in good time and completed by the responsible individual, Mrs Francesca Windsor and the registered manager, Susan Dixon. We sent out surveys to the people who live at Hazel Bank and the staff who work there to get their views on the service provided, the way the home is run for them and the staff experiences of working at the home. We looked at all the information we have about the service, including their improvement plan from our last visit to the home. We looked at any changes they have made and informed us of and how the registered persons have dealt with any complaints made to them or safeguarding vulnerable adults. We looked at what the manager has told us about things that happened in the service, these are called notifications and are a legal requirement. We looked at the previous key inspection and any calls or visits we have made to the home since their last inspection. We looked at any relevant information we had received from other agencies and organisations and any written comments people have made to us. We spent time talking to people who live there, and spent time with them to see what happens during their day and ask what they think about the way the home is run for them. We also spent time talking with staff who work there to get their opinions and views. We talked with relatives who had asked to speak with us as well as people living there. During the day we spent time with people living at Hazel Bank, in the lounges and also talking to them in private. We looked at care planning documents and assessments to make sure that people received the level of care they needed and expected. We made a tour of the premises to look at the environment people lived in, the standards of cleanliness and what facilities were available to them. We also looked at staff training and recruitment files and a sample of records and safety assessments required by regulation. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 32 Improvements continue to be made to the premises, through refurbishment of the kitchen to improve food preparation facilities for the people living there. There are 2 cooks and their hours have been extended to provide better cover so staff do not have to prepare meals on occasion. Improvements have also been made to the overall cleanliness and tidiness of the home since our last visit. There is now a dedicated cleaner to attend to the majority of cleaning but night staff still do some that cannot be done during the day. The owners have added to the number of nursing or profiling beds available for people to use according to their needs. There are also more pressure relieving mattresses to promote skin care and a new hoists to improve moving and handling equipment available for people. The owner has carried out an environmental risk assessment/audit to improve the building inside and out. One of the homes boilers has been replaced to improve its function. Externally some trees have been removed in the grounds to give more light onto a new patio area which means that people can sit and walk around the side of the home much more easily to enjoy the fresh air and the bird life in the trees. The manager has begun work to improve the layout and information in the care plans to make them better organised and easy to follow but this is still not fully implemented. There has been an increase in the number of staff on shifts, most notably the busy morning shift so there should be more staff available when needed. There have been occassional staff and residents meetings allowing for discussion and feedback to the manager. The owners have made improvements to their recruitment procedures and have acted quickly to discipline staff when required. What they could do better: Everyone living at Hazel Bank has an individual care plan but we saw some care plans that lacked clear guidance for staff to follow to ensure that health issues were managed appropriately and some that had not been properly reviewed and updated to reflect peoples changing needs. All individual care plans must set out in detail the action which needs to be taken by nursing and care staff to provide the health and personal care that people living there need. All care plans relating to personal and health care and medication need regular review although we noted that the manager had started to take this in hand at the time of the inspection. The manager must make sure that all medicines are administered in the correct dosage and that records are accurate so that residents receive safe and effective treatment. Care should be taken to remove duplicate or discontinued medication from the medicines trolley to reduce the risk of administration in error. The manager should also introduce a system of audit of medication and care plans so that areas of concern can be identified and managed without delay. We recommend as part of overall quality monitoring and quality assurance systems the registered persons implement a system to audit all their systems and records. It is important to have a continuous system of self monitoring throughout the home so standards can be maintained and any failures in systems can be addressed quickly. We recommended that in order to be truly effective in monitoring the quality of a service the views and expectations of the people using it should be frequently sought via meetings and satisfaction surveys. The providers have a complaints procedure but Care Homes for Older People
Page 9 of 32 we strongly recommend that in order to maintain good outcomes for people and good relationships in the home the registered persons consider including in their complaints procedures and practices not just written formal complaints but also the investigation of verbal complaints or issues raised by people generally. In this way the Providers can demonstrate to people their commitment to an open culture that welcomes suggestions and discussion. We recommend that the Providers attend to those areas where wallpaper is torn and carpets marked to maintain a homely atmosphere. We recommend that the manager considers the number of long days staff have worked without a break when doing rotas. This is to help ensure that it is safe for staff as despite it being an employees choice, it may not be in the best interests and safety of the people living there to be cared for by staff working long stretches of shifts of 12 hours or over. We recommend that the registered manager is given additional supervision and support and/or resources to deal with the additional work created by the proposed changes in registration and to be able to give the support required for residents, families and staff at an unsettling time, some effects of which we observed, with relatives during the visit. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 32 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Hazel Bank has a pre admission assessment and admissions process and information about the home is available to people thinking of using the service to help them make a decision about living there. Evidence: The home has a combined statement of purpose and service user guide that is on display in the homes foyer, this includes previous inspection reports. The information in the statement of Purpose and the service guide could be made available, if requested, in other formats to suit individual needs. The manager and senior nursing staff usually do the pre admission assessments with people before they come into the home. This is to help make sure that the service will be able to meet peoples individual needs and expectations when they move in. People thinking of coming to live in the home, and their families, are welcome to visit the home beforehand and look around and speak with staff and other people living there.
Care Homes for Older People Page 12 of 32 Evidence: There is a trial period for people following admission. We could see from records that a review of care had been held with the person, their social worker and other people involved in their care or supporting them. This helps to make sure the home is still meeting their needs and expectations and that they are happy with their care. We looked at the pre admission assessments that had been done for people living in the home now and some peoples in greater detail. Overall the pre admission assessments we looked at contained the relevant information about peoples needs and preferences from which staff could begin to develop care plans with people. Nursing staff continue the assessment process following admission and develop the care plan from all the information they have and continue to gather with people. Where a care management plan or nursing assessment had been done by social services or health care agencies a copy was kept and information included in the assessment and plan. The home does not provide intermediate care. Care Homes for Older People Page 13 of 32 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Hazel Bank have individual plans of care and assessments. Some records of care are inconsistent and lack insufficient detail to help people to manage their personal, health care and medication needs which may affect their welfare. Evidence: Everyone living at Hazel Bank has an individual care plan. We looked at the care plans for people living there to assess their levels of need and dependency and we looked at some peoples individual care plans in greater detail. The home uses a dependency monitoring tool to assess levels of need and physical dependency. People living there did speak highly regarding the manager and staff and the care and support they received and indicated they felt well cared for. It was evident from what people living there and their relatives told us, from their survey responses and from our observations of staff interaction and support that people living there felt their needs were being met and they were being supported. Good responses and comments from people living there indicated that they were satisfied with the support they received. Comments they and their relatives made to us about their care included: Care Homes for Older People Page 14 of 32 Evidence: I am confident the staff provide quality care despite the restrictions of on old building (Relative). A lot of flexibility for residents. (Relative) They, (staff) look after me exceptionally well. (Resident) The care plans we looked at showed a persons health, social, spiritual and personal care needs. Care and activities staff has been working with people to help develop their personal histories and record what was significant to them. The care plans we saw had been based on initial and ongoing assessments. However we found that not all the care plans were being regularly reviewed and updated by the nursing staff responsible as situations and conditions changed. This meant that information in the care plans did not always give a clear picture of a persons current care needs. We looked at a sample of care plans for management of health, personal care and medication. We saw some care plans that lacked clear guidance for all staff to follow to ensure that health issues were managed appropriately. For example, the care plan for a diabetic on insulin said that in the event of high blood sugar levels a single dose of insulin should be administered. However, there was no further information on the type of insulin to be administered or the dose, and no monitoring arrangements. Some care plans were also in need of review as they were out-of-date. For example, the care plan for managing an under-weight resident said that they should be weighed weekly. The manager said that since their weight had increased they only needed to be weighed once a month. We did note, however, that the manager was in the process of up-dating and reviewing care plans. The manager also promptly contacted the GP of one resident following concerns raised about their medication. We were told that the medication was reviewed as a result. Individual care records indicated that people living there had access in the home to health care services, such as speech and language therapists, occupational therapists and physiotherapists. Records are kept of all such visits to the home and those from peoples GPs and the outcomes. We saw that medical assessments were done by the GP for one person for controlling pain and managing anxiety. Care plans did not provide clear guidance for staff on the management of agitation or tools to monitor and assess it or pain levels. The pharmacy inspector looked at the handling of medicines by checking relevant documents, storage and meeting with the manager Susan Dixon, the owner and other staff. We looked at records for receipt, administration and disposal of medication. Whilst some administration records were well completed others contained errors such Care Homes for Older People Page 15 of 32 Evidence: as missing signatures when administration was due. This meant that we could not tell if residents had received their treatment or not. For example, the records for two eye drops prescribed four times a day were only signed for administration three times a day for four weeks and then were not signed at all for two and a half weeks until the inspection date. This increases the risk to residents of worsening eye conditions. We did a stock check of a sample of medicines. This showed that on occasions medicines were not given in the prescribed dosage. We checked medicines liable to misuse, called controlled drugs and a stock check was in order. We also checked storage of medication. Whilst this was in order we did note some duplicated and discontinued medication in the medicines trolley that should be removed to reduce the risk of administration by mistake. At the time of the inspection there was no formal process for in-house checks, or audits, of medication. These are important because they help to identify mistakes and areas for improvement. The manager would benefit from some dedicated time to do audits so that issues relating to medication can be identified and managed without delay to keep residents safe and well. Although there were a number of areas of concern regarding medication the manager promptly addressed some of the issues raised to reduce risk to residents. Care Homes for Older People Page 16 of 32 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Hazel Bank are being supported by staff to live their chosen lifestyles and take part in activities that meet their preferences, expectations and abilities. Evidence: We saw from our observations during the visit and speaking to people living in the home and their relatives that there are a variety of opportunities available for people to take part in organised activities and social events or follow their own interests. The care plans we looked at had a personal profile and social assessment for people. Photographs of recent events and activities people have taken part in are on display. The menu is also on display in the entrance of the home. The home has its own dedicated activities coordinator and activities on offer included music sessions and sing alongs, card and jewelry making and painting. We observed people as they took part in activities that interested them. We spoke with one person who was doing watercolour paintings and they showed us the art work they had done. Their paintings had been shown at a local exhibition along with other peoples work and they told us they had enjoyed that very much. One person commented in their survey They encourage us with our activities - for me my painting. We observed that staff interacted very well with the people living there and there was friendly chatter
Care Homes for Older People Page 17 of 32 Evidence: and joking. We observed that staff always spoke to people in a calm and kindly manner. One person living there commented in their survey that, They (staff) undertake daily routines with a sense of humour. We spoke with relatives visiting the home and they praised the social support being given to people. They told us that the manager and staff always made them feel welcome when they visited the home and They also offer a lot of flexibility to residents. All the visitors and residents we talked with told us that the manager was very good and that she and the staff kept them informed about any changes that might affect their relatives health or their care. Relatives and people living in the home also made comments about the time and effort that the manager and care staff put into supporting people to meet their social and recreational needs such as on trips out. People we talked with felt that the manager and staff had a genuine commitment to promoting a feeling of home and a good quality of life for people living there. Diabetic and special diets were being catered for and people could have their meals where they wished. The meals come from the kitchen and are served by the staff to the people using the dining room. There is a 4 week menu which offers some choice for breakfast and evening meal and the provision of alternatives to the main lunch time meal. One person living there said if you especially wanted something in particular the staff would try and get it. They told us there was some choice of alternatives and that ,They used to come round and ask us what we wanted but they dont now. Survey responses indicated people usually liked the meals in the home and one we spoke with felt it had improved lately. A comment was made in a survey that, There is plenty of good, home cooked food. The providers have made changes to staffing in the kitchen so the two cooks provide more cover and there is less need for nursing and care staff staff to be involved in any food preparation. Staff have been given training on food hygiene and some have had training in malnutrition care and assisting people with eating. At the last visit from the environmental health inspectors the home received 4 stars. Care Homes for Older People Page 18 of 32 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are complaints, whistle blowing and adult protection procedures in place but uncertainty over what is a formal complaint may undermine their use and effectiveness for people living there. Evidence: The service has a complaints procedure and this is on display and in the service guide. The procedure tells people how to raise a formal complaint. There had not been any formal written complaints received in the last year. There have been some concerns raised verbally by a relative that the providers had told us about. These are not logged. There were no records of the verbal complaints or issues raised having been investigated or the outcomes for people. We strongly recommend that in order to maintain good outcomes for people and good relationships in the home the registered persons consider including in their complaints procedures and practices not just written formal complaints but also the investigation of verbal complaints or issues raised by people generally that they would like considered. In this way the Providers can demonstrate their commitment to an open culture that welcomes suggestions and discussion and can demonstrate that they actively listen to what people living there and their families have to say. This would also avoid confusion over what is or is not a complaint. There have not been any referrals made under safeguarding vulnerable adults procedures. There are adult protection procedures and guidelines in place to help
Care Homes for Older People Page 19 of 32 Evidence: protect the welfare of people living there. Staff have been given training on safeguarding vulnerable adults and recognizing abuse and these are updated. This should help staff be aware and act quickly should they suspect abuse. Staff survey responses indicated that they knew what the procedures were and what they should do should a situation arise that needed referring to other agencies for someones protection. The home also has whistle blowing procedures in place for staff to report concerns about the practices of colleagues and managers. The owners have taken prompt disciplinary action with a staff member due to poor practice and reported this to the appropriate nursing body. Staff surveys and their supporting comments indicated that there may be a lack of confidence felt about making suggestions and raising concerns generally with the Provider. We spoke with 3 relatives who were visiting the home who also indicated to us that they did not feel their concerns and worries were taken seriously. We could see that as fundamental changes are being made within the home, that will have an effect upon the lives of people living there, people needed to be fully involved and kept up to date in what the process was going to be so they could influence it. Relatives we spoke with felt unable to influence this process to promote their relatives welfare and best interests. This may leave people living there, their relatives and staff reluctant to speak out on any concerns and could potentially leave vulnerable people at risk. We recommend that the providers put sytems in place to keep residents and families fully informed on the changes proposed for registration and how these may affect them and fully include them in this change process. This kind of imformation and inclusion may help reduce some peoples anxieties. Care Homes for Older People Page 20 of 32 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Hazel Bank is being maintained and improved to promote a clean and hygienic environment. Evidence: There are garden areas that are being kept tidy by the maintenance person and they also attend to the day to day maintenance of the buildings and the testing of equipment to keep it safe for use. The home has a programme of maintenance for general upkeep and checks are done on the premises. There are two communal lounges on the ground floor for people to use and a large dining room. The dining room is also used for activities and crafts and we saw people using it to do their painting in. The home has CCTV cameras for security purposes at the entrance and rear of the building and these are not positioned to intrude on the daily life of the people living there. There are accessible toilets and bathrooms close to the areas people living there use and there are 2 assisted baths and 1 walk in shower. We noted the toilet on the second floor smelt strongly of urine and there were empty urinals left there. The wallpaper was also torn around the sink and toilet areas which did not create a pleasant and homely environment for people using it or make it easy to clean. The
Care Homes for Older People Page 21 of 32 Evidence: sluice and laundry areas were situated away from communal areas and were clean and tidy. Infection control policies and procedures are in place and reflect current good practice and care staff have been given training on this. There are appropriate adaptations to help peoples mobility and moving and handling equipment and profiling beds in use to aid staff with peoples mobility and care. Surveys we got back from people living there indicated they were generally satisfied with standards of cleanliness. Most of those responding thought the home was fresh and clean. We spent time in the lounges and walking around the home and visiting bedrooms and found that the general level of cleanliness had improved in this respect since our last visit. The home now has dedicated domestic staff so the care and nursing staff do not routinely have to attend to cleaning. The bedrooms we saw, the communal areas we visited and the sluice and laundry were noticeably cleaner and less cluttered. They are still some areas where wallpaper is torn and carpets marked and the owners should attend to this to maintain a homely atmosphere. Care Homes for Older People Page 22 of 32 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are recruitment and training systems in place for staff and the levels of staffing sufficient for the current dependency of people living there. Evidence: We looked at staff rotas showing which staff were on duty and in what capacity during the day and night. The manager had prepared rotas in advance for staff and had given consideration to skill mix of staff and additional staff in the busier morning period. The numbers of staff on duty during our visit was a stated on the rotas. The manager was on duty all day as the nurse in charge and there were 3 health care assistants, including a senior carer on duty on the morning shift to support the 16 people living there. The manager and 2 carers were on duty until the 2 night staff came on. The manager told us they and staff worked long days, over 12 hours, by choice. We noted on the rota that some staff, especially the manager and a senior carer worked long shifts over a period of several days, one a six day period and one an eight day period. We recommend that the manager considers, when creating staff rotas, the number of long days staff are working without a break. This is to help ensure that it is safe for staff as despite it being an employees choice, it may not be in the best interests and safety of the people living there to be cared for by staff working long stretches of shifts of 12 hours or over. At our last visit there were only 2 carers and a registered nurse on duty for the 16 people living there, so there has been an improvement in staff for the busier morning period. This helps make sure there are still staff available
Care Homes for Older People Page 23 of 32 Evidence: to support people living there when care is being given to those with high needs. There were domestic staff on duty to attend to housekeeping duties which was an improvement since our last visit. NVQ training is well established in the home and a high percentage of care staff have this qualification in care at either level 2 and 3. We looked at staff individual records indicating mandatory training was being given to staff. Staff survey responses indicated they felt they had training relevant to their roles but it was raised that there was a reliance on DVDs for training rather than hands on experience. Records indicate that the services recruitment procedures are being followed and that staff have appropriate Criminal Record Bureau (CRB) checks and Protection of Vulnerable Adults (POVA) register checks before they start work and the employer takes up references. People living in the home and relatives did speak highly of the nursing and care staff and the support and care they provided for them and praised their efforts. Their survey responses and comments indicated that usually there are staff available when they need them. One person told us They come as quick as they can, they cant just drop everything when I ring the bell. Their comments included: The staff are around a lot, theyre friendly, nearly always happy themselves and make relatives realise that they are confident and able to provide quality care. The staff are spot on. Superb team of nurses and carers under the leadership of Sue Dixon. The nurses and care staff need to be respected and appreciated by the current owner, they need to be listened to. Care Homes for Older People Page 24 of 32 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Hazel Bank benefit from having a dedicated and supportive manager who places their best interests at the centre of her management approach. Evidence: The registered manager of the home, Susan Dixon is an experienced and suitably qualified registered nurse of many years experience. People living at Hazel Bank and relatives made many positive comments about the managers approach and the care and support she provided to them. We were aware from what people living there, their families and staff told us that people were cared for in an individualized way and that the manager organised the home around their needs. These comments included: The manager is a wonderful person, she holds it all together. I am very satisfied. If it was not for her there would be no staff now. The manager is very good. We could see from rotas and from speaking to people there that the manager was
Care Homes for Older People Page 25 of 32 Evidence: putting a lot of effort into trying to support people and act in their best interests and had a heavy work load both administrative and as a nurse. People living there, relatives and staff clearly appreciated her efforts and support. We recommend that the registered manager is given additional supervision and support and/or resources to deal with the additional work created by the proposed changes in registration and to be able to give the support required for residents, families and staff at an unsettling time, some effects of which we observed, with relatives during the visit. Staff also commented positively on the support they received from the manager including: The manager supports her staff where we need her help. I find her a very kind person who cares about residents and staff. The manager is wonderful at her job, when the owners let her do it. The registered persons use some quality monitoring systems to monitor success in meeting the services aims and objectives. The manager meets with staff for discussion on practice issues and changes in the home and to get their feedback. We were provided us with copies of the monthly reports of the responsible individuals monthly visits to the home. There had been a premises audit but no evidence of other internal audits of systems such as care plan documentation and assessments, medication practices and record and complaints. We recommend as part of quality monitoring and quality assurance systems the registered persons implement a system to audit audit their systems and records. It is important to have a continuous system of self monitoring so standards can be maintained and any failures in systems identified and addressed quickly. The service has achieved Investors in People, to help their quality monitoring. The service has used resident and relatives satisfaction surveys in the past to get peoples views about the service and if it is achieving the outcomes they want. There was no evidence of formal survey feedback, for quality monitoring, having been actively sought by the registered persons about the services provided from people living there since our last visit. The manager confirmed that these were due and it was being addressed. We recommended that be truly effective in monitoring the quality of a service the views and expectations of the people using it have to be frequently sought. We saw minutes from staff and residents meetings that were held periodically. The last residents meeting we saw evidence of was in September last year. A meeting had been held with relatives recently to inform them of the changes the owners proposed to the home that would affect some people living there. Care Homes for Older People Page 26 of 32 Evidence: The service has current insurance arrangements in place and these are displayed. There are procedures in place to safeguard the money of people living there. We found from records and from staff surveys that they have received training on safe moving and handling, infection control, safeguarding and fire safety is being given. The fire safety equipment is serviced under annual contracts and records for lift and hoist servicing were up to date as were tests for gas and electrical safety. There was a fire risk assessment and fire alarms and detectors, emergency lights are regularly tested and members of staff have done the Fire Wardens training course and train other staff. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 15 All individual care plans must set out in detail the action which needs to be taken by nursing and care staff to provide the health and personal care that people living there need This will help ensure that all aspects of health and personal care are clearly identified and all staff know the actions agreed to meet individuals needs. 01/07/2010 2 9 13 Records for administration of 29/06/2010 medication must be accurate and complete. This will protect residents from errors that could cause harm. 3 9 13 Medicines must be administered in the prescribed dose. 29/06/2010 Care Homes for Older People Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action This will ensure that people receive safe and effective treatment Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 7 It is highly recommended that care plans are reviewed and are more thorough to provide staff with clear guidance on managing residents with specific care needs. It is recommended that the manager undertake thorough checks, or audits, of medication so that risks are identified and managed without delay to keep residents safe. It is recommended that duplicated and discontinued medicines are removed from the medicines trolley to reduce the risk of administration in error. We strongly recommend that in order to maintain good outcomes for people and good relationships in the home the registered persons consider including in their complaints procedures and practices not just written formal complaints but also the investigation of verbal complaints or issues raised by people generally that they would like considered. In this way the Providers can demonstrate their commitment to an open culture that welcomes suggestions and discussion. We recommend that the providers put sytems in place to keep residents and families fully informed on the changes proposed for registration and how these may affect them and fully include them in this change process. We recommend that the Providers attend to those areas where wallpaper is torn and carpets marked to maintain a homely atmosphere. We recommend that the manager considers, when creating staff duty rotas, the number of long days staff have worked without a break. This is to help ensure that it is safe for 2 9 3 9 4 16 5 17 6 19 7 27 Care Homes for Older People Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations staff as despite it being an employees choice, it may not be in the best interests and safety of the people living there to be cared for by staff working long stretches of shifts of 12 hours or over. 8 33 We recommend as part of quality monitoring and quality assurance systems the registered persons implement a system to audit their systems and records. It is important to have a continuous system of self monitoring so standards can be maintained and any failures in systems can be addressed quickly. We recommended that be truly effective in monitoring the quality of a service the views and expectations of the people using it should be frequently sought via meetings and satisfaction surveys. We recommend that the registered manager is given additional supervision and support and/or resources to deal with the additional work created by the proposed changes in registration and to be able to give the support required for residents, families and staff at an unsettling time, some effects of which we observed, with relatives during the visit. 9 33 10 36 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 32 of 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
