Inspection on 10/06/09 for Hazel Court Nursing Home

This inspection was carried out on 10th June 2009.

CQC 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 Court Nursing Home 10/09/08

Hazel Court Nursing Home 11/06/07

Hazel Court Nursing Home 07/02/07

Hazel Court Nursing Home 21/06/06

Hazel Court Nursing Home 06/03/06

Hazel Court Nursing Home 12/04/05

Hazel Court Nursing Home 07/12/04

Hazel Court Nursing Home 06/05/04

Hazel Court Nursing Home 27/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Hazel Court Nursing Home Haydon Way Wandsworth Off St Johns Hill London SW11 1YF Lead Inspector Louise Phillips Key Unannounced Inspection 10th June 2009 09:30a DS0000019096.V375799.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hazel Court Nursing Home Address Haydon Way Wandsworth Off St Johns Hill London SW11 1YF 020 8870 6933 020 8871 0824 gaynor.hewitt@shaw.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) Shaw Healthcare (Homes) Ltd Mohamed Haroon Dusmohamed Care Home 24 Category(ies) of Dementia (24) registration, with number of places Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 24 10th September 2008 Date of last inspection Brief Description of the Service: Hazel Court is a purpose built single storey care home for older people with dementia. The service provides respite accommodation for up to two people at one time. It is situated off St Johns Hill in Battersea, approximately twenty minutes walk from Clapham Junction Station, and is also accessible by bus. The service is managed by Shaw Healthcare Limited. Hazel Court Nursing Home DS0000019096.V375799.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 outcomes. This inspection took place over one day by two inspectors. Time was spent talking to six staff. We also spent time looking at relevant paperwork, care records and documentation. The registered manager was on two weeks leave when we visited the service, and the deputy manager was present throughout the whole inspection. At the time of the inspection there was one respite placement vacancy at the service. What the service does well: The staff demonstrated a caring approach and respectful attitude towards the people who use the service. The deputy manager and the staff we spoke to displayed a good knowledge of the needs of the people who live at the home, and an understanding of areas where the service can improve. The environment at the service is very calm and relaxed, and the layout is suitable for meeting the needs of people with dementia. What has improved since the last inspection? What they could do better: Areas where the service could be doing better are highlighted in the report and were discussed with the deputy manager during the inspection. Findings from this inspection have resulted in the service moving from being a two star to a one star service. Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 6 This is because the findings indicate that some of the requirements from the last inspection have not been met, namely that of ensuring that any risks to people who use the service are being managed appropriately and ensuring that staff are appropriately supported and supervised in their work. We also found that staff, particularly nursing staff, are not receiving up-to-date training to help them do their work effectively, and they are also not working to current guidance and good practice guidelines. Quality monitoring, handover, record keeping and complaint recording also needs to improve at the service, where requirements and recommendations have been made for the service to address these. The Commission has sent a Warning Letter to the service over areas that must improve, and a further inspection of the service will assess whether these have been met. If they have not then further enforcement action will be considered by the Commission. 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. Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are appropriately assessed prior to moving to the service. EVIDENCE: Before people move to the service they are assessed by the manager or deputy manager to look at their needs and how these can be met. This is done using the home’s own assessment format that covers all activities of daily living, such as eating and drinking, personal care, mental state and where people need assistance with their mobility. As part of this process any needs assessment and care plan information is gained from the local authority or primary care team (PCT) to inform the home’s assessment. Intermediate care is not provided by the home. Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care needs of people are not being sufficiently met, due to lack of current guidance and practice in nursing care being implemented at the service. Plans to manage any areas of risk do not sufficiently record steps to be taken to promote the safety of people who use the service. People who use the service are treated with respect and dignity by the staff team. EVIDENCE: Each person who uses the service has a care file that contains a wealth of information in relation to their needs and any areas of risk identified. Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 10 The deputy manager said that the service has plans to reorganise and simplify the information held in each care file so that information is easier to locate, and to archive information that is not currently in use. When we last inspected the service in September 2008, we found that the service had introduced a new format to care planning that involved a risk assessment being developed, and then a care plan developed from this. In our report following the inspection we highlighted that this approach led to insufficient information in relation to some areas of need. We also highlighted that this newer style of risk assessment, risk management planning and care planning needed to be kept under review, and that robust risk management planning needed to be implemented. Following our inspection report the organisation wrote to us and told us that staff had been given guidance and instruction on risk assessment and risk management, and that these areas would be monitored by the manager of the service. At this inspection we looked at the care files for five people who use the service. We found that no changes had been made to the format of risk assessment, risk management and care planning, and that all the files we looked at contained these documents dated from since before the date of our last inspection. The risk assessments and care plans had been reviewed during this time, but it is unclear how the actual style of these documents are being monitored by the manager of the service. We found that whilst the care plans are quite detailed the risk assessments and risk management plans do not contain sufficient information on how to manage risks. This is because where an area of risk had been identified the action plans to manage the risks do not detail what needs to be done to promote the safety of the person using the service. The action plans for each area still continue to say that plans to minimise risks are: “…to formulate an appropriate care plan…”, or “…ensure the appropriate documentation is completed to ensure effectiveness of the intervention…”, neither of which give any indication as to how to manage the risk. It was also found that the majority of risk assessments and risk management plans that we looked at were written using the same wording, with differences only made where the area of risk was different, eg. social isolation, self neglect, catheterisation. It is unclear why these forms are being used when they simply always refer to the care plan, or other records, instead of recording actual measures and steps taken to reduce and manage risks. Similarly, the risk management plan for one person with diabetes states: “…to avoid any triggers that may lead to high or low blood sugar levels…”, without saying what these triggers might be. It also states “…to discuss the risk assessment with (person) as well as with next of kin…”. However, this had been written on the 10th February 2009, yet the dates for having discussed the plan with the person using the service and Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 11 their relatives was incomplete, demonstrating that this had not taken place. Similarly, there was no evidence that this risk assessment had been reviewed since the date it was implemented. The care plan for this person did also not clearly document the administration of their insulin, where it states “…take six units in the morning and five in the evening…”, without saying when this is to occur, such as before or after food. The risk assessment and care plan also did not describe what actions need to be taken should they experience hypoglycaemia or hyperglycaemia (where there is too little, or too much glucose in their blood), apart from “…report to the nurse in charge immediately who will act accordingly…”. Similarly, the risk assessment for one person with diabetes states ‘ensure that appropriate documentation is done in blood sugar monitoring’, without actually stating what this is, the frequency of this, and what to do if the blood sugar monitoring is too high or too low. The date that this had last been reviewed was February 2009. Other risk assessments were seen to have not been reviewed regularly, such as the Waterlow (risk of pressure sores measuring tool) for one person hadn’t been reviewed since January 2009, where it had been reviewed monthly prior to that date. The Deputy Manager said that this approach to recording risk assessments and risk management plans is carried out because the staff are following templates issued by the Shaw Healthcare quality department. She showed us the ‘master’ copies of these templates, which show that staff have been following what they have been told to do. The deputy manager said that they used to be able to complete more individualised risk assessments prior to these templates being issued. She said that the risk assessments and risk management plans used to describe a step-by-step approach towards how any areas of risk were to be managed. Guidance from the Nursing and Midwifery Council (NMC, the professional body that regulates all registered nurses) describes that nurses have a professional accountability for performing risk assessments. The use of the templates would seem to contradict the nurses’ professional accountabilities in this area, particularly because it is also unclear what guidance these templates are based on. It is required that the use of these are reviewed, and adapted in line with the latest guidance from the RCN (Royal College of Nursing) and NICE (National Institute for Health and Clinical Excellence) to ensure that individualised risk assessments and risk management plans used actually detail what actions are to be taken to minimise risks to people who use the service. During the inspection we found that the service is using one blood glucose monitoring machine (with single use strips), to measure the blood glucose for two people with diabetes. There are no records to evidence that this is calibrated to ensure that it is safe to use and is providing accurate Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 12 measurements. The staff nurse and deputy manager also stated that this does not take place. In order to minimise risks to the people with diabetes, an Immediate Requirement was made during the inspection for the service to ensure the machine is, and continues to be calibrated (in accordance with manufacturers instructions), by the 12th June 2009. The deputy manager of the service contacted us on the 11th June 2009, where she informed us that two new blood glucose monitoring machines had been purchased for the service, that they had been calibrated and were now in use. The deputy manager said that a number of staff had recently received training in managing diabetes from the local PCT clinical nurse specialist. Evidence was seen to demonstrate that five nurses and two care staff had attended this training. The deputy manager stated that of the people currently staying at Hazel Court, no-one has any pressure sores or leg ulcers. She informed us that one person uses a catheter, and that the management of this is overseen by district nurses from the local PCT. She informed us that they visit approximately every two months to change the catheter and that the service carries out it own urine testing if the urine looks darker than normal. She said that the fluids drank by the person are measured, as well as the amount of urine passed, and that this is recorded on a chart. Evidence was seen to demonstrate that the fluid monitoring takes place. There was also evidence in the daily records and care plan summaries that the district nurse changes the catheter. The care plan regarding catheter care is reviewed monthly. However, when we spoke to the deputy manager about staff training in catheter care, she stated that none of the staff had received this training, and that it is not provided by the organisation. She also confirmed that the service does not have the latest guidance on catheter care, where we provided a copy of the most recent RCN (Royal College of Nursing) guidance for nurses on catheter care, and advised her that the service must also obtain and implement the NICE, PCT and NMC guidance on catheter care to ensure staff are providing the most up-to-date care. It is also required that all nursing and care staff receive training, from an external organisation, on catheter care. The service should also consider not admitting any new people to the service, who have catheter care needs until staff have received this training, and demonstrated their competence in this. The deputy manager explained that the medication system is audited by two team leaders at the service who monitor the recording of the medicine charts and check the stock weekly. Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 13 When we looked at the medication for five people we found that these were in good order, with no omissions or errors identified. The medication is appropriately stored, with daily temperatures maintained for the medicine fridge that stores some medication that needs to be kept cool. Of the medicine charts that we looked at, three did not have any record of any allergies of the person, whereas some said ‘nil known’. It is required that this section of the MAR (medicine administration record) is completed to detail any allergies, of if none are known. The service should also obtain the most recent BNF (British National Formulary), so that they have the most up-to-date information about medication, as the one in current use is dated March 2008. The staff explained that the service has positive links with the local PCT, and that they are able to access a General Practitioner where they are concerned about the health of any people who use the service. Throughout the inspection we observed the staff being respectful and polite to the people who use the service, demonstrating patience and a caring approach to their work. Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have the opportunity to be involved in activities. EVIDENCE: The deputy manager explained that following the last inspection a new activity co-ordinator has been employed. She explained that the person used to be a care worker at the home, but now co-ordinates the activities, in addition to carrying out some care work. There is a schedule of activities on display at the service to reflect what people get involved in. These include outings, going into the garden, puzzles, playing dominoes and using the sensory room. During the inspection we observed different music playing to reflect the different cultures of the people who use the service, as well as staff accompanying some people into the garden area. Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 15 The care files for each person contain a document titled ‘outline of activity programme’, which includes information about the person’s orientation to reality (day, year, etc), reminiscence triggers, sensory stimulation, personal interests, hobbies and social activities that they like to do. These are a positive tool to use, though for a number of people they had not been reviewed for approximately eighteen months to two years. It is recommended that these are carried out monthly in light of the nature of the needs of people with dementia. This is because of the often dramatic changes they experience in their personality, interests, and physical needs, as a result of their dementia. The feedback from these should then be used to inform the activity programme to ensure that it is based on the current needs of people who use the service. We met with the second chef during the inspection, who showed us the kitchen at the home. He explained that the menu’s for the home are on a four-weekly rolling rota, and are provided by the organisation, however he did say that there is some flexibility within this to accommodate different cultural food preferences, and where people do not like what is offered at mealtimes. He demonstrated an awareness of the specific dietary needs of some of the people who use the service, and spoke about how these are accommodated, such as puddings made without sugar for people who are diabetic. We saw a variety of fresh, frozen, dried and tinned foods and vegetables available for the preparation of meals at the service. Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems in place to deal with complaints, though more robust recording of actions taken in response to these need to be maintained. Staff receive training in abuse awareness, and the service has demonstrated that it takes appropriate action to ensure any possible safeguarding issues are appropriately reported. EVIDENCE: The service has a complaints procedure that details the process for investigating complaints received about the service. At the last inspection we required that improvements be made to ensure a log is maintained of all complaints received at the service. The complaints file now contains information about any complaints received. The deputy manager said that no other complaints, other than the two held in the complaint file, had been received about the service. There is a complaint record form for one complaint held on the file, but not for the other one, and it is required this is used to detail more information about this, and any other complaints received, and of actions taken by the Registered Person to address this. Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 17 The staff training records demonstrate that they have received training in safeguarding adults and whistle-blowing from the organisation. The service has a copy of the most up-to-date safeguarding guidelines from Wandsworth local authority. The deputy manager informed us of a recent issue that happened at the service two days prior to our visit, which resulted in a person who uses the service being admitted hospital. She informed us that she promptly notified the appropriate agencies (including Wandsworth local authority and CQC). However, it was only when we advised that this might be a possible safeguarding issue, did she say that she would further follow this up with the local authority to investigate under their safeguarding procedures. Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The atmosphere at Hazel Court is welcoming and relaxed for the comfort of the people who use the service. Positive improvements have been made to the environment to made the service more homely and safe for the people who live there. EVIDENCE: Since the last inspection good improvements have been made to the service to address the damp areas on the ceilings in the hallways, and covering up the exposed pipe-work in the bathroom and toilet areas. A programme of ongoing re-decoration at the service was seen, and the deputy manager said that the service now has a handyperson who works Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 19 approximately 30 hours a week, and is able to address any issues as they arise. The service was observed to be clean and fresh-smelling throughout the time we were at the home. Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service demonstrates that appropriate recruitment checks are carried out on staff employed at the service, and there are appropriate numbers of staff working each shift. However, improvements need to be made to ensure that time is given to staff between shifts to enable them to provide a thorough handover to staff on the oncoming shift. Improvements also need to be made to ensure that staff are appropriately trained, and competent, to do the work they are expected to perform EVIDENCE: The deputy manager explained that each day there are two qualified nursing staff on duty, five care workers plus the activity co-ordinator, who also carried out some care duties. She said that at night there is one trained nurse and three care workers on duty. She said that the hours staff work are generally long days and night shifts, though some staff prefer to work just the morning shift. She said that the day shift is form 08:00hours until 20:00hours, and the night shift is from 20:00hours until 08:00hours. She said that staff often come in early, in their own time, to ensure that there is a ‘handover period’ between each shift, as the hours of work do not allow for Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 21 a overlap of shifts to enable this to happen. It is recommended that the shift times are altered to give a minimum of a thirty minute period between shifts to allow for a structured, thorough handover to take place. The care staff team at Hazel Court consists of trained mental health and general nurses, and care workers. The training record for staff demonstrates that a number of the care workers have obtained at least the NVQ (National Vocational Qualification) level 2 in care. The deputy manager explained that where staff have not undertaken this, they are due to in the near future. The service holds recruitment information on all staff employed at the service. These were seen to contain relevant information such as proof of identification, Criminal Records Bureau check, two references and a record of the interview of staff, to demonstrate that appropriate checks are carried out prior to their starting work at the service. All staff receive an induction when they first start working for the service. This is carried out over four days, where they undertake induction training in a number of areas, including safeguarding adults, challenging behaviour, food hygiene, infection control and moving and handling. The organisation provides various training to staff, including first aid, effective communication, mental capacity act, caring for people with dementia and fire safety. The staff training records detail that training is also provided in-house by the manager and senior staff who work at the home. As highlighted earlier in the report, staff who work at the home have not received catheter care training. During our visit we spoke to some staff who said that most of the training they have is provided by the organisation, and that they are not provided with opportunities and funding to attend external training. The deputy manager stated that very little external training is offered to staff. The deputy manager said that the service has also provided care to people in the past who have had needed to be administered with a suppository or enema, yet there was no evidence to demonstrate that training had been undertaken in this. These areas of training needs to be addressed, particularly as the home is a nursing home, and employs registered nurses. Training must be provided in all aspects of care that they are expected to perform, including catheter care, bowel care, suppositories, enemas and diabetes, as a minimum. It is highlighted earlier in the report that the service does not hold current, upto-date guidance from professional bodies about care practices, and the nurses are also not being provided with appropriate training to meet the needs of the people who use the service. A requirement has been made for the service to address these training needs to ensure that appropriate care is provided to the people who use the service. Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A number of improvements need to be made to ensure that the service is run in the best interests of the people who use it and that robust record-keeping systems are in place. Staff are not receiving regular and consistent support in their work. Appropriate systems are in place regarding health and safety checks. EVIDENCE: Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 23 At the time of the inspection the registered manager for Hazel Court was on two weeks leave and the deputy manager was overseeing the running of the home, with the support of the area manager. The deputy manager demonstrated a good knowledge of the staff and people who use the service. She was receptive to the feedback that we gave and had a good awareness of the areas of improvement needed at the service. The Registered Manager of the service has a number of years experience in nursing, and has relevant qualifications for his role. The home maintains records of visits carried out in accordance with Regulation 26 (of the Care Homes Regulations 2001) to demonstrate that these are taking place. The deputy manager explained that these are carried out predominantly by an area manager from a different area, and that feedback is provided via a report to the service and area manager for Hazel Court about any issues that arise. The deputy manager confirmed with the area manager during the inspection that any issues highlighted in the report are raised with the registered manager during their supervision sessions. A record is maintained of relatives meetings that have taken place quarterly since the start of the year. There are also records to demonstrate that staff meetings are taking place at the service. The organisation has a quality assurance policy that details the quality monitoring that takes place. The policy refers to a quarterly internal quality audit that each home is expected to be doing. The deputy manager said that she was not aware of this, and was only able to show us an audit that had taken place regarding medication monitoring. The Regulation 26 report for March 2009 stated that there was little evidence that the service is carrying out self monitoring, apart from health and safety audits. The report also stated that the quarterly quality audits had not been done for approximately 9 months. Finding from this inspection highlight that internal quality monitoring must be carried out, and a requirement has been made to ensure that the service does this, in accordance with the organisation policy. The service holds a personal allowance for each person who uses the service that is funded by themselves, their family or through social services. The money held is to purchase any toiletries, clothes or to pay for hairdressing carried out at the service. Records and receipts are maintained of all transactions. We checked the monies held for five people who use the service, and these were seen to correspond with the amount recorded. The administrator directly oversees the management of the money, which is overseen by the registered manager of the service. The administrator confirmed that the arrangements for holding money were the same as at the last inspection, whereby no-one within the organisation is Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 24 an appointee for any person who lives at the home, and that all the people’s monies held are paid into the same bank account. At the last inspection the Financial Accountant for the organisation confirmed that the account is noninterest bearing, and during this inspection the administrator confirmed that this was still the same situation. At the last inspection of the service a requirement was restated as it was found that staff were not receiving one-to-one supervision at least six times a year. The findings from this inspection indicate that there has been minimal improvement in this area. The deputy manager provided us with a computerised printout of supervision that had taken place for staff since July 2008. This record shows that supervision is taking place erratically, infrequently, and inconsistently. We compared the computerised record with the paper record of where supervision had taken place. We looked at the supervision records for six members of staff, whom the deputy manager confirmed are all currently employed at the service, and our findings are as follows: Staff member A (who was on duty on the day we visited the home) – computerised record states last supervision session as having taken place in July 2008. The staff member said that they had not had supervision since that time. Staff member B – computerised records and paper records confirm that they have had four supervision sessions which are two in October 2008, one in February 2009 and one in May 2009. The deputy manager said that where two supervisions have occurred in one month, the second is a ‘follow up’ to the first session. Staff member C – computerised record states supervision took place in December 2008 and in May 2009. The paper records are dated that supervision took place in January 2009 and May 2009. Staff member D – computerised record state supervision took place in July 2008, November 2008 and March 2009. The paper record available is dated for March 2009 only. Staff member E (who was on duty on the day we visited the home) – computerised record states that no supervision has taken place. The last paper record of supervision having taken place was for October 2008. The staff member told us that they have supervision approximately every four months. The records indicate that this member was on leave for a period between October 2008 until January 2009, however there is no record of their having had supervision this year. Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 25 Staff member F – computerised record states supervision took place in October 2008 and February 2009. The paper records confirm that supervision happened during these months. The supervision policy for Shaw Healthcare states that supervision should take place a minimum of six times a year. However, findings from this inspection indicate that supervision is still not taking place regularly, and so staff are not being properly supported in their work. Following a recent investigation at the service a number of discrepancies regarding record keeping were found. The deputy manager stated that following this a number of changes have been implemented at the service. She described that changes have been made to practices around recordkeeping, where the registered nurse now countersigns any entries made by care workers in the daily records about people who use the service. She said that there has been some in-house training on record-keeping to all staff, along with had different meetings with team leaders and care workers to address issues of record keeping at the service. Changes have also taken place to the break times to provide more time for accurate record keeping. The service has also recently implemented a new format for recording food offered to people who use the service, and a space to record what has actually been eaten. This is divided into sections under the headings of breakfast, midmorning, lunch, mid-afternoon, tea and bedtime. There is also space to detail any food supplements, the quantity eaten and any other comments. Care workers have received training in how to accurately record on this form. The deputy manager said that they are also planning to give all staff a notebook to have throughout each shift so that they can record any handover information and refer to this throughout their duty. She said that they are also making better use of the sheet used to record handover, so that areas needing significant attention are recorded and drawn to everyone’s attention. These are positive steps and demonstrate that the service is working to improve in the area of record keeping. We looked at some of the new forms being implemented and recommend that staff be reminded to date and sign documentation, as some people were just using their initials. Nurses should also countersign the food and fluid records. We also recommend that staff are encouraged to record in daily notes throughout the shift, as opposed to waiting until hours later, or the end of their shift when they need to try and remember what has taken place with different people who use the service. As stated earlier, consideration should also be given to altering the shift times to allow time for a structured, robust handover. We also recommend that the named nurses to do weekly audit of all the care files for people they directly oversee the care of, to ensure all records correspond with the charts and all entries made in daily record. This should be Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 26 demonstrated through a weekly record summarising the care of the person who is using the service. A requirement has been made to ensure that all records maintained at the home are kept up-to-date, as findings from this inspection have found that this is not always the case, for example risk assessments and complaint recording about actions taken. The service maintains records to demonstrate that appropriate health and safety checks are carried out. There is routine testing of fire equipment, along with hazard risk assessments for environmental issues in the home. Appropriate food safety checks are carried out on the temperature of the food being served, and of food storage temperatures. On the day of inspection four staff were doing infection control training, and records indicate that staff receive training in food hygiene, falls prevention, health and safety and moving and handling. Staff said that there is appropriate equipment for assisting people who use the service to mobilise, such as hoists and wheelchairs. Where bedrails have been used, we saw that relatives have signed to give their consent to the use of these. Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 27 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 1 2 3 Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 28 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 13(4) Requirement The Registered Persons must ensure that risk assessments and robust risk management plans are in place for all areas of need identified. To ensure that risks to residents are minimised. 2. OP7 & OP8 15(2) The service must ensure that care plans are reviewed at least monthly and prepared in accordance with relevant guidelines produced by the RCN, NICE, NMC and the local PCT. So that people who use the service get the right, and most up-to-date care. 3. OP7 13(4) It is required that the risk assessments are reviewed at least monthly and prepared in accordance with relevant guidelines produced by the RCN, NICE, NMC and the local PCT. To ensure that individualised risk assessments and risk management plans actually Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 29 Timescale for action 31/07/09 31/07/09 31/07/09 detail what actions are to be taken to minimise risks to people who use the service. 4. OP8 13 The service must ensure the blood glucose monitoring machine is calibrated (and to continue to be calibrated in accordance with manufacturer’s guidance. To minimise risks to people who use the service. IMMEDIATE REQUIREMENT MADE AT TIME OF INSPECTION 5. OP10 13(4) The MAR section of the MAR charts that asks for any allergies must be completed for all people who use the service. To ensure the safety of people who use the service. 6. OP16 17(2), Sch 4 (11) The service must maintain a record of actions taken by the Registered Person in response to any complaints received. To demonstrate that complaints are addressed and appropriate actions taken. 7. OP18 13(6) The service must ensure any potential safeguarding issues are reported accordingly. To ensure that appropriate actions are taken to minimise risks to people who use the service. 8. OP30 18(1)(c) Training must be provided to all nursing and care staff in all aspects of care that they are expected to perform. This must DS0000019096.V375799.R01.S.doc 12/06/09 31/07/09 31/07/09 12/06/09 30/08/09 Hazel Court Nursing Home Version 5.2 Page 30 include catheter care, bowel care, administering suppositories, administering enemas and diabetes care, as a minimum. So that people who use the service get the right, and safest care delivered by staff who are trained and competent. 9. OP33 24 The service must maintain a system for reviewing and improving the quality of care, and nursing care provided at the home. So that people who use the service get a high quality of care. 10. OP36 18 All staff must receive one-to-one supervision at least six times a year (pro-rata for part time staff) and this must be fully recorded. To ensure that staff competence, training and developmental needs are identified and addressed so that people who use the service are supported by appropriately trained and competent staff. 11. OP37 17(3)(a) The service must ensure that all records maintained at the home, including risk assessments and records of complaints are kept up-to-date. To demonstrate that appropriate records are maintained and appropriate actions taken to improve the quality of life of people who use the service. 31/07/09 31/07/09 31/07/09 Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP10 OP12 Good Practice Recommendations A copy of the most recent BNF (British National Formulary) should be held at the service. It is recommended that the ‘outline of activity programme’ assessments are carried out monthly, and the feedback from these used to inform the activity programme to ensure that it is based on the current needs of people who use the service. It is recommended that the shift times are altered to give a minimum of a thirty minute period between shifts to allow for a structured, thorough handover to take place. This is to ensure that all relevant information regarding the needs of people who use the service is communicated to the oncoming staff team. Staff should use their full signature when signing documentation and nurses should countersign the food and fluids charts in use at the service. All staff should be encouraged to record in daily notes throughout the shift, as opposed to waiting until hours later, or the end of their shift when they need to try and remember what has taken place with different people who use the service. It is recommended that the named nurses carry out a weekly audit of all the care files for people they directly oversee the care of, to ensure all records correspond with the charts and all entries made in daily record. This should be demonstrated through a weekly record summarising the care of the person who is using the service. 3. OP27 4. OP37 5. OP37 6. OP37 Hazel Court Nursing Home DS0000019096.V375799.R01.S.doc Version 5.2 Page 32 Care Quality Commission National Processing Centre Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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