Inspection on 11/06/07 for Hazel Court Nursing Home

This inspection was carried out on 11th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hazel Court Nursing Home 10/06/09

Hazel Court Nursing Home 10/09/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hazel Court Nursing Home Haydon Way Wandsworth Off St Johns Hill London SW11 1YF Lead Inspector Sharon Newman Unannounced Inspection 11th June 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hazel Court Nursing Home DS0000019096.V340894.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hazel Court Nursing Home DS0000019096.V340894.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 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 Limited Post Vacant Care Home 24 Category(ies) of Dementia - over 65 years of age (24) registration, with number of places Hazel Court Nursing Home DS0000019096.V340894.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th February 2007 Brief Description of the Service: Hazel Court is a purpose built single storey care home. The home provides care for persons who have dementia. Hazel Court is situated off St Johns Hill in Battersea. It is approximately twenty minutes walk from Clapham Junction Station and is accessible by bus. All accommodation is provided in single rooms, which have a hand basin and are situated near bathrooms and toilets. The home has two self-contained units, with their own kitchenettes and lounge areas. There is a conservatory and a garden area. In the centre of the home is an enclosed courtyard with seating for service users. A Primary Care Trust funds all service users. Hazel Court Nursing Home DS0000019096.V340894.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One regulation inspector conducted this unannounced inspection on 11th June 2007. The acting manager was present during the inspection. All staff were helpful and welcoming. Documentation looked at included medication records, staff recruitment information, residents care plans and health and safety records. A tour was also taken of the premises. An Annual Quality Assurance Assessment (AQAA)was sent out to the home prior to the inspection. This is a self assessment of the service. This was not received prior to completion of this report. Surveys were left for all residents to complete if they wished. Surveys were also left at the home to be given to relatives and staff. None were returned before this report was completed. What the service does well: Full and detailed assessments of the residents taken place to help ensure that the home is able to meet their needs. Reviews of the residents take place to help ensure that their ongoing needs are reassessed and any change in need is addressed. There is good multidisciplinary involvement from health and social care professionals and this helps to make sure that these needs are addressed promptly. There is a pleasant atmosphere at the home and the staff are professional and friendly. Good interaction was observed between staff members and residents and staff. Meals are taken in a relaxed atmosphere and staff promote residents choice and dignity at mealtimes. The home is clean and hygienic. Hazel Court Nursing Home DS0000019096.V340894.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hazel Court Nursing Home DS0000019096.V340894.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.V340894.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents are assessed prior to coming to live at the home. This helps to make sure that the home can meet their needs. EVIDENCE: Full assessments of need were seen to have been completed by health and social care professionals before residents come to live at the home. Residents files that were looked at each contained an assessment completed by a social services representative and also a nursing needs assessment. Management staff from the home also carry out assessments of potential residents to help ensure that the home will be able to offer them the support that they need. As reported in the previous inspection report all files had a copy of the service agreement in place, detailing what is included in the fee. Hazel Court Nursing Home DS0000019096.V340894.R01.S.doc Version 5.2 Page 9 Residents appeared happy and looked well dressed and clean on the day of the inspection. A family member spoken to during the inspection visit said that they were happy with the care given to their relative. Hazel Court Nursing Home DS0000019096.V340894.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who use this service have access to a range of health and social care services. Staff have not received enough training in clinical areas to demonstrate that they can meet all the health care needs of the residents. The allergies sections in the medication administration records are not always fully completed to help ensure that residents are not placed at risk. EVIDENCE: There was evidence of input from a wide range of health and social care professionals in the resident’s care plans. The residents’ care plans that were looked at during this visit contained a lot of detailed information about their health and social needs. However there are some areas that need to be addressed. Some of the information was not Hazel Court Nursing Home DS0000019096.V340894.R01.S.doc Version 5.2 Page 11 detailed enough. For example in one care plan it stated ‘Try to divert (the resident) when (they) want to leave the premises.’ However it did not specify how the staff member should do this. An entry in another care plan stated ‘occasionally incontinent’ but did not give further details of the type of incontinence, what advice had been sought and what action was being taken. Another entry recorded that the resident ‘needs assistance for personal hygiene and dressing’ but did not state what help was required. Information needs to be more specific to help to ensure that residents health and social needs can be met. Wound care recording has improved since the last inspection and a wound photograph was seen in one of the residents’ care plans. However it was quite blurred and these images need to be clearer to ensure that the progress of the wound can be monitored. It was discussed with the acting manager that some of the care planning information would benefit from being re-organised. In one file looked at information relating to wound care was found in at least three different sections of the report. It would be easier to follow and more logical if this information was placed within the same section. In another file the information about the resident’s catheter care was also contained within different sections of the report and it was difficult to see when the catheter changes were taking place and to find important information about the type of catheter used. The acting manager reported that she had become aware of this recently and was going to address this issue. A nutritional risk assessment indicated that a resident was losing weight, however there was no information to state how this issue was being addressed. Some fluid balance charts contained unclear information and it appeared from the entries that no fluids were being offered for many hours. Also some entries merely stated ‘glass of water’ and did not specify the amount in millilitres. Attention must be paid to detailed recording of health care information. It must be clear what action is being taken when a resident is losing weight and information about the health professionals involved for example the GP and dietician must be included. There was insufficient evidence that staff training has taken place in some areas. Up-to-date training in wound care, pressure area care, continence care and diabetes care needs to take place. This is to ensure that staff are aware of current good practice in these areas and that the residents receive care based on up-to-date clinical practice. All nursing staff in particular need to ensure that they attend accredited training updates regularly so that they remain competent to carry out clinical care. Staff must ensure that they remain up-todate with guidance issued by the National Institute of Health and Clinical Excellence and the Royal College of Nursing. Hazel Court Nursing Home DS0000019096.V340894.R01.S.doc Version 5.2 Page 12 The allergies section in the medication administration records was not fully completed for all residents. All allergies must be recorded and where there are none known then this needs to be documented. This is to help ensure the safety of the residents. Hazel Court Nursing Home DS0000019096.V340894.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use the service have the opportunity to develop and maintain important personal and family relationships. Staff are sensitive to the needs of those residents who find it difficult to eat and give assistance at mealtimes. Meals are taken in a relaxed and unhurried environment ensuring that it is a pleasant experience for residents. EVIDENCE: The home employs a full-time activities officer who was at the home on the day of inspection. They were seen to have a very caring attitude and demonstrated a good rapport with the residents. Activities on offer include card games, dominoes, reading, news updates, watching films, skittles and armchair exercises. The activities officer reported that they offered residents hand and shoulder massages which they have been trained to do. They said that residents are offered the opportunity to go on outings to Richmond park, Hazel Court Nursing Home DS0000019096.V340894.R01.S.doc Version 5.2 Page 14 Battersea Park and into Wimbledon. A relative said that their family member has been offered opportunities to participate in outings. Each resident has an allocated ‘keyworker’ and this helps to ensure that residents receive continuity of care. Residents were observed to walk freely around the home and there was a calm atmosphere. Good interaction was observed between staff and residents and they were seen to be treated with dignity and respect. Lunch was observed to be taken in a relaxed and unhurried atmosphere with peaceful background music playing. Residents needing help were supported to eat their lunch in a dignified manner by staff members who sat beside them to offer assistance. Lunch portions were a good size and residents were offered a choice of meal by staff. Hazel Court Nursing Home DS0000019096.V340894.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. This home has an open culture which allows residents to express any concerns. The service has a clear complaints procedure which is available in a format which is easier for the residents to understand. Policies and procedures for safeguarding adults are available tat the home and staff are aware of the procedures to follow. EVIDENCE: The Commission for Social care Inspection (CSCI) have not received any complaints since the previous inspection. A record of compliments is kept at the home. There have been no Protection of Vulnerable Adults investigations since the previous inspection. The home follows the London Borough of Wandsworths’ Adult Protection Procedures and a copy of these procedures was available at the home. There was evidence that staff attend training in abuse awareness and the protection of vulnerable adults and this helps to maintain the safety of the residents. Hazel Court Nursing Home DS0000019096.V340894.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The main building is old but the organisation tries to ensure, by use of colourful pictures and attractive plants that it is a homely environment and that there is a relaxed feel within the home. The home is free from offensive odours and is clean and tidy. EVIDENCE: The home was clean and tidy and free from unpleasant odours on the two sites visits. Residents live in a building, which is on one level, this allows a safe environment for walking around. Residents were observed to walk freely around the premises. As reported in the previous inspection report the décor and fabric of the buildings continue to look tired and old. The acting manager reported that Hazel Court Nursing Home DS0000019096.V340894.R01.S.doc Version 5.2 Page 17 some redecoration of resident’s rooms is taking place. A senior manager reported that the organisation is looking at future options for the home and residents may eventually be moved to a new building that will meet their needs more adequately. There is a range of equipment available to help meet the needs of residents this includes assisted baths and showers, wheelchairs and toilet rails. Hazel Court Nursing Home DS0000019096.V340894.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Staff are appropriately trained to help ensure that they can carry out their roles. Residents are protected from harm by a good recruitment procedure. EVIDENCE: Sufficient numbers of staff were observed at the home on the day of inspection. The acting manager reported that there were enough members of staff to meet the needs of the residents. The duty rota was clear and easy to follow. Staff at the home were observed to behave in a courteous and professional manner. They help to create a cheerful and friendly atmosphere at the home. There was evidence of a staff training programme and most staff are up-todate in mandatory areas including: moving and handling, first aid, health and safety and food hygiene. Four staff recruitment files were looked at and there was evidence that all necessary pre-employment checks are carried out. Some of this information is held on computer records and this is easy to follow. Hazel Court Nursing Home DS0000019096.V340894.R01.S.doc Version 5.2 Page 19 The acting manager reported that there was ‘an excellent team’ of staff at the home. A relative reported that staff were caring and looked after their relative well. Hazel Court Nursing Home DS0000019096.V340894.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Management staff have a professional attitude and are knowledgeable about the residents in their care. One- to one staff supervision is not taking place frequently enough and needs to be increased to ensure that staff received the support they require to carry out their duties. EVIDENCE: The acting manager and deputy manager were both helpful, professional and friendly. The acting manager is experienced in the care of people with dementia and reported that they are just completing their Registered Managers Award (RMA) Qualification. They reported that they were being re-interviewed Hazel Court Nursing Home DS0000019096.V340894.R01.S.doc Version 5.2 Page 21 for their post along with all the other staff employed at the home. It was discussed with the acting manager that a manager needs to be in post who is registered with the Commission for Social care Inspection (CSCI). She reported that this would be addressed when a decision had been made as to who would be offered the managers’ position. A member of senior management staff introduced themselves and was spoken to during the inspection visit. They reported that changes were taking place at the home due to the decision to close another local home within the organisation. This has meant that staff from both this home and the home which is closing have all had to be re-interviewed for the jobs available at this home. Some interviews were taking place on the day of inspection. Evidence was seen that quality assurance is carried out to help gain the views of the relatives. Health and safety and medication audits are also carried out throughout the year. Staff one-to-one supervision is taking place but the frequency needs to increase and this was discussed with staff on the day of inspection. This is to help ensure that staff have the direction and support that they need to carry out their roles. And for any training and development needs to be identified. Although hot water checks are taking place this is not always carried out weekly and this needs to be addressed. Also, the hot water for the basin in one of the residents’ rooms was recorded as 52 degrees centigrade. Hot water temperatures must not rise above 43 degrees centigrade to help ensure that residents are not placed at risk. Other checks relating to health and safety including portable appliance testing, electrical installation checks, gas safety and legionella were in order. Hazel Court Nursing Home DS0000019096.V340894.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X x 3 X X x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 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 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 2 Hazel Court Nursing Home DS0000019096.V340894.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 17 (1) (a) & Sch 3 Requirement The registered person must ensure that daily records reflect the actual care given. Previous timescales of 30/09/06 and 30/05/07 not met. Information in the care plans needs to be more specific in relation to health and social care. This is to help to ensure that the residents health and social needs - for example in relation to continence and nutritional care are met. Staff training in areas including continence care, diabetes care, wound care and pressure area care needs to take place. This must be in line with current clinical guidance to ensure that nursing staff remain up-to-date with their practice. Medication administration records must be fully completed for all residents. Where residents have allergies then this must be documented and where there are none then this must also be recorded. The manager must register with DS0000019096.V340894.R01.S.doc Timescale for action 01/08/07 2 OP7 15 (1) (2) 01/08/07 3 OP8 18 (1) 01/10/07 4 OP9 13 (2) 11/06/07 5 OP31 8 01/09/07 Page 24 Hazel Court Nursing Home Version 5.2 6 OP36 18(2)a 7 OP38 13 (4) the Commission for Social Care Inspection. 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. Hot water temperatures must be recorded weekly and must not rise above 43 degrees centigrade. 01/08/07 01/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The home should consider reorganising the care plans to help ensure that they are easy for staff to follow and the information is more accessible. Hazel Court Nursing Home DS0000019096.V340894.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hazel Court Nursing Home DS0000019096.V340894.R01.S.doc Version 5.2 Page 26 - 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!