Inspection on 12/04/05 for Hazel Court Nursing Home

This inspection was carried out on 12th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 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 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 London SW11 1YF Lead Inspector Janet Pitt Unannounced 12 April 2005 10:25 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 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 Version 1.10 Page 3 SERVICE INFORMATION Name of service Hazel Court Nursing Home Address Haydon Way, Wandsworth, Off St Johns Hill, London SW11 1YF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8870 6933 020 8871 0824 SHAW Homes Limited Mrs Ann Hinds Care Home with Nursing 24 Category(ies) of Dementia-over 65 years of age (24) registration, with number of places Hazel Court Nursing Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 7th December 2004 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 accomodation 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. Hazel Court Nursing Home Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was undertaken unannounced by one inspector. The inspection commenced at 10:25 hrs and concluded at 16:00 hrs. Service user files and staff records were examined. A tour of the premises was undertaken. The inspector spoke with two service users and one visitor. The service users thought the care was adequate and the visitor, who was a health professional had concerns regarding the care planning process and documentation of care. The inspecting pharmacist undertook an unannounced visit on 19th April 2005 and his findings are reflected in this report. Due to requirements not being met from previous inspections an Enforcement Notice was served after the inspection in relation to the content of service user plans and the poorly maintained environment. What the service does well: What has improved since the last inspection? What they could do better: Completion of assessments of service users and care plans needs to be improved to ensure that all care needs are assessed and demonstrated to be met. Daily records need to reflect the care given and provide sufficient detail of changes in condition and interventions. Risk assessments need to be completed fully and consent obtained for cot side usage. To ensure that service users are not subject to unnecessary restraint. Hazel Court Nursing Home Version 1.10 Page 6 Medicines within the home need to be accurately recorded to ensure that there is an appropriate audit trail and the home can demonstrate that service users are not at risk from errors. Daily activities provided for service users need to be in place to demonstrate choice for service users and indicate that service users are enabled to maintain personal interests. Attention must be given to ensuring that the environment provides a homely atmosphere and repairs and redecoration are undertaken in a reasonable time. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hazel Court Nursing Home Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Hazel Court Nursing Home Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 3 Failure to complete assessments of service users on admission does not enable the home to ensure that care needs are identified. This puts service users at risk of not having their care needs met. EVIDENCE: The Statement of Purpose was examined. A Requirement from the previous inspection to ensure that the document reflected the service provided. This has been achieved. However, the correct Regulatory Authority was not reflected in the complaints procedure, which does not provide accurate information for service users or their representatives. The structure of the care documentation is Standard compliant, which provides a good basis for assessment of service users needs, but assessments not being fully completed and lack of detail of service users wishes in the event of death and dying, does not demonstrate that service users are involved in planning their care. (see comments under Health and Personal Care). Service users assessments examined were not completed fully e.g. the continence assessment on one service user was partly filled in, an assessment on behavioural and mental health needs was not completed and food likes and dislikes were not completed on two of the assessments. Which places service Hazel Court Nursing Home Version 1.10 Page 9 users at risk of not having care needs identified and adequate information being available to inform the care planning process. The background and social assessments were not completed fully, for example on one assessment it stated that the daughter’s birthday was important, but did not record the date of the birthday. This indicates that the life of service users is not an important part of the process and does not give an holistic perspective of the service users needs. Lack of recording of vital information, such as medicines on admission and whether they are to be continued, places service users at risk of not receiving the correct medical treatment. Assessments undertaken by other health professionals were present in the service user files, but information had not always been transferred to the admission assessment undertaken by the home. Hazel Court Nursing Home Version 1.10 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 11 Progress has been made on ensuring that service user plans have a clear structure. Further work is required to ensure that care given is accurately assessed, recorded and evaluated to demonstrate that care needs are met and ensure service users are not at risk. Omissions in administration, directions and recording of medication put service users health and welfare at risk EVIDENCE: Four service user plans were examined, not all contain recent photographs of the service user, although consent forms for photographs were in place, this does not enable staff to correctly identify a service user. Lack of consistent evaluation and review of care/support plans places service users at risk of not receiving appropriate care. Risk assessments relating to pressure area care had not been consistently reviewed, which places service users at risk of changes in condition not being identified and acted upon. Staff were aware of the use of pressure relieving aids but this had not been detailed in the care plan and this practice could Hazel Court Nursing Home Version 1.10 Page 11 mean that important information regarding service users is not known to all care staff. Use of cot sides without consent is a form of restraint and impacts on service users rights and dignity. Evidence of input by other health professionals was available, which indicated that the home is aware of the need to ensure that all care needs are met. However, lack of detail in recording of a wound, did not evidence whether healing was occurring. Identified care needs were not consistently followed through in the care planning process, therefore there was no evidence to support that conditions were being monitored consistently and the use of medication was effective. Service users and their representatives had not indicated that they were involved in the care planning process; this suggests that their views had not been sought. Views on death and dying had not been obtained, thus not respecting service users choice. Entries were noted not to have legible signatures and there was no indication of the time the entries were made. Another health professional present at the time of inspection commented that there was ‘no re-assessment or follow through’ of care planned. Recording of care given to service users contained vague statements such as ‘today did not shout much’, ‘very noisy’ and ‘challenging behaviour’. This did not demonstrate that appropriate interventions by staff were made to ensure that service users safety was maintained. The Inspecting Pharmacist examined medications on 19th April 2005 and the following was found: The written policies and procedures were found to be adequate on the last inspection and were not reviewed on this visit. Observations of medicine admistration revealed that eye medication had not been given, indicating that service user had not received appropriate treatment. Review of prescribed medications had not been acted upon, resulting in service users receiving medication that had been discontinued, placing their health at risk. Discussion with a staff member revealed that large quantities of medication had been returned to the pharmacist, with no information of why. Medication had also been prescribed to service users outside of guidelines. Both of these issue place service users at risk of harm. It was not possible to evidence whether all service users had received their correct medication, as the quantity received, directions for use and variable Hazel Court Nursing Home Version 1.10 Page 12 dose was not accurately recorded and there were gaps in recording. Which places service users at risk of not receiving the correct medication. Hazel Court Nursing Home Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 Limited progress has been made on providing daily activities for service users. The practice within the home does not ensure that social needs of people living in the home are met. EVIDENCE: A Requirement from the two previous inspections to ensure that there is a programme of activities for service users to participate in has not been met. The manager stated that the activities co-ordinator had recently left and there are plans to advertise the vacancy. On the day of inspection in the small lounge a television and radio were on and the service user who wished to watch television, was unable to hear the programme because of the radio. There was no plan of activities available and there was no evidence of activities being carried out by care staff. Hazel Court Nursing Home Version 1.10 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The complaints process and Protection of Vulnerable Adults procedure indicate that there are systems in place for dealing with these issues if they occur and service users safety is maintained. EVIDENCE: The absent of complaints since the previous inspection demonstrates that service users and their representatives had no concerns at the time of inspection The complaints policy did not detail the current Regulatory Authority, which does not provide accurate information for service users to act on if required. The manager reported that there were no Protection of Vulnerable Adults investigations at the time of inspection. The policy relating to Vulnerable Adults was examined and noted to be satisfactory and give information on the procedures to be followed, which indicates that there are appropriate procedures in place to protect service users from abuse. Hazel Court Nursing Home Version 1.10 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,23,24,25 and26. The standard of the décor within this home is poor with little evidence of improvement through maintenance or future planning. The home does not, therefore, present as a homely and comfortable environment for service users. EVIDENCE: Carpeting in two service users rooms and the corridors was old, stained and worn, there was food debris over the carpet in the main lounge and dust on door frames, three toilets examined required the flooring to be replaced, as the flooring was old and worn. This does not provide a safe, comfortable homely environment for service users. Inadequate storage of food in the fridge in the blue/beige unit was identified. There was half eaten food, an unlabelled bottle of liquid and out of date food in the fridge. This was disposed of on the instructions of the inspector. Food was found to be stored in the fridge on the pink unit at too high a temperature and items of food, which required refrigeration, were on a work surface. Hazel Court Nursing Home Version 1.10 Page 16 Inappropriate storage and handling of food place service users at risk of harm from infection and food poisoning. A Requirement from the previous inspection for risk assessments relating to call bells and lighting cords has not been met. The home has adequate communal, bathing and toilet facilities for service users. There was evidence of service users personalising their rooms. Hazel Court Nursing Home Version 1.10 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30 Improvements have been made on the information collated on employees and checks made. But the home needs to explore ‘gaps’ in employment history to ensure that service users are protected from harm. EVIDENCE: The published duty rota indicated that there were adequate care staff available on the day of inspection. However, minutes of a staff meeting indicated that staff were deployed from the home to assist in the day centre, thus breaching staffing levels. An immediate requirement was issued on the day of inspection to stop this occurring again, to ensure adequate staffing levels to provide care for the existing service users. Lack of high dusting placed service users at risk from infection and on discussion with a domestic member of staff; it was found that adequate equipment had not been provided. Two staff files were examined; both members of staff had recently been recruited. All relevant information and checks had been carried out. One employee had a ‘gap’ in their employment history, which had not been adequately evidenced, which places service users at risk of harm. A copy of the planned mandatory training was provided and noted to be satisfactory. The manager informed the inspector that training files relating to staffs Foundation training were being reviewed. Therefore the Requirement Hazel Court Nursing Home Version 1.10 Page 18 timescale from the previous inspection will be extended to allow for this work to be completed. Hazel Court Nursing Home Version 1.10 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 The Commission is unable to form a judgement on whether the manager is ‘fit’ and suitable to managed the home, due to the delay in applying for registration, thereby placing service users at risk. EVIDENCE: The manager of the home had at the time of inspection not formally applied for registration with the Commission. The manager has been in post for six months and it is expected that an application be made upon appointment. Hazel Court Nursing Home Version 1.10 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 1 x 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 x 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 x 15 x COMPLAINTS AND PROTECTION 1 1 3 x 2 3 2 1 STAFFING Standard No Score 27 2 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 1 x x x x x x x Hazel Court Nursing Home Version 1.10 Page 21 yes Are there any outstanding requirements from the last inspection? 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 1 Regulation Schedule 2&4 Requirement The registered person must ensure that the correct Regulatory Authority is reflected in the complaints document. (The previous timescale of 28/02/05 not met). The registered person must ensure that service user assessments are fully completed and contain specific details. (The previous timescale of 28/02/05 not met). The registered person must ensure that service user plans include specific details of care given and contain legible signatures. (The previous timescale of 28/02/05 not met).Subject of an Enforcement Notice. The registered person must ensure that service user plans are evaluated monthly and evidence that there has been service user or representative involvement. The registered person must ensure that wounds are accurately documented. (the previous timescale of 28/02/05 not met). Version 1.10 Timescale for action 30th June 2005 2. 3 14 30th June 2005 3. 7 15 20th May 2005 4. 7 15 30th June 2005 5. 8 Schedule 3 (3) (k) 30th June 2005 Hazel Court Nursing Home Page 22 6. 8 13 (4) (c) 7. 8 13 (4) (c) 8. 9 13(2) The registered person must ensure that Waterlow pressure sore risk assessments are reviewed monthly. The registered person must ensure that consent forms for the use of cot sides are in place, prior to the use of cot sides. and the use of the cot sides is reviewed monthly. Immediate Requirements: The registered person must ensure that all staff record the administration/nonadministration of medication accurately on the administration record. The registered person must ensure that the receipt of all medication is recorded accurately. The registered person must inform the GP that two service users have not received their eye medication and complete an incident form for the errors. The incident form must be sent to the local CSCI office. 09.00am on 21st April 2005. 30th June 2005 30th June 2005 20th April 2005 9. 9 13(2) The registered person must 16th May ensure that directions for use are 2005 available for all items of prescribed medication received into the home labelled “to be used as directed”. The registered person must ensure that all expired items and items of medication no longer prescribed are removed from use and disposed of appropriately. The registered person must ensure that the quantity of medication carried over from one Hazel Court Nursing Home Version 1.10 Page 23 month to the next is recorded on the administration record. The registered person must ensure that the doctor reviews the medication used outside the national guidance. The registered person must ensure that the service users wishes relating to death and dying must be recorded.(the previous timescale of 28/02/05 not met) Subject of an Enforcement Notice. The registered person must ensure that there is a planned programme of activities in place (the previous timescale of 28/02/05 not met). Subject of an Enforcement Notice. The registered person must ensure that the carpeting in the corridors are replaced.(The previous timescale of 28/02/05 not met) Subject of an Enforcement Notice. The registered person must ensure that the flooring in the toilets are adequately repaired or replaced. (the previous timescale of 28/02/05 not met). The registered person must ensure that the home is clean and hygienic throughout; high dusting is done routinely. Remedial action to ensure fridges are maintined at the correct temperature must be undertaken, to prevent the risk of food poisoning. The registered person must ensure that risk assessments relating to call bells and lighting cords are in place. (the previous timescale of 28/02/05 not met). Subject of an Enforcement Notice. Version 1.10 10. 11 12 (2) 20th May 2005 11. 12 16 (2) (n) 20th May 2005 12. 19 23 (2) (d) 20th May 2005 13. 21 23(2) (b) 20th May 2005 14. 26 13(4c) 20th May 2005 15. 22 13 (4) (a) 20th May 2005 Hazel Court Nursing Home Page 24 16. 29 Schedule 2 (6) 17 and 18 (1) (c) 17. 30 18. 31 9 The registered person must ensure that any gaps; in employment history are explored. The registered person must ensure that care home staff records are maintained separately from other workers records. Foundation training in line with National Organisational training targets must be implemented. (the previous timescale of 28/02/05 has been extended.) The registered person must ensure that the manager applies for registration with the CSCI. 30th June 2005 30th June 2005 2nd June 2005 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 9 Good Practice Recommendations it is recommended that the reason for disposal be recorded when large amounts of medication are returned. Hazel Court Nursing Home Version 1.10 Page 25 Commission for Social Care Inspection Ground Floor - CSCI 41-47 Hartfield road Wimbledon SW19 3RG National Enquiry Line: 0845 015 0120 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. 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