CARE HOMES FOR OLDER PEOPLE
Hazel House Nursing Home Hazel House Nursing Home 30 Paradise Lane Moss Side Leyland Preston Lancashire PR26 7ST Lead Inspector
Mrs Marie Matthews Key Unannounced Inspection 30th May 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 House Nursing Home DS0000025562.V333147.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 House Nursing Home DS0000025562.V333147.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Hazel House Nursing Home Address Hazel House Nursing Home 30 Paradise Lane Moss Side Leyland Preston Lancashire PR26 7ST 01772 452750 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) hazelhousecare@btconnect.com Hazel House Nursing Home Limited Mrs Lynn Cosgrove Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43), Physical disability (10) of places Hazel House Nursing Home DS0000025562.V333147.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. The home is registered for a maximum of 43 service users to include: Up to 43 service users in the category of OP. Up to 10 service users in the category of PD aged 60-64. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. 27th March 2006 Date of last inspection Brief Description of the Service: Hazel House Care Home provides 24 hour nursing and personal care for up to forty-three people of either sex. Hazel House is situated in a quiet cul-de-sac in Leyland close to local amenities. The home provides accommodation mainly in single rooms, although shared rooms are available for married couples, friends or people who prefer to share facilities. Accommodation is provided over two floors and a passenger lift enables wheelchair users and the less mobile access to all areas. There are three separate lounge areas for residents to join in activities or sit quietly enjoying more solitary pursuits. Information about the services offered by the home is provided in the form of a service user guide and is available, with a summary of the most recent inspection report, to existing and prospective residents and their relatives. On the day of the inspection the weekly fees ranged from £405.00 to £565.00. Items not included in the fee include newspapers, hairdressing and some excursions. Hazel House Nursing Home DS0000025562.V333147.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The key unannounced inspection, including a visit to the home, took place on 30th May 2007. The inspection process included looking at records, a tour of the home, discussion with the registered provider, registered manager, two staff, four residents and three visitors. Information was also included from survey forms completed by four visitors and fifteen residents. The inspection also looked at things that should have been done since the last visit and a number of areas that affect people’s lives. There were thirty-six residents living in the home on the day of the inspection. What the service does well:
People were given clear information about available services to help them to decide whether the home was suitable for them and whether their needs would be met. One resident said it had been ’useful to gain information about the home. Staff were very supportive in helping me to settle into the home’. Each resident had individual care plans that were developed from the initial assessment information and included details about how residents needs would be met. Records showed that residents and their relatives had been involved in decisions about their care. Relatives said they were kept up to date and consulted about changes to care. Medication policies and procedures were clear and had been reviewed to ensure nursing staff had access to safe guidance. Residents said they received the care and attention they needed. Staff were friendly and aware of people’s needs and treated residents and visitors with respect and kindness. One visitor said staff not only looked after her relative but also supported the family and this was ‘greatly appreciated’. A range of activities and entertainments were provided to ensure resident’s diverse needs and expectations were met. Hazel House Nursing Home DS0000025562.V333147.R01.S.doc Version 5.2 Page 6 Residents received a choice of healthy and varied meals that suited their individual preferences and requirements. Positive comments were made about the standard of the meals; one resident said ‘the food is excellent’. The complaints procedure was clear and accessible to people; people knew how to complain, whom to complain to and were satisfied that their complaint would be dealt with appropriately. The adult protection procedure was detailed and provided staff with clear and appropriate guidance to help them protect residents. Residents lived in an attractive, safe, well-maintained and comfortable environment that was suited to their diverse needs. The staff team were experienced and competent and provided in sufficient numbers to meet resident’s needs. Safe recruitment procedures were followed to ensure residents were not put at risk. One care worker said ‘the team works well together’. Comments from residents included ’I’m looked after very well’, ‘I can’t ask for better care’ and ‘the care is faultless’. One visitor said ‘matron and staff provide an excellent service’. A number of systems were in place to obtain people’s views and opinions as to whether the home was meeting their needs and expectations. It was clear from discussion and documentation that people were involved in decisions about the way the home was run. The home was safe and well managed by a qualified and competent manager. What has improved since the last inspection?
The gardens were safe, accessible and well maintained; a sensory garden, patio furniture and raised flower beds had been provided to ensure all residents and their visitors could enjoy the gardens. There was a development plan that supported ongoing and future improvements to the premises that would ensure residents were provided with a pleasant environment to live in. Hazel House Nursing Home DS0000025562.V333147.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hazel House Nursing Home DS0000025562.V333147.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hazel House Nursing Home DS0000025562.V333147.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People were given clear information about services offered by the home to be able to decide whether the home was suitable for them and whether their needs would be met. EVIDENCE: Residents and visitors said they had been given enough information about the home and had been visited by staff prior to admission. One resident said it had been ’useful to gain information about the home. Staff were very supportive in helping me to settle into the home’. One lady who had recently been admitted confirmed she had been given lots of ‘useful information about the home’. Prospective residents and their visitors with supplied with an admission pack that included the service user guide, brochure and newsletter;
Hazel House Nursing Home DS0000025562.V333147.R01.S.doc Version 5.2 Page 10 an album containing photographs of different areas of the home was used for those residents that were unable to visit the home prior to admission. Detailed information was collected about residents before they were admitted to the home to determine they could be looked after properly and then the home confirmed they were able to meet their needs. Records showed that staff were given appropriate training to help them to meet resident’s diverse and changing needs. Hazel House Nursing Home DS0000025562.V333147.R01.S.doc Version 5.2 Page 11 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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s individual health and personal care needs were met. EVIDENCE: Three residents care plans were looked at in detail. The individual care plans were developed from information obtained prior to admission and included details about how residents care needs would be met. Records showed that residents and their relatives had been involved in decisions about their care. Relatives said they were kept up to date and consulted about changes to care. Risk assessments were in place and action to be taken by care workers to reduce any risks had been included in the care plan. Each resident had been assessed as to their risk of injury from falling although instructions to guide staff had not always been included in a plan of care. Hazel House Nursing Home DS0000025562.V333147.R01.S.doc Version 5.2 Page 12 Records and discussions with residents confirmed they were given assistance and support by staff when needed and that they had access to other healthcare professionals. Staff had received training to help them to meet resident’s health care needs; health care magazines were provided as reference. All residents had key workers to help them to settle into the home and maintain a special relationship with. Residents were provided with a range of specialised aids and adaptations to maintain their comfort and safety and to help them to maintain their independence wherever possible. Medication policies and procedures were clear and had been reviewed to ensure nursing staff had access to safe guidance. Residents who wished to self medicate would be supported by nursing staff using the safe procedure. Records were clear and accurate and showed that the system was well managed. However nursing staff needed to ensure all handwritten directions were witnessed by a second person to reduce the risk of error and any medicines prescribed ‘as needed’ should have clear protocols to support staff with their decisions to administer medication or not. Some of the medication procedures needed minor adjustment to ensure staff had access to clear and safe guidance these included the ordering procedure to reflect that prescriptions should be seen by the nursing staff prior to dispensing by the chemist, the oxygen procedure needed to include use of appropriate signage and a PRN medication procedure should be developed. Medicine storage areas were clean and safe and appropriate for the storage of medicines although the temperatures of storage areas needed to be regularly recorded. Residents said they received the care and attention they needed. Staff were friendly and aware of people’s needs and treated residents and visitors to the home with respect and kindness. One visitor said staff not only looked after her relative but also supported the family and this was ‘greatly appreciated’. Staff were seen respecting people’s privacy in various ways. Hazel House Nursing Home DS0000025562.V333147.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 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Social, cultural and recreational activities met resident’s diverse needs and expectations. Residents received a healthy, varied diet that was suited to their individual preferences and requirements. EVIDENCE: Residents said they were able to make choices and decisions about their life in the home. One resident said ‘ I can suit myself what I do’. Bedrooms had been personalised and some residents had brought in their personal belongings to enhance the homely atmosphere. Records showed that a range of suitable activities and entertainments were provided and each resident had an activity record showing their participation in either group or one to one activities and whether this had been enjoyed. One visitor said there was ‘more variety in activities now which makes a huge difference’. One residents said he had been provided with an electric keyboard as he had expressed an interest in music another resident said he enjoyed the gardens and was able to maintain a herb garden in the raised beds. There had
Hazel House Nursing Home DS0000025562.V333147.R01.S.doc Version 5.2 Page 14 been various excursions and the residents had use of a minibus, one resident confirmed he had been asked where he would like to visit; a record was maintained of the various entertainments information included whether residents had enjoyed them or not. Prayer and praise sessions were held to meet the spiritual needs of residents who were unable to visit their place of worship; records showed that staff would be able to meet the needs of people from different cultures. Residents confirmed their visitors were made to feel welcome. Visitors said nursing staff and care workers were ‘very friendly’ and ‘very supportive’. Residents and their relatives said friends and relatives were always made to feel welcome and could visit at any time and in any area of the home. The menu showed that people were offered a varied and nutritious diet and alternative meals were always available; this was confirmed by a number of residents although not supported with a detailed record of food served. Residents made positive comments about the standard of the meals and said they could dine in their room or in the dining areas. One resident said ‘the food is excellent’. A qualified nutritionist regularly reviewed the menus to ensure residents were provided with a varied, appealing and nutritious diet that met their needs and preferences. Hazel House Nursing Home DS0000025562.V333147.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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents had access to a clear and effective complaints procedure and were protected from abuse. EVIDENCE: The complaints procedure was clear and accessible to people; people knew how to complain, whom to complain to and were satisfied that their complaint would be dealt with appropriately. One resident said he had no complaints but any ‘grumbles’ had been sorted out to his satisfaction. Another resident said he had no complaints but had been told who to speak to if he was unhappy. Records showed that complaints and concerns had generally been responded to appropriately although some records did not always record sufficient detail about the complaint and it was unclear whether the issue had been dealt with appropriately. The adult protection procedure was clear and provided staff with clear and appropriate guidance although contact information for local agencies should be attached to the procedure to ensure staff could quickly access the information if needed. Two care workers were spoken to and were aware of action to be taken to protect residents if abuse was suspected; it was recommended that
Hazel House Nursing Home DS0000025562.V333147.R01.S.doc Version 5.2 Page 16 staff were provided with adult protection training to refresh their knowledge and skills in this area. Information regarding advocacy and support services was available to residents. Residents and their visitors were satisfied with the service provided and were happy they would be safe and looked after properly. Hazel House Nursing Home DS0000025562.V333147.R01.S.doc Version 5.2 Page 17 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, 20, 21, 22, 24 and 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents lived in an attractive, safe, well-maintained and comfortable environment that was suited to their diverse needs. EVIDENCE: During a tour of the home it was clear that the home was well maintained, safe and comfortable and was equipped with specialist equipment and adaptations to meet resident’s individual needs. There was a development plan that supported ongoing and future improvements. Resident’s rooms were clean and bright and most had been personalised with treasured possessions. There was a selection of communal areas where residents could sit quietly, meet with visitors or meet with other residents.
Hazel House Nursing Home DS0000025562.V333147.R01.S.doc Version 5.2 Page 18 Call bells were available within reach of residents and any requests for assistance were answered promptly. The gardens were safe, accessible and well maintained; a sensory garden, patio furniture and raised flower beds had been provided to ensure all residents could enjoy the gardens. Residents and relatives said the home was always clean, bright and odour free. Hazel House Nursing Home DS0000025562.V333147.R01.S.doc Version 5.2 Page 19 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 and 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The staff team were experienced and competent and provided in sufficient numbers to meet resident’s needs. Safe recruitment procedures were thorough to ensure residents were not put at risk. EVIDENCE: Rotas showed the home was staffed with sufficient numbers of staff to meet the needs of the residents. Two visitors had commented that staffing was not always sufficient although residents spoken to said there were enough care workers to give them the support they needed; staff spoken to felt there was enough staff on duty to enable them to provide a good standard of care to residents. The registered manager and staff confirmed that staffing numbers would be adjusted to meet the needs of the residents. Training records showed that staff were competent and skilled and received relevant training that focussed on improving outcomes for residents. Care was provided by a well-established team of staff; one care worker said ‘the team works well together’. Comments from residents included ’I’m looked
Hazel House Nursing Home DS0000025562.V333147.R01.S.doc Version 5.2 Page 20 after very well’, ‘I can’t ask for better care’ and ‘the care is faultless’. One visitor said ‘matron and staff provide and excellent service’. The recruitment procedure was clear and had been followed to ensure that residents were protected from harm. Residents were not involved in the recruitment and selection of new staff as yet. Hazel House Nursing Home DS0000025562.V333147.R01.S.doc Version 5.2 Page 21 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 and 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home was safe and well managed by a qualified and competent manager and had quality assurance systems that monitored whether people’s needs and expectations were being met. EVIDENCE: The registered manager is Mrs Lynn Cosgrove. Mrs Cosgrove has the required qualifications and experience to run the home. She leads a strong staff team who had been trained to a high standard. People spoke very highly regarding Mrs Cosgrove. One person said ‘I have a lot of respect for her’.
Hazel House Nursing Home DS0000025562.V333147.R01.S.doc Version 5.2 Page 22 A number of quality systems were in place to obtain people’s views and opinions as to whether their needs and expectations were being met. It was clear from discussion and documentation that people were involved in decisions about the way the home was run. Policies and procedures were reviewed and updated to provide current and safe guidance and systems were audited by internal and external auditors to ensure staff were following policies and procedures. Resident’s finances were safe guarded by the systems and record keeping. Systems and equipment in the home had been serviced to ensure they were safe to use. Training in relation to health and safety issues had been provided for all staff so that they were able to promote people’s health, safety and welfare. Hazel House Nursing Home DS0000025562.V333147.R01.S.doc Version 5.2 Page 23 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 4 X 4 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 4 3 3 3 X 3 X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 3 Hazel House Nursing Home DS0000025562.V333147.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO 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 OP16 Regulation 22 Requirement The complaints record must include details of the initial complaint and any action taken so that the outcome is clear. Timescale for action 16/07/07 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. 2. Refer to Standard OP7 OP9 Good Practice Recommendations Interventions to reduce or eliminate the risk of falls should be identified clearly in the care plan to guide staff. Handwritten additions or alterations to the MAR should be independently checked and countersigned to ensure safe practices. Staff should check prescriptions prior to dispensing to support safe practices and the procedure should be amended to reflect this. Medications prescribed ‘as needed’ or ‘PRN’ should be supported by clear instructions to guide staff. A procedure should be developed to support staff. Hazel House Nursing Home DS0000025562.V333147.R01.S.doc Version 5.2 Page 25 Appropriate signage should be used where oxygen is in use to ensure safe storage and the procedure should reflect this. Temperatures of medication storage areas should be checked regularly to ensure medications are stored at the correct temperatures. Records of meals served should be maintained to support that choices are given. Staff should be provided with adult protection training to refresh their skills and knowledge. 3. 4. OP15 OP18 Hazel House Nursing Home DS0000025562.V333147.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection 2nd Floor, Unit 1 Tustin Court Port Way Preston Lancashire PR2 2YQ 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
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