CARE HOMES FOR OLDER PEOPLE
Hazeldene Nursing Home 84 Poole Road Darnall Sheffield South Yorkshire S9 4JQ Lead Inspector
Janice Griffin Unannounced Inspection 27th February 2006 09:30 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 Hazeldene Nursing Home DS0000021784.V285303.R01.S.doc Version 5.1 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. Hazeldene Nursing Home DS0000021784.V285303.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Hazeldene Nursing Home Address 84 Poole Road Darnall Sheffield South Yorkshire S9 4JQ 0114 242 5757 0114 242 1312 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) S & S Health Care Mrs Susan Horne Care Home 60 Category(ies) of Dementia - over 65 years of age (60) registration, with number of places Hazeldene Nursing Home DS0000021784.V285303.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 3rd November 2005 Brief Description of the Service: Hazeldene is a 60-bed home for older people. It is in a residential area of Sheffield with good access to public services and amenities (e.g. bus services, shops, pubs, etc). It is over two floors both serviced by a lift. All the bedrooms are single and there are a suitable number of lounges and dining rooms. The gardens are landscaped and it has a small car park. Hazeldene Nursing Home DS0000021784.V285303.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place from 9:30 am to 3:30 pm. The reason for the inspection was to check out issues of concern noted in previous inspection visits and to check out issues of concerns raised by two complainants in complaints made to the CSCI. As part of the inspection process eight staff, including the two managers on duty, were spoken to. A number of records were examined and several areas of the building were inspected. The inspectors were pleased to note that throughout the inspection staff interacted positively and sensitively with each service user. The inspectors would like to thank service users, the managers and staff for their commitment to the inspection process What the service does well: What has improved since the last inspection? What they could do better:
Although the owners of the home have tried to improve the organisation and management of the home, at present the service users are not benefiting from a well run home. Service users are not overall, benefiting from the ethos, leadership and management approach of the home at this point, even though it is acknowledged that the manager is very experienced. Service users rights and best interests have not been safeguarded by the homes record keeping policies and procedures as they had not been followed and could have placed service users at risk of harm. The service users health and safety had not been promoted and protected in several areas and had once again could have placed them at risk. Hazeldene Nursing Home DS0000021784.V285303.R01.S.doc Version 5.1 Page 6 The registered owners must ensure that they produce a quality assurance system to ensure that the responsible individual following their visits to the home makes thorough checks on all aspects of the service provision. The managers must produce a system to monitor the health and safety needs of service users and report any concerns to the service users GPS immediately. The reviews of pressure area care must be done weekly and recorded. The daily recording of all health and safety checks made on service users must be fully completed. Steps must be taken to eradicate the offensive smell in some parts of the home. Complaints made to the manager must be fully investigated within the homes complaints procedures and timescales. A record must be kept of all of all complaints made to the home, including details of any investigation made by the manager. Records of all complaints made and investigation reports must be kept on site at the home and available for inspection. The local office of the CSCI must be notified without delay of all deaths, illness’s and other events as detailed in Regulation 37 of the Care Homes Regulations 2001.The homes contract of care must detail what basic toiletries will be provided by the home. Medication for external use must be kept in secure place at all times. Old out of date food must not be kept in the fridges that house food for service users. Service users must be offered a choice of meal at all meal times. All care staff must have training for caring for service users with severe mental health problems. Areas around the home with damaged decoration must be redecorated. The dirty/damaged easy chairs must be cleaned or replaced. All areas of the home must be kept clean at all times. 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. Hazeldene Nursing Home DS0000021784.V285303.R01.S.doc Version 5.1 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 Hazeldene Nursing Home DS0000021784.V285303.R01.S.doc Version 5.1 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 the following standard(s): 2. The home had a detailed service user guide and statement of purpose that clearly provided service users with the necessary information regarding the services and facilities provided by the home. Each service user had been provided with a contract containing most of the relevant information, but the contract needs reviewing. EVIDENCE: The home had a detailed service user guide and statement of purpose that provided service users with the necessary information regarding the services and facilities provided by the home. Service users were able to have informal introductory visits to the home. Each service user had also been provided with a contract containing most of the relevant information, however it was stated in three service users contracts that the home would provide the service users with basic toiletries but checks made on the service users account sheets showed that they were in fact being charged for some toiletries provided, it was not clear who was responsible for providing which toiletries. Hazeldene Nursing Home DS0000021784.V285303.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8,9 and 10. Service users received individual personal support that promoted their privacy, dignity and independence. Some monitoring charts had not been fully completed. Procedures were not in place to closely monitor all the health, safety and personal care of each service user. Medication for external use was noted to be insecurely stored. Hazeldene Nursing Home DS0000021784.V285303.R01.S.doc Version 5.1 Page 10 EVIDENCE: The case files of two service users were checked and it was noted some weeks ago that staff had recorded in their daily notes that both were showing signs of being ill. The records showed in one case it was 16 days before a Doctor was asked to visit and in the other 18 days. Four service users had pressure sores and the tissue viability nurse was visiting the service users to advise staff on the treatment of the pressure sores, however pressure care charts were not being reviewed on a weekly basis. Records kept of the health and safety checks for some service users were not fully completed. It was noted that there were a very high number of accidents to service users, there was no evidence that showed the manager was monitoring the accidents. The staff gave examples of how on a daily basis they respected service users right to privacy and dignity, but some said they had not received training in mental care, this they felt would help them to understand how privacy and dignity could continue to be maintained for people living with dementia. There was a system in place for the booking in of medication and for the recording and administration of medication. Medication for external use was noted to be insecurely stored. Hazeldene Nursing Home DS0000021784.V285303.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 15. The meals provided for some service users were balanced, to the liking of some service users, but not all. EVIDENCE: The day staff informed the inspectors that the night staff gave some service users their breakfast before going off duty; this was usually about 7:00am the breakfast was usually a food supplement or cereals and a drink. The service users were not offered any other choice of other food when the breakfast was served later. This does not allow those service users a choice of cooked food at breakfast time. The fridge in the upstairs kitchenette contained yoghurt that was out of date and portion of old dry cake, the managers said they believed the food was the property of a member of staff. Hazeldene Nursing Home DS0000021784.V285303.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 16 and 17. The homes complaints procedure was clear, accessible and contained the necessary information. Service users were not protected from abuse by the homes procedures. EVIDENCE: Details of how to make a complaint was provided to service users and their relatives, and displayed in the home. Records were not kept of all complaints made at the home. The managers on duty said the home had recently received a complaint from the local hospital about the attitude of two members of staff. There was no evidence available at the home to show that the complaint had been fully investigated by the manager. Another incident noted by the inspectors was the records of one service users showed that she had been found last year with a fractured shoulder, the records showed that the relatives had asked how the service user had sustained the injury, the manager reported that she was not sure but there was no evidence kept at the home to indicate whether the manager had investigated why the service user had sustained a fractured shoulder. This does not protect the service users from abuse. Hazeldene Nursing Home DS0000021784.V285303.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 19,20,21,22,24 and 26. The location and layout of the home is suitable for its stated purpose. Some service users bedrooms smelt offensively, some had damaged decoration and some did not have a lockable facility. The home was generally clean. Some areas of the building were in need of redecoration and some easy chairs need cleaning or replacing. EVIDENCE: Some bedrooms had an offensive smell. The bedroom doors were fitted with suitable door locks but lockable facilities were not provided in all rooms. Some areas of the building were in need of redecoration. Hazeldene Nursing Home DS0000021784.V285303.R01.S.doc Version 5.1 Page 14 Lounges and dining rooms were homely but some of the chairs were badly stained in parts. Some string light cords were stained. Service users could choose to meet with their visitors in these rooms or in the privacy of their own bedroom. The appropriate seating had been provided in the garden for those service users wishing to sit outdoors whenever the weather permitted. Each floor had a number of toilets and bathrooms provided as required. Toilets were easily accessible as they were close to lounge and dining areas. The kitchen drawers in the small kitchenette were dirty. Staff spoken to said they were provided with protective aprons and gloves. They also said that they were provided with suitable lifting equipment. Hazeldene Nursing Home DS0000021784.V285303.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30. The number and skill mix of the staff met most of the service users needs. The rotas checked did contain enough details of the staff. Care staff that had a range of skills and experience, which should effectively support service users. EVIDENCE: The staff said that staffing levels were always enough to meet the needs of the service users .On the day of the inspection four qualified nurses, nine care assistants, one administrator, two kitchen staff and four domestic assistants were on duty at the home. The home had a training and development plan and all staff had completed a range of training relevant to their role. Some staff said they would benefit on more training on dealing with service users with mental health problems. Hazeldene Nursing Home DS0000021784.V285303.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,37 and 38. Although the owners of the home have tried to improve the organisation and management of the home, at present the service users are not benefiting from a well run home. Service users are not overall, benefiting from the ethos, leadership and management approach of the home at this point, even though it is acknowledged that the manager is very experienced. The homes record keeping, policies and procedures do not safeguard service users rights and best interests as they had not been followed and have placed some service users at risk of harm. The service users health and safety had not been promoted and protected in several areas. Hazeldene Nursing Home DS0000021784.V285303.R01.S.doc Version 5.1 Page 17 EVIDENCE: The manager is a registered nurse who has a lot of previous management experience in residential care settings. The current management arrangements were not organised. There was little evidence of direction. The managers on duty were co-operative with inspectors and responded to all requests for information and investigations in a professional manner. There was evidence from recent complaints and this inspection that the home is not running at an acceptable, safe level at present. The care given to some service users meets some basic primary needs, but does not meet the full range of health care needs. At present the home is not meeting the service users needs in an acceptable manner. The nature of incidents and complaints at the home are very concerning, the fact that some procedures and polices have not been followed. The responsible individual had been visiting the home at regular intervals put his monthly reports show he has not pick up on the poor quality of service provided at this home. The safe storage of medication is not being managed appropriately and the general levels of record keeping in many areas are wholly inadequate. All of these practices could place service users at risk from harm and are not acceptable in a registered care home. Hazeldene Nursing Home DS0000021784.V285303.R01.S.doc Version 5.1 Page 18 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 2 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 1 3 3 3 X 1 X 1 STAFFING Standard No Score 27 4 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X X X 2 1 Hazeldene Nursing Home DS0000021784.V285303.R01.S.doc Version 5.1 Page 19 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. 2. Standard OP2 OP8 Regulation 4 12 Requirement The homes contract of care must detail what basic toiletries the home will provide. A weekly review of the service users pressure sore care must be completed and recorded in the service users case notes. All sections of health care monitoring charts must be fully completed by the nurse in charge on each shift. The service users GP must be informed immediately of any service user showing signs of being ill. Medication for external use must be kept in a secure place at all times. Timescale for action 01/05/06 01/03/06 3. OP8 12 27/02/06 4. OP8 12 27/02/06 5. OP9 13 27/02/06 6. OP8 12 7. 8. OP15 OP18 16 37 The manager must set up a 27/02/06 system to monitor the accidents to service users and the risk assessment updated accordingly. All service users must be offered 01/03/06 a choice of food at all meals. All notifiable incidents as detailed 27/02/06 in Regulation 37 of the Care Homes Regulations 2001 must be reported to the CSCI.
DS0000021784.V285303.R01.S.doc Version 5.1 Page 20 Hazeldene Nursing Home 9. OP26OP19 12 10. 11. 12. 13. 14. 15. OP26 OP19 OP24 OP26OP19 OP26 OP30 12 23 16 23 12 18. The premises must be kept clean. Therefore steps must be taken to eradicate the offensive smell in some bedrooms. Old out of date food must not be kept in the service users fridges. Those areas with stained decoration must be redecorated A lockable facility must be provided in each bedroom. The dirty chairs must be cleaned or replaced. The string light cords must be replaced. 01/03/06 27/02/06 01/05/06 01/05/06 01/04/06 01/04/06 At least 50 of the staff must be 01/05/06 trained to NVQ level 2. All care staff must have training on caring for service users with severe mental health problems. Improvements must be made in 01/05/06 how the home is run, therefore the manager must :Investigate all complaints made at the home and records must be kept of all complaints made and include details of any investigation reports. The responsible individual must ensure that a thorough check is made of all aspects of the service provision following his monthly monitoring visits to the home. Records must be maintained and available for inspection as detailed in section 17 of the Care Homes Regulations 2001. 01/04/06 16. OP16OP32 OP31 9,17. 17. OP33 26. 18. OP37 17. 28/02/06 Hazeldene Nursing Home DS0000021784.V285303.R01.S.doc Version 5.1 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hazeldene Nursing Home DS0000021784.V285303.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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. Extracts may not be used or reproduced without the express permission of CSCI Hazeldene Nursing Home DS0000021784.V285303.R01.S.doc Version 5.1 Page 23 - 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!
