Inspection on 11/06/08 for Hazeldown Care Home

This inspection was carried out on 11th June 2008.

CSCI found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hazeldown Care Home 30/01/09

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

CARE HOME ADULTS 18-65 Hazeldown Care Home High Street Foulsham Dereham Norfolk NR20 5RT Lead Inspector Jenny Rose Unannounced Inspection 11th June 2008 09:15 Hazeldown Care Home DS0000071181.V366143.R02.S.doc Version 5.2 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 Hazeldown Care Home DS0000071181.V366143.R02.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 Adults 18-65. 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. Hazeldown Care Home DS0000071181.V366143.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hazeldown Care Home Address High Street Foulsham Dereham Norfolk NR20 5RT 01362 683307 01362 683257 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) www.twoacres.co.uk Devaglade Limited Manager post vacant Care Home 18 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (18) of places Hazeldown Care Home DS0000071181.V366143.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Mental Disorder, excluding Learning Disability - code MD The maximum number of service users who can be accommodated is 18 First inspection after new ownership Date of last inspection Brief Description of the Service: Hazeldown is a care home providing personal care and accommodation for 18 adults with mental health support needs. It is owned by Devaglade Limited who oversee the general management with additional management responsibility given to staff employed within the Home. The Home is situated in the village of Foulsham close to local shops, pubs, post office and certain other local amenities. The original building provides accommodation on two floors, with a newer single floor extension to the rear of the building. As a result, there are several changes of level within the home and there is no lift or other assistance to access first floor bedrooms. At this time there are 13 bedrooms, nine of which are for single occupancy and four for shared occupation. One of the shared bedrooms has en-suite facilities. Bedrooms are located on both the ground and first floors. There are two lounges, a dining room and a small kitchenette for the use of people living in the Home. There is enclosed outdoor space at the rear of the building, with a patio area. Some of the external space is also given over to (limited) car parking. There is some access to public transport in the village, but the services are Hazeldown Care Home DS0000071181.V366143.R02.S.doc Version 5.2 Page 5 fairly limited. There is a vehicle for transporting residents if required. Hazeldown Care Home DS0000071181.V366143.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The Quality Rating for this service is 0 Star. This means the people who use this service experience poor quality outcomes. Care services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. This report gives a brief overview of the service and current judgements for each outcome group. This Inspection was unannounced and took place on a weekday over 7 hours. Since December 2007 the home has changed ownership, although there have been few changes of staff or residents. Discussions took place with the newly appointed Manager, the Owner and the two-person team overseeing the change of ownership. One member of this team is the Manager of a Care Home for Elderly People with dementia needs also owned by the new Owner, who hereinafter is referred to as the “Transition Manager”. The opportunity was taken to look around the home, to listen to and observe what was going on. Three people living in the home were spoken with, as well as three staff members in private. Other residents and staff were spoken with in passing. In addition care records and policies were examined. Other information was available from the Annual Quality Assurance Assessment (AQAA), which the previous Owner/Manager had completed and returned to the Commission in March 2008, at which time she (the previous Owner/Manager) had been retained as the Registered Manager for the new Owners, until 31 May 2008. Six Comment cards completed by residents, with support from a senior carer, were received after the Inspection, (although they were dated and completed before this), and one from relatives. These were positive in the main about the quality of care received by the residents, although there are some areas, which need improvement. These comments are reflected in the Report. The range of fees is from £485 to £850 per week What the service does well: • The Home is in an old building which has been adapted to suit individuals’ ongoing complex and changing needs as far as possible It is situated in the heart of the village with access to its facilities and has provided a safe home for people living there, some for many years. People living in the Home benefit from a relaxed, friendly, homely and clean atmosphere, although there was some refurbishment taking place DS0000071181.V366143.R02.S.doc Version 5.2 Page 7 • Hazeldown Care Home at the time of the Inspection. Those bedrooms seen were personalised to individual choice. • People are supported to take part in local community facilities and to maintain contact with relatives, as appropriate. Staff understand those areas where people’s health or social skills might make this difficult or affect their motivation to join in activities and thus try to provide extra support and advice where this is needed. However, some comment cards remarked on a lack of ‘activities’ in the Home, although a number of people had recently been on a holiday. There is a vehicle and access to another larger one, shared with another home, for transporting people living in the Home. The Home - under new management - appears to continue to provide good assessments of people’s needs and abilities and whether the home is able to provide the required support for people considering moving there. Good links are established with other professional bodies to support people with their difficulties. Care staff were observed to display an understanding, attentive approach to the individual needs of the people living there, one person described the staff as being “very kind”. There was evidence of encouragement and support to people to enable them to pursue their own personal growth and development. Records for the safekeeping of people’s money appeared to be well kept and in good order. All the comment cards received stated that people knew how to make their complaints/concerns known. • • • • • • What has improved since the last inspection? • New equipment has been provided in the office and elsewhere in the Home. Redecoration and total refurbishment has taken place in several areas, including lighting and carpeting in corridors and people have chosen carpets, curtains and colours for redecoration in their rooms. Training in nutrition and healthy eating is being introduced for staff as well as Malnutrition Universal Screening Tool (MUST) assessments for everyone living in the Home. • Hazeldown Care Home DS0000071181.V366143.R02.S.doc Version 5.2 Page 8 • • • Staff spoken with said that morale had improved following a period of uncertainty during the change of ownership. Some people have been enabled to move to alternative, more suitable accommodation according to their needs. One person considering moving to the Home had been given the opportunity of visiting and choosing the colour scheme decoration and refurbishing of the room. Clinical waste disposal has been organised. • What they could do better: • • • • Outside maintenance and the car parking area could be improved Several comment cards mentioned that there could be more activities provided. Where people have no independent advocate/representative, this should be encouraged/developed. There was a Residents’ Brochure drawn up under the new management. However, this was not in a format, which would enable those people with communication difficulties to access information. There are plans for the following to be implemented by the new owners • There are issues of concern regarding medication administration, recording and storage. The manager was aware of some areas of risk, including attempting to change a long standing system and had already introduced new Medication Administration Record (MAR) sheets and was reviewing everyone’s care plans. During the changeover period of the new management, there was one particular area of ‘slippage’ in the identification of peoples’ changing needs in the care plans, although the new manager was already addressing and reviewing at least one person’s changed needs and was using this example as a staff training tool. Another area of ‘slippage’ was that a staff file for the most recently employed member of care staff did not contain the necessary recruitment documents required for the protection of the people living in the Home. Although many of the staff have achieved NVQ2 level and above and have experience, there is a need for a training programme to be DS0000071181.V366143.R02.S.doc Version 5.2 Page 9 • • • Hazeldown Care Home developed, together with staff appraisals and development, as well as to identify specialist areas of training for the benefit of individual residents. • Although staff demonstrated knowledge of how they can help to protect vulnerable adults and what they should do if they have any concerns, this should be reflected and included in written Policies and Procedures by the new owners, although these were in the process of being produced. Formal supervision by the new management, of all staff, needs to be improved, so that staff are supported, monitored and developed, although there were formatted forms in place for this. A formal quality assurance system needs to be implemented in order to ensure that the service is monitored according to the wishes and needs of the people living in the Home. The shortcomings in the records required for ensuring the health, safety and welfare of the people living in the Home and the staff should be addressed, namely, water temperatures, Legionella and Fire Alarm Testing. • • • • The Commission will be asking the new Owners to produce an Improvement Plan which will need to set out how and when these and other matters, particularly in relation to the safe administration, recording and storage of medication, are going to be addressed. 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. Hazeldown Care Home DS0000071181.V366143.R02.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hazeldown Care Home DS0000071181.V366143.R02.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The needs and aspirations of the people living in the home are well known, but the Residents’ Brochure should also be in a format accessible by people with communication difficulties. EVIDENCE: It was evident from the needs of the group of residents at the home that appropriate assessments had been carried out as to the suitability of the home to meet individual needs. Several residents had lived in the home for long periods, i.e. 20/30 years, although since the last Inspection with the former owner some people had been enabled to move to more suitable accommodation according to their needs. There had only been one new admission to the home since the last inspection of 29th May 2007, but the manager had recently undertaken the pre-admission assessment of a prospective resident who had also visited the home to ensure that the home is able to meet his/her needs. The manager confirmed he carries out a prospective resident’s mobility assessment because of the changes in level in the Home. This person had chosen the colours for redecorating the bedroom and new furniture was seen ready to be unpacked. Hazeldown Care Home DS0000071181.V366143.R02.S.doc Version 5.2 Page 12 All the comment cards stated that people had received contracts. The new Residents’ Brochure was seen which gave a clear picture of the staffing structure, and other details, but this could, in addition, be produced in a format more accessible to people with communication difficulties Hazeldown Care Home DS0000071181.V366143.R02.S.doc Version 5.2 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9,10 People who use the service experience adequate quality outcomes in this area. We have made this judgement using available evidence including a visit to this service. Improvements have started to be made in care planning to ensure staff have the information to know the support that is needed by the people living at the Home, especially to changing needs and to further involve people in making choices and decisions about their lives within their respective capacities EVIDENCE: There were some difficulties in securing the views of the people living in the home as, for the most part, they declined to talk, other than to confirm that they were happy with the service and had no complaints. There were at least two people who go out every day and therefore were not available for comment. Four comment cards, completed with the support of a senior member of staff, stated that people usually received the care and support they needed. One stated they always did and one that some staff provided the care and support they needed. Hazeldown Care Home DS0000071181.V366143.R02.S.doc Version 5.2 Page 14 The care plans and daily notes are kept separately and not organised individually, although they did also contain financial plans. However, they also varied in quality. Although all care plans contained personal information, relatives/representatives contact details and professional contacts, for example, physiotherapist, chiropodist, continence nurse and speech therapist; some did not contain a photograph. There was evidence of risk assessments and guidance for staff for support, but during the period of changeover the manager said that there had been some slippages in monitoring residents’ changing needs. The transition team (see the Summary) confirmed that this was being addressed for all care plans, which have started to be reviewed and reorganised with daily notes and care plans filed individually, rather than the present arrangement. This reorganisation was seen in one care plan, which also included a MUST assessment, which is also intended for all residents. This will address issues of confidentiality in terms of visiting professionals being able to access information promptly about support, given that this would breach the confidentiality of others. It also means that people will be empowered to access their own daily records to see what staff had written about them should they want to. In the event of any coroner’s or police enquiry original documentation would then be accessible and not have to be edited/blanked out and photocopied to protect confidentiality. Daily records showed the efforts staff made to engage people with decisions about their health. They also showed discussion about what people want to do. Staff spoken with gave consistent accounts of peoples support needs, showing that they understood these were different and treated people as individuals and this was also observed on the day. It is also intended to review the keyworker system. Information in the AQAA states that there were nine people without active family or advocate support. This form of support should be encouraged. One persons review, with a healthcare professional, was taking place on the day of the Inspection and which had been rescheduled as the person wished to be on time to take public transport, providing evidence of attention to individual needs. Hazeldown Care Home DS0000071181.V366143.R02.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. In the main people are able to make choices about their life style and are supported to develop life skills and maintain community relationships. However, some people feel there is some lack of activities. EVIDENCE: People living in the Home are from a diverse age group. There are some who are over 60 and whose home this has been for 20/30 years. Others have the capacity to go out daily, do their own shopping and laundry and one person (at least) who has part time employment. Of the six comment cards received, four said there were sometimes activities in which they could participate and two said that there were never activities in which the people participated, but at the same time there was acknowledgement that some people were unable to decide what they wished to do. (see elsewhere in this Report – Quality Assurance) Hazeldown Care Home DS0000071181.V366143.R02.S.doc Version 5.2 Page 16 One person is in the process of applying for a passport; at least two people do their own shopping and laundry. At least another two members have regular contact with family. A member of staff spoken with described a recent holiday which had been taken with several people in the home, which she confirmed had been enjoyed by residents and staff alike and provided positive outcomes for relationships. There are also outings to places of interest and the theatre. The manager said that some people enjoyed playing Bingo, several people liked to go shopping in a group, making use of the homes vehicle and one person spoken with said that he/she liked to go to the local supermarket, as well as shopping in the village. Another person particularly liked using the vacuum cleaner around the house as well as keeping his/her own room tidy and clean. One person is supported to maintain life long hobbies. People came and went freely from the home. There is a small kitchen available for residents’ use where they can make snacks on a 24hourly basis. As mentioned elsewhere in this Report, MUST nutritional assessments are in the process of being established for each person and the AQAA states that there is a wide and varied menu from which residents may choose. Of the comment cards received, one said that the meals were always good, three that they were usually good and two that they were sometimes good. The AQAA states that plans for improvement were to review menu planning with evidenciary particulars of each persons input into the planning (see elsewhere in this Report Quality Assurance Assessment). The dining room has recently been refurbished and is a light, pleasant area, and meals are served in different sittings, which reduces the flexibility of mealtimes. Hazeldown Care Home DS0000071181.V366143.R02.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s health and personal care needs are met in the main and changed needs are under review. However, there were some issues of concern in the administration, storage and recording of medication, which the manager had started to address, in order to eliminate risk to the people living in the home as far as possible. EVIDENCE: People in the main are encouraged to be self-caring as far as possible, but some people required assistance with their personal care and hygiene. Other people required prompts and yet others, indirect support from staff. Individual preferences of residents were demonstrated in their care plans so that staff should be clear about the most appropriate ways to provide support and as stated elsewhere in this Report, a review of the keyworker system is planned. As also stated elsewhere in this Report there was evidence of the involvement of other healthcare specialists, including psychiatrists and epilepsy specialists, access to GPs, dental services, chiropody and optical services. A social worker Hazeldown Care Home DS0000071181.V366143.R02.S.doc Version 5.2 Page 18 and community psychiatric nurse were attending the Home for a review on the day of the Inspection. However, the following are issues of concern in the administration, storage and recording of medication. The manager was aware of the areas of risk, including attempting to change a long-standing system, but had already begun to make changes. Issues of concern include: • • • • • The secondary dispensing system. Poor record keeping regarding the audit trail. Residents self-administering certain medication Inadequate storage facilities, including lack of refrigeration and temperature control in the storage area. The new manager had begun to redesign some of the Medication Administration Records as a monthly, rather than a weekly record and to include prn (as necessary) medication. Although staff had received training in medication, this was subject to review at a meeting called in the week following the date of this Inspection. The storage area was untidy. There was no identifiable procedure for the disposal of empty medication packets in order to ensure data protection and confidentiality. Policies and procedures for the safe administration of medication were not yet written by the new Owners to underpin safe practice. The arrangement for dispensing Homely Remedies needed review. There was no provision for the storage of Controlled Drugs, although no one in the home required these at the time of the Inspection. The Community Psychiatric Nurses administered medication where necessary and maintained their own records in the Home. • There were risk assessments seen for some people administering their own medication, but in view of other areas of slippages during the change of ownership, the manager said that all individual medications would be reviewed. There were some consent forms seen for the home to administer certain of the people’s medication. • • • • • Hazeldown Care Home DS0000071181.V366143.R02.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 People who use the service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to this service. All the comment cards received stated that people knew how to make a complaint and the procedure was contained in the brochure and people are protected from abuse as far as possible. EVIDENCE: The complaints procedure was not on display in the home but it is contained in the Brochure. All the comment cards said that people knew how to make a complaint, although the written policies and procedures for making complaints or for safeguarding people were in the process of being produced. The complaints book for the new owners was not available, but there were no complaints recorded in the AQAA nor had any been received by the Commission. From the training records all staff have received training in recognising and understanding abuse. All staff spoken with confirmed that they were confident as to how they would raise any concerns they had immediately. The manager and the Transition Team also confirmed that the local procedure for reporting any concerns was in the process of being produced by the new management. Hazeldown Care Home DS0000071181.V366143.R02.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable, clean and generally safe environment, but with various changes of floor level, where many improvements have and are taking place. The external areas require some attention. EVIDENCE: The general appearance of the home is ‘domestic’ in character and in keeping with the local community. One upstairs single room has been taken back from being a staff room and was in the process of refurbishment to the prospective resident’s choice of decoration and with new furniture; another double room was also seen to be in the process of total refurbishment. No variation of conditions has been requested and the occupancy on the day was 14 in number. There have been improvements internally with new lighting and carpets in corridors and painting all brown doors white to brighten the environment. Other communal areas were comfortably furnished. Hazeldown Care Home DS0000071181.V366143.R02.S.doc Version 5.2 Page 21 Two rooms seen on the day (by invitation) were personalised with personal possessions, pictures, photographs and ‘collections’. One resident was choosing the colour of a new bedroom carpet. All bedrooms are lockable with some residents choosing to lock doors to their own accommodation. There are many changes of floor level within the home and as mentioned elsewhere in this report, the manager said that a mobility assessment is made for prospective residents. There is no assisted means of access to the first floor. The outside surfaces at the moment are not suitable for wheelchair access and the AQAA states that there are plans to develop a sensory garden and renew garden furniture for the benefit of residents. All areas seen during the Inspection, apart from some untidiness in the medication storage area and in areas where refurbishment was taking place, were clean, tidy and hygienic. Hazeldown Care Home DS0000071181.V366143.R02.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 People who use the service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. All staff supervision should be up-to-date, recruitment documents complete and training development plans in place to ensure staff are properly trained and supervised so residents are protected. EVIDENCE: Five out of six comment cards received stated that staff listen and act on what residents said. One comment card said that some staff did this. In addition all the comment cards said that they would know - or usually know - to whom to speak if they had any concerns. All staff spoken with on the day of the Inspection referred to the residents with confidentiality and respect and that the best thing about their job was supporting the residents. Three staff members spoken with in private confirmed that staff morale had improved after a period of uncertainty during the change of ownership and they were feeling their work was appreciated by the new management team, as well as being supported in such areas as dealing with challenging behaviour. In addition, they felt their concerns were Hazeldown Care Home DS0000071181.V366143.R02.S.doc Version 5.2 Page 23 listened to and acted upon. “I think we are coming through it” was a comment from one member of staff. There were no staff vacancies on the day of the Inspection. There has been a relatively stable staff team providing consistency of care during the change of ownership, some of who have many years experience. The most recent member of staff had been in post nearly a year. Both the new owner and manager had ‘worked’ night shifts in order to experience and understand any difficulties for staff. Staff spoken with and files examined showed that staff have received induction and foundation training and have had access to a range of mandatory training including fire awareness, infection control, adult protection and good hygiene, as well as opportunities to network with other homes. More specialist training has also been undertaken in areas of medication, dementia, epilepsy, challenging behaviour and aspects of the Mental Capacity Act. However, the manager pointed out that the Training Co-ordinator from the wider organisation was due to visit the week beginning 23 June 2008 following the Inspection in order to further develop training plans and to carry out a full training needs assessment with each member of the staff team, to highlight any weaknesses and to develop a more detailed personal development plan and encourage staff in obtaining NVQ qualifications. This would also encompass a six monthly personal appraisal. Examination of staff files showed they contained proof of identity, verification of employment history, an application process including the taking up of two references and that Criminal Records Bureau (CRB) clearance had been obtained. In one file, however, there was only one written reference and the CRB information was missing. There should be evidence on file of this information being obtained to further ensure the safety of people living in the home. There is ongoing day-to-day supervision of the practice of staff by the manager and senior staff. However, more formal arrangements for a systematic approach to supervision have yet to be established by the new manager (of a few weeks), although there were plans in place for this to happen. All staff at the home must be formally supervised. This will help to ensure that care provided meets the needs of people who use the service and the philosophy of care in the home. Hazeldown Care Home DS0000071181.V366143.R02.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 People who use the service experience adequate quality outcomes in this area. We have made this judgement using available evidence including a visit to this service. The new manager is already providing leadership to the staff team and, in this, has the support of the Transition Team. There is a need under the new ownership for several issues to be addressed, but particularly a quality assurance system to ensure that the service is based on the views and best interests of the people living in the Home. EVIDENCE: On the day of the Inspection the new manager had only been in post for two weeks, although he had undertaken a short induction period with the previous owner/manager. However, he has worked for three and a half years for the new owners in the same area in a residential home for elderly people with dementia needs. He is a qualified general nurse with previous experience in Hazeldown Care Home DS0000071181.V366143.R02.S.doc Version 5.2 Page 25 psychiatric hospitals and has management experience. He has started on the NVQ4 qualification and the Registered Managers Award. He spoke of the good support he was receiving from the Transition Team and that a member of this team had previously been his Line Manager previously and would continue to provide supervision. He described his management style as working alongside staff and getting to know them as individuals in order to expect the best for the care of the residents. There is evidence that he has already been proactive in addressing acknowledged shortcomings, especially in the care plans and administration and recording of medication, and identifying further improvements the service can make in the interests of those who use it. Staff spoken with said that the new manager was approachable and wanting to get to know the staff and that the longest time they had to wait for requests for new/replacement equipment to assist them in their work was 48 hours. The new owners will be asked to submit a clear description of how staff know who is in charge and what the organisations expectations are of the new manager, what decisions he can make, what must be passed on to the new organisation and how management responsibilities are to be shared on a day to day basis. There was no formal quality assurance survey under the management of the previous owner, to gather the views of others about how satisfactorily the Home was operating. However, there was evidence of staff meetings and residents’ meetings and the new owner said that it was his intention that the agenda for staff meetings would be centred round the outcomes expected by the Commission for the National Minimum Standards. Daily notes provide evidence of discussions with residents about their preferences and goals and also that views of relatives are sought where appropriate. However, the Transition Manager confirmed that the Blue Cross system is now being implemented to seek the views of family, friends, advocates and other agencies in the community such as social workers, community psychiatric nurses, GPs and other professionals on how the home is achieving goals for the people living there. This would also include such issues (mentioned elsewhere in this report) as food choices and activities for people living in the home. The records examined for peoples monies kept by the home were well kept, correct and consent forms signed for home to keep these monies. There were also records of residents’ valuables in safe keeping where necessary. The new Owner said that the Home previously used Penninsula Business Services as an independent health and safety consultancy, as well as contractors to carry out regular servicing and checks and this would continue. All Policies and Procedures were in the process of being completed by the Transition Team and this was taking place on the day of the Inspection. Hazeldown Care Home DS0000071181.V366143.R02.S.doc Version 5.2 Page 26 However, several documents and records were not available, namely a Complaints Book, a new Accident Book, nor records of water temperatures for bathing and washing, nor Legionella testing. Although all staff have been trained in health and safety, including first aid, food hygiene and fire safety awareness and the testing of the fire alarm system had been regularly carried out, there had been some slippage in this area over the period of a week’s holiday for some residents. The new manager acknowledged this slippage and said that he would take steps to remedy it. A current fire risk assessment for the building was also not available on the day of the Inspection. The Transition Team are aware that all these issues need to be addressed to ensure the health, safety and welfare of the people living in the home and the staff working there. Hazeldown Care Home DS0000071181.V366143.R02.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 2 X 2 X X 2 X Hazeldown Care Home DS0000071181.V366143.R02.S.doc Version 5.2 Page 28 New service 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. YA10 Standard Regulation 17 Requirement Individual records of the people living in the Home should be accurate, secure and confidential and accessible to individual residents There should be a Policy and Procedure for the safe receipt, recording, storage, handling, administration and disposal of medicines for the protection of the people living in the Home. There should be robust, written local procedures for responding to suspicion or evidence of abuse or neglect to ensure the safety and protection of the people living in the Home Staff files should contain all the necessary documents when staff are confirmed in post (in this case CRB clearance and two written references) to ensure the safety and protection of the people living in the Home All staff at the Home should be formally supervised. This DS0000071181.V366143.R02.S.doc Version 5.2 Timescale for action 30/09/08 2. YA20 13(2) Schedule 3 (3)(1) 30/09/08 3. YA23 13(6) 31/08/08 4. YA34 19 Schedule 2(5) 31/08/08 5. YA36 18(2) 30/09/08 Hazeldown Care Home Page 29 6. YA38 39 7. YA39 24(1)(a)(b) (2)(3) 8. YA42 13(4)(a) 23(2)(p) 9. YA42 13(4)(a) 23(2) (p) 10. YA6 15(2) will help to ensure that the care provided meets the needs of the people who use the service and the philosophy of care in the Home A clear description of how the day to day management tasks are allocated in the Home, how staff know who is in charge and what expectations there are of the manager and what decisions he can make should be provided to the Commission, to ensure the Home is run in the best interests of the people living there. Feedback should be actively sought about the service provided from the people living in the Home and/or their independent advocates and other professionals in order to further ensure that the Home is run in the best interests of the people living there. Feedback should be sought particularly on meals and activities. The health, safety and welfare of the people living in the Home and the staff should be ensured by carrying out regulation and recording of water temperatures and a risk assessment for Legionella so that these risks are so far as possible eliminated and managed. Fire Alarms should be tested on a regular basis to ensure the safety of the people living in the Home and the staff. Care plans should be reviewed with the resident DS0000071181.V366143.R02.S.doc Version 5.2 30/09/08 30/09/08 30/09/08 30/09/08 30/09/08 Hazeldown Care Home Page 30 (involving significant professionals, family, friends and advocates as agreed with the service user) in this case to ascertain changing or changed needs and agreed changes should be recorded and actioned. 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 YA1 Good Practice Recommendations People living in the Home should be provided with a service users’ guide, which details available independent advocacy services, in a format accessible by people with communication difficulties. It would be good practice to support the people living in the Home, if they wish, to find peer support or an independent advocate to help them make decisions about their own lives. 2. YA7 Hazeldown Care Home DS0000071181.V366143.R02.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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