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Inspection on 15/02/06 for Hazelhurst

Also see our care home review for Hazelhurst for more information

This inspection was carried out on 15th February 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home had a welcoming and homely atmosphere and was clean and presentable in all areas. The lounge areas were light and airy and comfortably furnished. The resident`s rooms were furnished to suit their individual needs and some were furnished with the resident`s own small items of furniture and personal possessions. The residents spoken with praised the home and the staff saying they were well looked after, and the staff were kind and caring. The residents sitting in the communal areas all looked well cared for and appeared relaxed in their surroundings. Staff members were in the lounge sitting and talking with the residents and showed a good understanding of the resident`s individual needs. The home is well run and the staff, residents and visitors all said that the registered manager was always available to speak with and was very approachable. The staff are supported and provided with the training necessary for them to carry out their duties to a high standard. Two visitors spoken with expressed their satisfaction of the home and said that their relative had recently moved into the home, and had settled in well. The home had provided them with all the necessary information prior to admission and arrangements were made for them to visit the home to look at the facilities. All records seen were well maintained and the resident`s care plans and assessments were thorough in identifying the needs of each resident.

What has improved since the last inspection?

There were only two minor improvements identified at the last inspection with regard to the recruitment procedures and staff supervision. On examining the staff files all the necessary checks had been carried out on new staff prior to them working in the home. Formal staff supervision for all staff now takes place at the required intervals.

What the care home could do better:

Only minor improvements were identified with regard to the updating of the Statement of Purpose and Service User Guide for the home to reflect the structure of the organisation. All new staff had an induction into the home but in some cases the content of the programme was not documented and signed by the member of staff on completion. All medicines disposed of in the home should be recorded and signed. It was recommended that a survey at least annually should be carried out to gain the view of the residents and their relatives about the home.

CARE HOMES FOR OLDER PEOPLE Hazelhurst 23 Kings Road Horsham West Sussex RH13 5PP Lead Inspector Mrs J Hough Unannounced Inspection 10:25 15 February 2006 th 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 Hazelhurst DS0000065774.V275316.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. Hazelhurst DS0000065774.V275316.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hazelhurst Address 23 Kings Road Horsham West Sussex RH13 5PP 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) 01403 276333 01403 276344 Ashbourne (Eton) Limited Mrs Dorothy Elizabeth Walker Care Home 38 Category(ies) of Dementia - over 65 years of age (38) registration, with number of places Hazelhurst DS0000065774.V275316.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 27th June 2005 Brief Description of the Service: Hazelhurst is a registered care home that provides personal and nursing care for up to 38 persons aged 65 years and over with dementia. The home is owned by Ashbourne (Eton) Limited and the Responsible Individual for the organisation is Marlyn MacDougall. The Registered Manager is Dorothy Walker who is responsible for the day-to-day running of the home. Accommodation is provided on three floors accessed by a passenger lift. There are 29 single and 5 double bedrooms and 6 offer en-suite facilities. Communal space consists of three lounge areas and one dining area. Hazelhurst DS0000065774.V275316.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over a period of five hours and the registered manager Dorothy Walker was present during the inspection and provided all the necessary information and documentation. Records were examined for medication, accidents, complaints, maintenance checks, together with a random sample of some of the resident’s care plans and assessments. Seven residents, two visitors and three members of staff were spoken with. A tour of the building took place and some of the resident’s rooms were seen. Lunchtime was observed in the dining room and time was spent in the lounge observing the residents participating in the activities going on that afternoon. What the service does well: The home had a welcoming and homely atmosphere and was clean and presentable in all areas. The lounge areas were light and airy and comfortably furnished. The resident’s rooms were furnished to suit their individual needs and some were furnished with the resident’s own small items of furniture and personal possessions. The residents spoken with praised the home and the staff saying they were well looked after, and the staff were kind and caring. The residents sitting in the communal areas all looked well cared for and appeared relaxed in their surroundings. Staff members were in the lounge sitting and talking with the residents and showed a good understanding of the resident’s individual needs. The home is well run and the staff, residents and visitors all said that the registered manager was always available to speak with and was very approachable. The staff are supported and provided with the training necessary for them to carry out their duties to a high standard. Two visitors spoken with expressed their satisfaction of the home and said that their relative had recently moved into the home, and had settled in well. The home had provided them with all the necessary information prior to admission and arrangements were made for them to visit the home to look at the facilities. All records seen were well maintained and the resident’s care plans and assessments were thorough in identifying the needs of each resident. Hazelhurst DS0000065774.V275316.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hazelhurst DS0000065774.V275316.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 Hazelhurst DS0000065774.V275316.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): 1,2,3,4,5. The Statement of Purpose and Service User Guide needs updating. Admissions to the home are well planned. EVIDENCE: The Statement of Purpose and Service User Guide needs updating to reflect the structure of the new organisation since Ashbourne(Eton) Limited took ownership of the home last year. All residents have a contract of terms and conditions of the home that are agreed and signed on admission. Anyone expressing a wish to move into the home are provided with all the information about the home and it’s services, and the registered manager or the deputy manager will carry out an assessment of need to ensure the home is able to provide the appropriate level of care. A visit to the home is encouraged to see the room available and meet with other residents and staff. Staff training records showed that the staff are provided with the specialist training for them to care for the residents. Hazelhurst DS0000065774.V275316.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): 7,8,9,11. The residents are well looked after. The medication procedures in the home are thorough. EVIDENCE: Each resident has a key worker and a named nurse who is responsible for maintaining and reviewing their care plans and assessments. Three care plans were read and gave a detailed account of the level of care and assistance needed. Risk assessments were completed were appropriate and in one case where a resident presented with some challenging behaviour great detail was given on how to best handle the situation to safeguard the health and safety of the resident and staff. Due to the residents having dementia the home has high incidents of falls that are carefully monitored and recorded. The home involves a falls support manager for advice when needed. The resident’s weight is monitored on a monthly basis or more frequently if needed. From observations made of the residents and speaking with some of them, it was clear that the resident’s needs were fully met. The medication administration records examined showed that all documentation was generally well maintained and accurate. It was advised Hazelhurst DS0000065774.V275316.R01.S.doc Version 5.1 Page 10 that disposed medicines be recorded and signed by two persons. Controlled drugs administered were recorded in a separate register and stored in a metal cupboard. The registered nurses administer the medication to the residents and are responsible for maintaining all the medication records. Following the change of ownership of the home to Ashbourne (Eton) Limited in 2005 the policies and procedures had been updated. However a policy and procedure for the death and care of the dying resident could not be found. However, the home continues to look after the residents during their final days unless there were strong medical reasons that prevent this. Specialist advice and support from other health professionals would be provided when necessary. Hazelhurst DS0000065774.V275316.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): 12,14,15. The residents are able to make choices about their lifestyle. The home offers a varied and well balanced diet. EVIDENCE: The home has an activity organiser who works three days per week and provides activities to suit the resident’s interests. The number of residents who participate in activities varies according to their capabilities. On the day of inspection a game of darts was taking place in the lounge with darts that stuck onto a felt dartboard, and the residents taking part were thoroughly enjoying themselves. An activity programme was displayed in the home showing various activities such as games and musical events. On speaking with some of the residents it was clear that they were happy with the activities provided. None of the present residents were able to manage their own finances and money and had a relative or representative who handled their affairs for them. On touring the building and looking at some of the resident’s rooms it was noted that some of the residents had furnished their rooms with their own small items of furniture and personal possessions. There is a four-week menu that offers a varied and well balanced diet. The residents have a choice of meals and special diets are catered for. Hazelhurst DS0000065774.V275316.R01.S.doc Version 5.1 Page 12 Lunchtime was observed and some of the residents were eating a pureed diet that was served and presented well with the meat and vegetables liquidised separately. Staff were seen giving assistance to those residents who required help with their eating and drinking in a pleasant and caring manner. Lunchtime in the dining area was unhurried and relaxed. Hazelhurst DS0000065774.V275316.R01.S.doc Version 5.1 Page 13 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): 16,17, 18. The home has a clear complaints procedure. The residents are protected from harm as far as practicable. EVIDENCE: The complaints log was examined and the home had received no formal complaints since 2001. The registered manager said that there were only small issues that occasionally arose which usually could be sorted out immediately, and so were not recorded. Due to the mental frailty of most of the residents not many of them express the wish to vote in elections. However all residents are recorded on the electoral register and would be given the opportunity to make a postal vote. The home has the West Sussex County Council policies and procedures on Vulnerable Adults, and the staff have had training on abuse. The staff spoken with understood their responsibilities and obligations in reporting any incidents in the home. All new members of staff have had all the necessary checks carried out prior to commencing work in the home. Hazelhurst DS0000065774.V275316.R01.S.doc Version 5.1 Page 14 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): 21,22,26. The home was clean and fresh and has adequate bathrooms and toilets for the number of residents. EVIDENCE: The home has three assisted bathrooms and sufficient toilets for the number of residents. Toilets are situated close to communal areas for easy access. Grab rails are fitted in all corridors, bathrooms, toilets and other areas where required. On touring the building all areas were fresh and clean, and the laundry facilities were adequate for the number of residents and provided handwashing facilities. The housekeeper is responsible for the laundry and all soiled linen is handled following good infection control procedures. Hazelhurst DS0000065774.V275316.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): 27,28,29,30. The recruitment procedures in the home were thorough. The number of staff on duty on each shift is appropriate to care for the residents. The staff are qualified and experienced for their work. EVIDENCE: The staffing levels maintained in the home consist of two trained nurses plus six care assistants each morning and one trained nurse and five care assistants each afternoon, and one trained nurse plus three care assistants during the night. On speaking with the staff and residents it appears that these numbers are appropriate to provide the residents with a good level of care. The home has no care or nurse vacancies, and many of the staff have worked in the home for many years. Agency staff were only used in emergencies to cover sickness and holidays. The home continues to provide training for the care staff for NVQ level 2 and 3 in care and nearly 50 of the care staff were qualified to level 2 or 3. Five staff files were examined for new members of staff and all contained the required documents and showed that the appropriate checks had been carried out prior to starting work in the home. Hazelhurst DS0000065774.V275316.R01.S.doc Version 5.1 Page 16 Staff training records showed that the staff had received the appropriate training for them to do their work and all new staff had completed an induction programme into the home before working on their own. However, in some cases no recorded evidence was available to the content of the induction training completed. Hazelhurst DS0000065774.V275316.R01.S.doc Version 5.1 Page 17 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): 31,32,33,37,38. The home is managed and run well. The health and safety of the residents and staff is protected as far as practicable. EVIDENCE: The registered manager has worked in the home for several years, first as the deputy manager then promoted to the registered manager in 2001. She has also obtained her Registered Managers Award and keeps herself updated with regular training. The staff, residents and visitors spoken with all said that she was very approachable and made herself available to those who wished to speak with her. The home has a quality assurance system in place in which to gain the views of the residents and relatives, and the last questionnaires sent out were in July 2004. Comment cards are always available in the reception of the home Hazelhurst DS0000065774.V275316.R01.S.doc Version 5.1 Page 18 although the registered manager said they were rarely completed and returned. All the records in the home were kept secure in locked filing cabinets and offices, and the resident’s personal files would be made accessible to them when requested. The maintenance records were examined and showed that all equipment and systems were serviced and maintained within the appropriate timescales. In-house maintenance checks were also carried out that include monitoring of the water temperatures for the baths and washbasins and other equipment used in the home. The home records and reports all accidents, incidents and injuries to the appropriate authorities. The accident book was examined and although there were a high number of incidents only two resulted in the residents having to be treated in hospital as a result of a fall. The staff training records showed that the staff receive training in manual handling, food hygiene, fire safety and infection control. The home has one member of staff who is a qualified first aider, but has a trained nurse on duty for all shifts. Hazelhurst DS0000065774.V275316.R01.S.doc Version 5.1 Page 19 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 2 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 X X 3 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 2 X X X 3 3 Hazelhurst DS0000065774.V275316.R01.S.doc Version 5.1 Page 20 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. Standard Regulation Requirement Timescale for action 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 3 4 Refer to Standard 1 9 30 33 Good Practice Recommendations The Statement of Purpose and Service User Guide should be updated to reflect the new organisation. All medicines disposed of in the home must be recorded and signed. The content of the induction programme for new staff should be recorded and signed by the member of staff on completion. A survey should be carried out at least annually to gain the views of the residents and relatives. Hazelhurst DS0000065774.V275316.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY 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 Hazelhurst DS0000065774.V275316.R01.S.doc Version 5.1 Page 22 - 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. 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