CARE HOMES FOR OLDER PEOPLE
Hazelhurst 23 Kings Road Horsham West Sussex RH13 5PP Lead Inspector
Mrs S Rodgers Key Unannounced Inspection 18th July 2006 11:45 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.V297676.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hazelhurst DS0000065774.V297676.R01.S.doc Version 5.2 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.V297676.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 15th February 2006 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 Mrs Angela Knight. The Registered Manager is Mrs Dorothy Walker who is responsible for the day-to-day running of the home. Monthly fees range from £469.92 to £742.50. Extras include hairdressing, toiletries and chiropody. The most recent inspection report is displayed in the hallway 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.V297676.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a period of 5 hours. Preparation for this inspection focused on reviewing the completed pre inspection questionnaire, policies and procedures submitted with the pre inspection questionnaire, the most recent inspection reports, and general correspondence held on file. The majority of residents were seen during this inspection, due to the varying degrees of cognitive ability the inspector was not able to gain the views of residents about the service, therefore time was taken to observe interaction between resident and staff to gain a view of how they experience the service. Two relative who was visiting the home at the time of the visit spoke with the inspector privately. Both were complimentary about the services provided. Some of there comments will be included in the main body of this report. Records that are required to be kept by legislation were also reviewed. Three care staff were spoken with to gain their views on the support and training they receive in order to carry out their jobs. What the service does well: What has improved since the last inspection?
Since the last inspection a new system for recording the disposal of medication has been introduced. The providers have decorated various parts of the home including renewing some carpets. The views of residents and/or their relatives have been sought in order that the management can assess the standards of services being provided. Hazelhurst DS0000065774.V297676.R01.S.doc Version 5.2 Page 6 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.V297676.R01.S.doc Version 5.2 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.V297676.R01.S.doc Version 5.2 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): 1,3,6 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A draft copy of the Statement Of Purpose and Service User Guide was available however it has not been finalised. Pre admission assessments are undertaken on all prospective residents. Intermediate care is not provided. EVIDENCE: A final draft Statement of Purpose and Service User Guide was submitted with the pre inspection material. It was confirmed by the manager that this remains a draft; the documents have been agreed however they are waiting for the final printed version. The previous providers version remains in circulation this may cause confusion to people who are thinking of moving into the home. A finalised copy should be submitted to the Commission and also circulated in the home to ensure that all prospective residents or their relatives are aware of the change of provider.
Hazelhurst DS0000065774.V297676.R01.S.doc Version 5.2 Page 9 Four care plans were reviewed. Pre admission assessment documentation kept of resident’s individual files that indicated that assessments are undertaken on all prospective residents in order that the management and prospective resident can make an informed decision on whether the service can meet their needs. The home does offer respite services however intermediate care is not provided. Hazelhurst DS0000065774.V297676.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans clearly document the needs of residents. Systems are in place to promote the health and social care need of residents. The homes policies and procedures for the management of medication promote safe practices. Residents feel they are treated in a respectful manner. EVIDENCE: Four care plans were reviewed. The documents contained the basic information required to monitor the health personal and social needs of residents. Care plans are completed for identified areas that require staff intervention or assistance. The manager informed the inspector she is in the process of changing all care plans to the new format introduced by the Southern Cross Healthcare, the new registered providers. The new care plans are in a structured format that should promote consistency, however staff
Hazelhurst DS0000065774.V297676.R01.S.doc Version 5.2 Page 11 need to ensure that all information from the previous care plans are transferred. It was noticed by the inspector that there was no reference to oral hygiene on the new documents. Health care needs were identified in the care plans and records of Doctors and other health professional’s visits are recorded. All medication is stored in a lockable trolley or a wall hung lockable cupboard within a locked storeroom. The Monitored Dosage System is used, the medication being pre dispensed by the pharmacist. There was no stock piling of medication. The Medicine Administration Record sheets were viewed; a photograph of each resident is attached. Staff sign the record sheets at the time of administration. The home has a contract with a Clinical Waste company to dispose of unwanted. A record of medication disposed of was available, the manager has been introduced a new recording system whereby nursing staff note and sign for the medication being disposed of. Trained staff administer all medication. Due to their diagnosis residents do not selfadminister medication. Visitors spoken with confirmed that they felt that the dignity and privacy of their relatives is maintained. They confirmed that staff knock on closed doors prior to entering and that when they are carrying out personal care staff make sure that they are appropriately covered at all times. During the visit the inspector observed that staff went about their tasks in a sensitive manner. Hazelhurst DS0000065774.V297676.R01.S.doc Version 5.2 Page 12 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): 12,13,14,15 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a planned programme of activities. Residents are encouraged to maintain contact with family and friends. Residents are able to access the community as they wish. The standard of meals provided is satisfactory. EVIDENCE: A programme of activities is displayed on residents notice boards placed at various points around the home. The service has an activities coordinator who works 3 days a week. Activities offered include group exercise, news and videos, games, arts and craft, sing a long, quizzes reminiscence, outings. There were no activities taking place at this inspection, residents sitting in the lounge were listening to the radio. Due to the extremely hot whether conditions residents were being offered cold drinks at regular intervals and Hazelhurst DS0000065774.V297676.R01.S.doc Version 5.2 Page 13 every effort was being made to keep residents cool by the use of electric fans and having doors and windows open. The inspector spoke with two relatives. They confirmed that they are satisfied with the services their relatives receive. They confirmed that they are able to visit the home at reasonable times. Comments include “This place here is one of the nicest places I’ve been to, the care from not one but all staff is 110 . Manager more like relative, we are treated with respect. Office staff efficient, my wife is getting the best attention she has ever had, they treat me like it’s my home, girls wonderful, can’t find fault. I can bring in our dog, staff and residents like her, I don’t have to pay for my meal, they give me on each day.’ From observation during the inspection the inspector was able to determine that residents are able to have autonomy over their daily lives, as they are able, they have access all communal areas of the home. None of the current residents manage their finances, generally family or a representative do so on their behalf. The home administrator is appointee for one resident. Appropriate systems are in place. The home does look after resident’s personal allowances. All monies are kept in a Hazlehurst resident’s bank account. Records kept of transaction made on behalf of residents were in good order. The midday meal provided was well presented and looked appetising. Special diets are catered for as required. the inspector noted that all liquidised meals were appropriately presented with each individual ingredient separately. The lunchtime was observed it was noted that staff who were feeding residents did so in a relaxed and respectful manner. They sat beside the resident they were feeding and only fed one person at a time. A 4 weekly menu is followed; sample menus seen indicated that a varied diet is offered. Hazelhurst DS0000065774.V297676.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously and are managed within an appropriate manner. Systems are in place to promote the protection of vulnerable adults. EVIDENCE: A complaints procedure is in place. The procedure informs residents and their relative who they should address their concerns to in the first instance and timescales in which a response will be made. The procedure contains the address and telephone number of the Local office of the Commission for Social Care Inspection so that in the event that they are not satisfied with the outcome of the homes investigation they can contact Commission directly. A complaints book was available. There have been no complaints since the last inspection. Training record evidence and staff confirmed that they receive training in adult protection procedures. However some have not received Adult Protection training since 2003/4. In the interest of good practise staff should have regular updates. Hazelhurst DS0000065774.V297676.R01.S.doc Version 5.2 Page 15 Staff spoken with formally at this inspection were generally aware of the indicators of abuse and what they should do should they suspect abuse of a resident. They confirmed that they would report any suspected incidents of abuse to the manager/person in charge. Hazelhurst DS0000065774.V297676.R01.S.doc Version 5.2 Page 16 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): 19,26 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The location and layout of the home meets the needs of the current service users. The home is well maintained. The home is clean, pleasant and hygienic. EVIDENCE: Whilst touring the home the inspector was able to establish that the physical environment is well maintained. The pre inspection questionnaire records that and the from touring the building the inspector observed that 3 bedrooms have had new carpets fitted and 4 bedrooms have been redecorated. Resident’s rooms are being furnished with personal belongings which gives them a homely, individual atmosphere. All radiators have recently been fitted with covers to reduce the risk of burning. All communal areas of the home are Hazelhurst DS0000065774.V297676.R01.S.doc Version 5.2 Page 17 accessible. There are ramps in place enabling service users easy access to out door communal facilities. The home was clean and free from offensive odours. Laundry facilities appear appropriate for the needs of the current residents. Infection control procedures are in place, appropriate protective clothing is available. Hazelhurst DS0000065774.V297676.R01.S.doc Version 5.2 Page 18 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 quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are on duty in sufficient numbers to meet the needs of the current residents. The service is working towards achieving the ratio of 50 of care staff holding a National Vocational Qualification. Staff receive induction training. The homes recruitment process promotes the protection of residents. EVIDENCE: Duty rotas seen on the day of inspection and those submitted with the pre inspection documentation indicated that there are generally 2 trained nurses and 5 carers in the morning, 2 nurses until 5pm and 4 carers in the evening, I trained nurse and 3 carers at night. Mrs Walker, the manager is also on duty Monday to Friday 9-5. At weekends there are generally 2 nurses on in the morning and 1 in the afternoon, the number of care staff on duty generally remains the same. Staff spoken with at this visit confirmed that they felt that they were appropriately staffed to meet the needs of the current residents. Training records indicate that staff receive induction and mandatory training such as fire, manual handling, Hazelhurst DS0000065774.V297676.R01.S.doc Version 5.2 Page 19 The pre inspection questionnaire indicates that at present that approximately 32 of care staff have gained a National Vocational Qualification level 2 or 3. Two nurses from overseas are employed as carers in the home, the inspector advised Mrs Walker to seek the advice of Skills for Care regarding whether their qualifications are equivalent to National Vocational Qualifications. A further 3 staff have recently been enrolled to undertake National Vocational Qualification level 2. Although this standard has not been met in full a requirement has not been made as the service is working toward compliance. A formal recruitment procedure is followed. The records of 2 staff were reviewed. References and Enhanced Criminal Record bureau check are undertaken. Hazelhurst DS0000065774.V297676.R01.S.doc Version 5.2 Page 20 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): 31,33,35,38 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed and run well. Systems are in place to gain the views of residents. Systems are in place to manage resident’s money held in safekeeping. Annual maintenance checks are undertaken. EVIDENCE: Mrs Walker the registered manager is a Registered Nurse Mental Health and has many years experience in working in a care home setting. She also has obtained her Registered Managers Award. Staff spoken with felt they are supported by management and that their views are listened to. They also confirmed that they are supported and encouraged to undertake training. Relatives spoken with were complimentary about Mrs Walker and her team. Hazelhurst DS0000065774.V297676.R01.S.doc Version 5.2 Page 21 Mrs Walker confirmed that she has undertaken quality assurance survey of residents or their relatives to gain their views on how the home is being run. Information gained from these surveys and information from the quality audits that take place regularly should be collated and form a written report identifying what the service does well, what can be improved and what action they will take to make improvements including estimated timescales. Systems are in place to safeguard the financial interests of residents. See standard 14.2. Pre inspection documentation demonstrates that annual checks and services are carried out annually. Accident records were seen. There was no discernable pattern identified. Monthly audits of accidents are undertaken. Training records indicate that staff have received fire safety instruction, manual handling, food hygiene and infection control. Hazelhurst DS0000065774.V297676.R01.S.doc Version 5.2 Page 22 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 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 X 3 X 3 X X 3 Hazelhurst DS0000065774.V297676.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4&5 Requirement An up to date Statement of Purpose and Service User Guide must be circulated to resident, relatives and submitted to the Commission. Timescale for action 24/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA18 YA33 Good Practice Recommendations Consideration should be given to providing staff with regular training in Adult Protection Procedures. The information gained from resident/relatives surveys and internal audits should be used to formulate a written report on what the service does well, what needs to be improved and how improvements will be made. Hazelhurst DS0000065774.V297676.R01.S.doc Version 5.2 Page 24 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
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