CARE HOMES FOR OLDER PEOPLE
Hazelhurst 23 Kings Road Horsham West Sussex RH13 5PP Lead Inspector
Sarah MacLennan Unannounced Inspection 5th August 2008 08:45 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.V369167.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.V369167.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 hazelhurst@ashbourne.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Manager post vacant Care Home 38 Category(ies) of Dementia - over 65 years of age (38) registration, with number of places Hazelhurst DS0000065774.V369167.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 29th February 2008 Brief Description of the Service: Hazelhurst is a registered care home that is registered to provide care for up to 38 persons aged 65 years and over with dementia. On the day of the inspection there were 29 service users. A voluntary suspension of admissions was in place following issues in relation to the safeguarding of vulnerable adults. The registered provider is Ashbourne (Eton) ltd, a subsidiary of Southern Cross Healthcare Group Plc. There is an acting manger in post responsible for the day-to-day management of the home; the responsible individual is Ms Sarah O’Mara. The home is located near to public transport links and the town is within walking distance. Currently there is a new acting manager in post 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. At the time of the inspection the range of fees was £555.50 to £825.83; this does not include hairdressing, toiletries and chiropody. Hazelhurst DS0000065774.V369167.R01.S.doc Version 5.2 Page 5 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.
The Commission for Social Care Inspection has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This unannounced visit formed part of a ‘key’ inspection and was carried out by Sarah MacLennan, Regulation Inspector. The regional operations manager was present as the representative for the establishment. It was a thorough look at how well the service is doing. It took into account detailed information provided by the acting manager and any information that CSCI has received about the service since the last inspection. A tour of the premises took place. On the day of this visit the inspector met with some people who use the service and some on-duty staff. Three staff members and three relatives returned surveys. Some of the comments made to the inspector and made on the survey forms are quoted in this report. Observations of the interactions between staff and the people who use the service were also used to form the judgements reached in this report. The home completed an annual quality assurance assessment (AQAA) prior to the visit and care plans, pre-admission assessments, risk assessments and food and drink records of people who use the service, staff recruitment and training records, health and safety check lists, activity records, policies, procedures, medication records and storage were all sampled on the day of this visit. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. An additional unannounced visit was conducted on the 21st August 2008 by the pharmacist inspector, Suni Chotai. This additional visit was to assess medicine management at the home and the findings are included within this report. We would like to thank the people who use the service and staff for their time, assistance and hospitality during the visits. Hazelhurst DS0000065774.V369167.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better:
There are significant ongoing shortfalls in this service that must be addressed urgently. There has been a lack of good leadership and management in the home that is detrimental to the care given to those living at Hazelhurst; this is especially evident in the lack of supply of enough skilled staff. Staff do not have clear and accurate risk assessments, pre-admission assessments and care planning which means people do not always have their needs met. This is especially concerning for those with dementia or challenging behaviour needs or are at risk of falls. The environment needs attention to areas in disrepair such as some doors and walls and areas of the home are not clean enough. Some people may be going hungry as there are 12 hours between the early evening meal and breakfast, this must be reviewed The medication management needs to be improved in respect of the covert administration of medication as well as the correct storage of medication Hazelhurst DS0000065774.V369167.R01.S.doc Version 5.2 Page 7 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. Hazelhurst DS0000065774.V369167.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hazelhurst DS0000065774.V369167.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The pre-admission needs assessments were incomplete, contained contradictory information and did not include information as to how the home will meet the assessed needs. EVIDENCE: The inspector was advised that is the responsibility of the acting manager to carry out a pre-admission assessment on all prospective admissions to the home. The home had had four new admissions since the previous inspection on 29th February 2008. At the time of this inspection, a voluntary suspension of admission was in place following issues in relation to the safeguarding of vulnerable adults, this had been in place since April 2008. Hazelhurst DS0000065774.V369167.R01.S.doc Version 5.2 Page 10 Several care plans and pre-admission needs assessments were randomly sampled during the inspection and the records relating to the recent admissions were inspected in detail. The assessment form covered all elements of physical, mental, and social needs. One pre-admission assessment stated that they had ‘pressure damage to both hips and sacrum’ and in the same persons pre-admission draft care plan it stated ‘skin intact at present’, this pre-admission draft care plan did not contain a date or the signature or name of the assessor. The assessment stated that the person had a history of falls. A pre-admission dementia assessment had also been completed and describes his character as ‘Good, but lashes out at times’ and him as having ‘aggression’ other comments included ‘he has dementia and can lash out to anybody especially strangers’. There was no information as to how these would be managed on admission and how the home would meet the persons assessed needs. Another person’s pre-admission assessment scores were not totalled and did not contain a signature or name of the assessor. It stated that the person was at ‘risk of falls and potential injury’ and that ‘… can be very non-compliant when taking medication’. The nutritional assessment score identified that they were at ‘very high risk’ and the assessment stated that the person was at ‘risk of malnutrition and self neglect’, at ‘risk of dehydration’ and ‘paranoid – accuses people of stealing – reluctant to eat, will say food is poisoned’. There was no information as to how these would be managed on admission and how the home would meet this persons assessed needs. The dementia assessment did not contain a date or the signature or name of the assessor and the summary section had not been completed. One pre-admission dementia assessment describes the person as ‘confused, forgetful, self-neglect (risk), non-compliant with care and medication’ and they are described as having ‘inadequate dietary intake’. There was no information as to how these would be managed on admission and how the home would meet the persons assessed needs. The requirement that the pre-admission document be expanded to include information as to how the home will meet assessed needs remains un-met. Hazelhurst DS0000065774.V369167.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care planning and practices within the home are placing the people who use the service at risk. EVIDENCE: Several peoples records including their care plans, risk assessment, food intake records, weight records and medication administration records were randomly sampled during the inspection and the records relating to the four most recent admissions were inspected in detail. One persons care plan stated that he ‘can be resistive and aggressive during personal care. He therefore needs at least two staff members’ there was no explanation regarding the need for an additional member of staff or any guidelines for the staff to follow. His ‘behaviour is very challenging at times, attempts to grab other staff and residents hands, lashing out at residents and staff’ and if he ‘becomes aggressive remove him quietly from area using minimal force, to quieter area’ there was no clarification of the term ‘minimal
Hazelhurst DS0000065774.V369167.R01.S.doc Version 5.2 Page 12 force’ or guidelines for staff. One entry in the daily statements describes him as being ‘noisy’. Another care plan states that ‘it appears that … sustained a fall on the night of...’ there was no signature or name of the person who made the entry and it was dated three days after the apparent fall. The staff spoken to were unsure why this entry had been made, but thought that it may have been following observation of bruising to the person. The homes accident and incident records were seen and there were no additional records to support this. The care plan stated that she ‘needs one staff to assist in personal care but when agitated and resistive two staff need to attend’. There were no behavioural guidelines for staff and it was not clear why an additional staff member was required. The requirement that care plans are fully and regularly reviewed and accurately reflect service users current care needs remains un-met. The folder containing the food intake records for all the people who use the service was seen. The records were poorly maintained and several gaps were noted. No entries had been made for Sunday 3rd August 2008. There were several incidences of no evening meal or supper / evening drink being recorded. The inspector was informed that the service users are weighed regularly and there are computer records of weekly weight; however these records have not been updated since the acting manager has been on holiday. The weight records folder, which contained hand written entries, was seen. One person had lost 2.25 kg between July 2008 and August 2008, her risk assessment was up to date and identified her as being at very high risk; however the care plan did not contain any clear information as to how this risk is managed or any evidence of action taken. Three other weigh records showed significant weigh loss between July 2008 and August 2008; one person had lost 3.8 kg. The requirement that food intake records must be maintained for all service users that require them as under Regulation 17 (1) (a) and records of action taken when service users are noted to have lost weight remains un-met. The people who use the service had risk assessments in relation to falls and tissue breakdown, but the records sampled did not contain information as to how the risk would be managed and how the home would meet the assessed needs. The requirement that risk assessments undertaken for those at risk of falls and tissue breakdown must include the management of the risk and be regularly reviewed remains un-met.
Hazelhurst DS0000065774.V369167.R01.S.doc Version 5.2 Page 13 The homes storage and recording of medication were seen; no people selfadminister their medication and two of the people who use the service were having their medication disguised in food or drink. One of the persons care plan stated that her ‘son signed convert administration policy as she has no insight into her condition and she needs antipsychotic medication to promote her mental health and prevent severe relapse’. A later entry states that she is ‘taking medication with drinks and food to disguise…’ There was no evidence that covert administration of medication was in the person’s best interests. It was not mentioned in the pre-admission assessment; however the covert administration policy was sign on admission. The persons care plan instructs staff to ‘give prescribed antipsychotic only if reaches a point where she cannot be controlled’. There was no clarification of ‘where she cannot be controlled’ and there were no behavioural guidelines for staff. The other person having their medication disguised in food had a consent form signed by her daughter and the care plan gives instruction to look at the crushing and disguising medication policy ‘as a last resort’. The medication administration records of both people state the medication should be given ‘when required’, contain additional copies of the consent to disguise medication in food, but there are no explanations of the necessity to disguise medication in food or drinks. The home had a policy on ‘crushing and disguising medication’ which stated that ‘it is the policy of Southern Cross Healthcare that service users medication will only be crushed or disguised in extreme circumstances and then only after recorded exploration of other alternatives and thorough risk assessment. There must also be a multi-professional agreement that it is in the service users best interests…’ There was no evidence that the covert administration of medication was in the best interests of the people who use the service and that any other alternative had been explored. It is required that medication is only administered covertly if there is clear documented evidence that it is in the service users best interests. On arrival at home the inspector overheard a staff member raise their voice at one of the people who use the service in an aggressive tone, telling them to ‘stop it’ and saying ‘ no don’t’. Another staff member was then heard to say ‘it you just let him sit on his own he’ll be fine’. This was discussed with the homes operations manager. Whilst some staff have received training in dementia awareness and challenging behaviour the attitude and care practices of some of the staff evidences that this training is not followed in practice.
Hazelhurst DS0000065774.V369167.R01.S.doc Version 5.2 Page 14 The requirement that home is conducted to ensure the dignity of service users is protected and promoted at all times remains un-met. The pharmacist inspector, Suni Chotai, visited the home on the 21st August 2008 to assess medicine management at the home. The storage of medicines was in a specially designated room, which was kept at a cool temperature, a fridge and two lockable trolleys were available. The trolleys are used during medicine administration. The written policies on medicines management were out of date and did not reflect current practice, for example the disposal of medicine now goes through a licensed firm and yet the policy states that the supplying pharmacy takes away unwanted medicines. It is required that the medicine policies reflect actual practice and are current. The supplying pharmacy visited the home the previous month to train staff on the ordering and recording system. The controlled drugs cupboard did not comply with the Misuse of Drugs Act and it regulations. This has been ordered. Photographs of the people who use the service were available. These were not signed and dated. For completeness this is required. Suni Chotai spoke to a relative who was feeding fruit to her relative. She said that ‘it is so difficult for the staff but they try their best’ she went on to say that she was happy with the treatment her relative got. The vascular nurse was called in on advice for two of the people who use the service who have pressure sores. The doctor visits every Wednesday and any changes made to medicine use were recorded on the (medication administration record) MAR chart and signed by the doctor. This entry is often not dated by the doctor. For several residents a medicine that has additional special instructions (to be given on an empty stomach and with plenty of water) was not observed. This is unacceptable. It is required that medicines are given to the people who use the service as per instructions from the manufacturers. None of the care plans had any guidance on criteria to use medicines prescribed on a ‘when required basis’. This is important so that staff use a common approach and the people who use the service are treated as individuals. Consent forms from the relative and the doctor are available for medicines given covertly. Additional documentation is necessary to ensure covert administration is in the best interest of the people who use the service. Hazelhurst DS0000065774.V369167.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The routine within the home does not always promote independence and lifestyle choice to the people who use the service. EVIDENCE: The inspector was informed that the home had recently recruited an activities coordinator. Comments from relatives included ‘the residents need stimulation and activities. This area has improved dramatically over the past few weeks since the appointment of the new activities organiser, and hopefully will continue’. The activities programme was displayed on the wall in the main lounge and included: 1 to 1 activities, visits to the shops, park and town, board games, cooking, reading, reminiscence and film afternoons. Downstairs bedrooms were locked with the key hanging on the outside of the door frame and inaccessible to the people who live at the home. The inspector was informed that this was to prevent the people who wander from entering
Hazelhurst DS0000065774.V369167.R01.S.doc Version 5.2 Page 16 other persons room. This practice was also seen to prevent the people who live at the home from being able to access their bedrooms independently as they are reliant on staff to unlock their bedroom door. The folder containing the food intake records for all the people who use the service was seen. The records were poorly maintained and several gaps were noted. No entries had been made for Sunday 3rd August 2008. There were several incidences of no evening meal or supper / evening drink being recorded. Some of the people who use the service were eating breakfast when the inspection commenced at 8.45 am. A staff member was heard to request that a persons breakfast was changed, as they did not want what they had been given. The people who use the service were observed to have eaten their evening meal by 6 pm. Staff spoken to stated that some of the people had an evening snack or drink, but that this was not routinely offered to all the people who use the service. It is required that the interval between the evening meal and breakfast is no more than 12 hours if no other food is readily offered and recorded. Hazelhurst DS0000065774.V369167.R01.S.doc Version 5.2 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are safeguarding concerns regarding the people who use the service. EVIDENCE: The home had a simple and accessible complaints procedure. Details of which were displayed in the hallway. The inspector was informed that no complaints had been received since the previous inspection. At the time of the inspection a voluntary suspension of admissions to the home was in place following issues in relation to the safeguarding of vulnerable adults and the home was subject to an investigation by the Local Authority Social Care Department in line with the Sussex Multi-Agency Policy and Procedures for Safeguarding Vulnerable Adults. The concerns mostly relate to falls by service users, staff training, including moving and handling training and staffing levels. Following the completion of the safeguarding investigation the Commission will decide what, if any, action to take. The homes staff training records stated 69 of staff had received training in safeguarding vulnerable adults. Five staff member had not received any training in safeguarding vulnerable adults. The requirement that all staff be trained in safeguarding vulnerable adults remains un-met.
Hazelhurst DS0000065774.V369167.R01.S.doc Version 5.2 Page 18 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not provide a completely clean and well-maintained environment for people who live there. EVIDENCE: The inspector toured areas of the home. The people who use the service were able to access all communal areas of the home, downstairs bedrooms were locked with the key hanging on the outside of the door frame and inaccessible to the people living at the home. The inspector was informed that this was to prevent the people who wander from entering other persons bedrooms. Hazelhurst DS0000065774.V369167.R01.S.doc Version 5.2 Page 19 The décor was domestic in nature. Individual rooms were furnished in a homely way and the people who use the service were encouraged to bring their own possessions with them to personalise their rooms. Several areas in need of maintenance were seen. These included peeling paint and scuff marks to the corridor walls and scuff marks and damage to the bottom of some of the doors. Peeling paint and scuff mark on the walls were also present in several of the bedrooms, one room had chipped plaster by the socket and another room had had the outside of the door handle removed. Several areas of the home were not clean at the time of the inspection including the laundry room sink and the sink in the first floor sluice. One of the shower rooms had stained lino that was lifting in the corners and the shower curtain had mould on. Unpleasant odours were present in one of the bedrooms and the sluice on the first floor. The requirement that high standards of cleanliness are maintained throughout the home, including the elimination of offensive odours remains un-met. The inspector was informed that all radiators were low surface temperature, upstairs windows were restricted and thermostatic valves were fitted to taps and checked regularly. The water temperature checks were randomly sampled; two hot water taps were delivering temperatures of 37.30C and 37.50C. Water needs to be delivered at temperatures that are comfortable for people to wash in but not so hot as to place them at risk, with the optimum temperature being 430C. Hazelhurst DS0000065774.V369167.R01.S.doc Version 5.2 Page 20 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The people who use the service are placed at risk by insufficient staffing numbers and inadequately trained staff. The records are not up to date when staff levels are low. Despite falls in the home staff are still not up to date in moving and handling training. Despite training in challenging behaviour this is not translated in the home leaving people at real risk of not getting the care they need placing them at risk of harm EVIDENCE: The inspector was informed that the homes normal staffing levels are five carers and 1 or 2 trained nurses during the day. However the duty rota showed that on Sunday 27th July there were 3 carers and 1 trained nurse on duty between 8 am and 11 am when the numbers increased to 4 carers until 8 pm and on Sunday 3rd August there were 3 carers and 1 trained nurse on duty between 8 am and 5 pm. As the home is set out on three floors and a carer is assigned to the main lounge, with only three carers on duty it is not possible to supervise the people who use the service and ensure their safety. Significant shortfalls were noted in the homes recorded keeping during this incidence of inadequate staffing numbers. Surveys completed by staff members prior to the inspection included the comments staffing numbers need to be improved, ‘half the staff call in sick and
Hazelhurst DS0000065774.V369167.R01.S.doc Version 5.2 Page 21 it’s not fair on the residents or staff’, ‘staffing levels and communication between staff are the key problems’ and that the home should ‘improve staffing levels so residents do not miss out’. A survey completed by a relative raised the question ‘are there always enough staff on duty?’ The requirement that staffing levels need to be reviewed to ensure service users needs are met remains un-met. The inspector was informed that four members of care staff had achieved a National Vocational Qualification (NVQ) level 2 and one NVQ level 3, three further staff members had signed up to commence studying for the qualification in September. This will meet the requirement that 50 of care staff achieves NVQ level 2 or above. Four staff files were seen during the visit and found to contain most of the required information and documents specified in paragraphs 1 – 9 of Schedule 2 of The Care Homes Regulations 2001 (as amended by The Care Standards Act 2000 (Establishments and Agencies) (Miscellaneous Amendments) Regulations 2004). There was no evidence that the Personal Identification Numbers (PIN) of one the trained nurses had been checked, the staff file contained details of a PIN that expired in July 2008. This shortfall was address during the inspection. The requirement made at the previous inspection in respect of staff recruitment has now been met. The staff training records were sampled and demonstrated that most staff had received mandatory training in infection control, fire safety and food hygiene. No staff members had received recent training in moving and handling; thirteen staff members had received this training in January 2007. The inspector was informed that this training was booked for September. The requirement that all staff have up to date training in manual handling remains un-met. Less than half the staff had received training in service user specific topics, including challenging behaviour and dementia awareness. Despite some training in challenging behaviour this is not translated into the care practices within this home. A requirement has been made that all staff are trained in dementia care and that this training is translated into the care practices within the home. Hazelhurst DS0000065774.V369167.R01.S.doc Version 5.2 Page 22 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The people who use the service are placed at risk by the lack of clear leadership and much needed good management practices. The failures place people at real risk of harm to health and wellbeing and this is a serious concern. EVIDENCE: The acting manager has been in post since May 2008 and was not present during the inspection. Surveys completed by relatives prior to the inspection included the comments ‘the home has gone through a lot of change over the past year and some
Hazelhurst DS0000065774.V369167.R01.S.doc Version 5.2 Page 23 stability and direction is required’ and ‘there have been a lot of staff changes recently and some of the staff seem demoralised’. During this inspection concerns have been identified regarding the management of the home. The management of the home has failed to provide adequate staffing numbers and has failed in the organisation of staff training, specifically moving and handling and safeguarding of vulnerable adults training. Significant shortfalls were noted in the care plans, practices and documentation, this provided evidence of poor management and leadership. Some quality assurance systems were in place; monthly visits were conducted as required by Regulation 26. Concerns had been raised regarding the high number of falls by people living at the home. A ‘tick-box’ audit had been conducted of the accident book, but this did not ascertain whether there were any common themes or if any action could be taken to reduce the incidence of falls within the home. Procedures were in place to safeguard the financial interests of the people who use the service. No staff members were appointees for service users. The inspector was informed that staff received regular supervision and that records were maintained and usually stored in a folder in the office; however the staff supervision folder had recently gone missing. The folder had subsequently been returned, but without several of the records. Staff confirmed that they had received supervision. This inspection has continued to identify shortfalls, nine of the requirements made at the previous inspection on 29th February 2008 remain un-met. Hazelhurst DS0000065774.V369167.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X 3 X X 1 Hazelhurst DS0000065774.V369167.R01.S.doc Version 5.2 Page 25 Yes 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 OP4 Regulation 14 (1)(d) Requirement That the pre-admission document be expanded to include information as to how the home will meet assessed needs. This is a repeat requirement from 29th February 2008. Risk assessments undertaken for those at risk of falls and tissue breakdown must include the management of the risk and be regularly reviewed. This is a repeat requirement from 29th February 2008. That care plans are fully and regularly reviewed and accurately reflect service users current care needs. This is a repeat requirement from 29th February 2008. Food intake records must be maintained for all service users that require them as under Regulation 17 (1) (a) and records of action taken when service users are noted to have lost weight. This is a repeat requirement from 29th February 2008.
DS0000065774.V369167.R01.S.doc Timescale for action 30/10/08 2. OP7 13 (4)(b)(c) 30/10/08 3. OP7 15 (1) (2)(b)(c) 30/10/08 4. OP7 Schedule 3 (o) 13 (4)(b)(c) 30/10/08 Hazelhurst Version 5.2 Page 26 5. OP9 12 (1)(a) 6. 7. OP9 OP9 13 (2) 13 (2) 8. OP10 12 (4)(a) 9. OP15 16 (2)(i) 10. OP18 13 (3)(6) (7)(8) 23 (1)(d) 16 (2)(j) (k) 11. OP26 12. OP27 18 (1)(a) 13. OP30 18 (1)(a) (c)(i)(ii) 10 (1) 13 (5) 14. 15. OP31 OP38 That medication is only administered covertly if there is clear documented evidence that it is in the service users best interests. That the medicine policies reflect actual practice and are current. That medicines are given to the people who use the service as per instructions from the manufacturers. That the home is conducted to ensure the dignity of service users is protected and promoted at all times. This is a repeat requirement from 29th February 2008. That the people must be offered sufficient food to ensure there are not 12 hour gaps with no food being readily available, and this must be recorded. That all staff are trained in safeguarding vulnerable adults. This is a repeat requirement from 29th February 2008. That high standards of cleanliness are maintained throughout the home, including the elimination of offensive odours. This is a repeat requirement from 29th February 2008. Staffing levels need to be reviewed to ensure service users needs are met. This is a repeat requirement from 29th February 2008. That all staff are trained in dementia care and that this training is translated into the care practices within the home. That arrangements must be made for a permanent manager to be appointed to the home. That all staff have up to date training in moving and handling. This is a repeat requirement
DS0000065774.V369167.R01.S.doc 30/09/08 30/11/08 15/09/08 30/10/08 30/09/08 30/10/08 30/10/08 30/09/08 30/11/08 30/10/08 30/10/08 Hazelhurst Version 5.2 Page 27 from 29th February 2008. 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 OP9 Good Practice Recommendations Medicine prescribed on a ‘when required’ basis would benefit from a guideline in the care plan which give criteria to use as to when to administer this medicine. This would ensure a common approach in the use of this medicine. Hazelhurst DS0000065774.V369167.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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