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Inspection on 03/06/05 for Hazelhurst Nursing Home

Also see our care home review for Hazelhurst Nursing Home for more information

This inspection was carried out on 3rd June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 is committed to ensuring staff are fully trained and are able to care for residents in a way which promotes their independence and protects their privacy and dignity. Relationships between staff and residents appeared warm and friendly. Visitors to the home said staff were always friendly.

What has improved since the last inspection?

Following an incident where a resident sustained a serious injury the home had ensured that all areas had been subject to an in depth health and safety check and audit and measures to prevent a reoccurrence of a similar incident had been addressed.

What the care home could do better:

Care plans to show how individual residents needs are met and how staff are going to help them need to be improved, cross referenced and standardised. Records required by Regulation needed to be addressed. There were some environmental issues around residents doors being wedged open which caused concern as the home had a resident who smoked. Although risk assessments were in place for those residents who had access to hot water from the wash hand basin in their bedroom, due to the mental frailty of residents it was of concern to the inspector that their understanding of the danger was limited and the home should therefore consider a programme of fitting thermostatic control valves.

CARE HOMES FOR OLDER PEOPLE Hazelhurst Nursing Home Bishopswood Ross-on-Wye Herefordshire HR9 5QX Lead Inspector Chrissy Presley Unannounced 3 & 4 June 2005 17.30 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 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 Nursing Home E52 S27679 Hazelhurst NH V226849 030605.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hazelhurst Nursing Home Address Bishopswood Ross-on-Wye Herefordshire HR9 5QX 01600 890600 01600 890926 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Hazelhurst Nursing Home Limited Mrs Bernice Cooper Care Home with Nursing 45 Category(ies) of DE Dementia - 45 registration, with number DE(E) Dementia (over 65) - 45 of places OP Old Age - 45 PD Physical Disability - 45 PD(E) Physical Disability - 45 TI Terminally Ill - 45 Hazelhurst Nursing Home E52 S27679 Hazelhurst NH V226849 030605.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10 November 2004 Brief Description of the Service: An Edwardian country home set in extensive grounds with gardens. Hazelhurst has been modernised and extended to create a care home with nursing. It is registered to offer services for up to 45 people, and most people there are aged over 65 years. On the outskirts of the village of Bishopswood, the property is approached by a long drive and is in a peaceful rural situation. Hazelhurst Nursing Home E52 S27679 Hazelhurst NH V226849 030605.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out late on a Thursday afternoon and evening and a Friday afternoon. Many of the residents were mentally frail. One resident was able to tell the inspector what it was like living in the home. A number of visitors to the home were spoken to. Six staff in total were interviewed during the course of the inspection. The inspector also spent time with the cook and activities co-coordinator. Care plans were discussed with the matron and trained staff. What the service does well: What has improved since the last inspection? Following an incident where a resident sustained a serious injury the home had ensured that all areas had been subject to an in depth health and safety check and audit and measures to prevent a reoccurrence of a similar incident had been addressed. Hazelhurst Nursing Home E52 S27679 Hazelhurst NH V226849 030605.doc Version 1.30 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 Nursing Home E52 S27679 Hazelhurst NH V226849 030605.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Hazelhurst Nursing Home E52 S27679 Hazelhurst NH V226849 030605.doc Version 1.30 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 standard(s) 3 The Manager ensures that no resident is admitted to the home unless they had been fully assessed by her to ensure staff and the home facilities are appropriate. Residents or families are encouraged to visit the home prior to admission. EVIDENCE: There were individual records kept for each resident. The record of the latest admission to the home was inspected and included a record of a full assessment that was carried out prior to admission. The assessment documentation used was comprehensive. All aspects of the daily activities of living were addressed to ensure any specialised support or equipment needs would be in place prior to admission of any new resident. Hazelhurst Nursing Home E52 S27679 Hazelhurst NH V226849 030605.doc Version 1.30 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 standard(s) 7, 8, 10 The health needs of residents are well met with evidence of ongoing multidisciplinary working. Each resident had an individual care plan, which recorded their individual needs; information contained in these documents was not always appropriate. Personal support was offered to residents in a way that ensured their privacy and dignity is respected and independence is promoted whenever possible. EVIDENCE: The care plans of two residents were inspected in depth. Although these documents contained information that enabled staff to deliver care information was not set out in a way, which did not cause confusion. Care records did not have accurate dates and did not cross-reference when reviews or incidents had happened. The home was planning to work to a more standardised model. Records showed evidence of multidisciplinary team involvement and the General Practitioner carried out a weekly round in the home. A number of residents in the home had some degree of mental frailty; it was difficult for those residents to have any input into their care plans. The home had undertaken an intensive programme of moving and handling training for all staff, care plans and discussion with staff reflected the work undertaken. The home was well equipped with hoists and other moving and Hazelhurst Nursing Home E52 S27679 Hazelhurst NH V226849 030605.doc Version 1.30 Page 10 handling equipment to ensure residents safety. It was noted in one record seen that the type of hoist to be used had not been named. Families and a resident who spoke with the inspector said they were always given choice about the daily activities of living with regard to getting up, going to bed and mealtimes. Staff knocked on doors before entering bedrooms and were observed maintaining the dignity and privacy of residents. Hazelhurst Nursing Home E52 S27679 Hazelhurst NH V226849 030605.doc Version 1.30 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 standard(s) 12,13 & 15, Residents are offered a stimulating range of activities in the home. Activities are available according to the individuals needs. Meals offered choice and variety and residents appeared to enjoy them. EVIDENCE: A resident and families spoken to said the food was of good quality and the inspector saw the choices that were offered to residents. Most residents sat in the dining room for their meals, the room was pleasant and tables were laid. Residents were observed interacting with each other during suppertime and staff were supporting those residents who needed help in a positive manner. Liquefied meals were served appropriately to ensure they looked appetising. Catering staff who understood the needs of residents were employed throughout the day. The home had a visit from the Environmental Health Officer; requirements following this visit had been addressed. Residents were observed playing scrabble which was organised by the activities co-ordinator who ensured that a range of activities was offered to residents including one – to – one activities for those residents less able. Records of activities and events that had taken place were seen. Further activities which included an extend class (gentle exercise and movement) and music and movement were accessed via external sources. Hazelhurst Nursing Home E52 S27679 Hazelhurst NH V226849 030605.doc Version 1.30 Page 12 The inspector saw a number of visitors all said they were made welcome and were happy with all aspects of care given to their families. One family were concerned that their relative did not have enough fluids, this was discussed with matron and nursing staff that said if they were any concerns the resident would be placed on a fluid chart. Hazelhurst Nursing Home E52 S27679 Hazelhurst NH V226849 030605.doc Version 1.30 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 standard(s) 16 & 18 The complaints process in the home is comprehensive. Families feel that matron and her staff are approachable. All complaints are taken seriously and acted upon. Staff have knowledge and understanding of adult protection issues which ensure a safe environment for residents. EVIDENCE: Records of training evidenced staff had received training regarding types of abuse and the policies and procedures in the event that an incident of abuse is suspected. A resident spoken to during the inspection said she would not be afraid to complain. Records of complaints were seen and all had been fully investigated and appropriate action taken. Hazelhurst Nursing Home E52 S27679 Hazelhurst NH V226849 030605.doc Version 1.30 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 standard(s) 19 The home is warm, comfortable and residents were able to personalise their bedrooms. Residents are able to access the grounds which are exceptionally well maintained. EVIDENCE: The home is a country house set in extensive grounds in a rural area. There is a lift between floors which enables residents access to all areas of the home. Several residents bedrooms were seen, these had all been environmentally risk assessed, had been personalised and records of furnishings belonging to residents were seen. Communal areas were furnished to a good standard and were homely in appearance. A number of fire doors were wedged. The maintenance man said the fire brigade had not inspected the home in the last five years. The fitting of intumescent strips on doors was discussed and also the fitting of appropriate devices, which comply with fire regulations, to doors which are currently wedged open. Hazelhurst Nursing Home E52 S27679 Hazelhurst NH V226849 030605.doc Version 1.30 Page 15 Records of bathing temperatures were seen. These appeared low and the matron said she would check the thermometers were appropriately calibrated. There were currently no thermostatic control valves fitted to wash hand basins in residents bedrooms. A warning sign of hot water was seen although the inspector was unsure due to the mental frailty of residents whether they would have an understanding of this hazard. Hazelhurst Nursing Home E52 S27679 Hazelhurst NH V226849 030605.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29 Recruitment procedures are robust to ensure safety of residents. There are enough staff on duty that have appropriate skills and knowledge to meet individual needs. EVIDENCE: Families and a resident spoken to said there were enough staff on duty. One family member said ‘Mum is kept beautifully clean’. There is a strong commitment for staff training and staff are given the opportunity to undertake NVQ training in care. There were enough catering and ancillary staff employed in the home. Three recruitment files were inspected and evidenced there was a robust procedure in place to ensure right staff were employed. Hazelhurst Nursing Home E52 S27679 Hazelhurst NH V226849 030605.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 37&38 The home is well managed and staff are provided with support and guidance to meet the individual needs of residents. Residents are well cared for in a homely environment. EVIDENCE: The matron is a registered nurse who has knowledge and experience in working with older people. She has a team of committed trained nurses and care staff. The matron was evident within the home and was observed talking to relatives and residents. Staff received regular supervision and records were seen. The maintenance man said that all rooms were audited at least three monthly, and all equipment is well maintained, this included the call bell system, wheelchair maintenance, mobile hoists and mattresses. There is a legionella risk assessment in place. Hazelhurst Nursing Home E52 S27679 Hazelhurst NH V226849 030605.doc Version 1.30 Page 18 Event notification, which is required under Regulation 37 of the Care Homes Regulations 2001, was not being forwarded to the Commission for Social Care Inspection, an immediate requirement was left with the home Hazelhurst Nursing Home E52 S27679 Hazelhurst NH V226849 030605.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x x STAFFING Standard No Score 27 3 28 x 29 4 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x 3 x 2 3 Hazelhurst Nursing Home E52 S27679 Hazelhurst NH V226849 030605.doc Version 1.30 Page 20 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. 2. 3. 4. Standard OP7 OP7 OP7 OP7 Regulation 15 15 13 & 15 13 & 15 Timescale for action Information in care plans must Immediate have instructions which are more and onprecise going Dates written in care plans must Immediate be accurate. Instructions with regards to Immediate moving and handling resdients must be precise The registered person must Immediate ensure residents are bathed in a water temperature that is appropriate Fire doors must not be wedged Immediate Notifiable events under Regulation 37 of the Care Homes Regulations 2001 must be reported to the Commission without delay. Risk assessments must be further developed to measure the level of risk of each individual resident against uncontolled hot water from the wash hand basin (where a thermostatic control valve is not fitted) Immediate Requirement 5. 6. OP19 OP38 23 37 7. OP38 13 Immediate and ongoing Hazelhurst Nursing Home E52 S27679 Hazelhurst NH V226849 030605.doc Version 1.30 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP19 OP33 Good Practice Recommendations It is recocommended the home discuss with the fire brigade the fitting of intumescent strips to doors. Residents and relatives meeting should be considered Hazelhurst Nursing Home E52 S27679 Hazelhurst NH V226849 030605.doc Version 1.30 Page 22 Commission for Social Care Inspection The Coach House John Comyn Drive, Perdiswell Park Droitwich Road Worcester WR3 7NW 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 Nursing Home E52 S27679 Hazelhurst NH V226849 030605.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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