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Inspection on 05/06/07 for Hazelhurst Nursing Home

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

This inspection was carried out on 5th June 2007.

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

Residents who have complex health care needs are well cared for by a team of competent nursing staff. This results in many complimentary comments from the relatives of residents who have been cared for at the end of their lives. There is a strong management team so that all aspects of the service are carefully monitored. The employment of a very skilled Welfare Officer means that the staff receive good guidance on the way to recognise each resident as an individual.

What has improved since the last inspection?

Regular meetings of the management team with the Provider have strengthened the communication at all levels through the home so it is easier to identify any work that needs doing to make life comfortable for the residents. There have been fewer complaints about the service and none received recently by the Commission for Social Care Inspection. There is a new computerised system of recording the care given to each resident. This will be very useful in helping staff plan the care they give and to know what each resident needs from them each day.

What the care home could do better:

When potential residents are visited and their care needs are assessed by senior staff at the home, there should be more attention to the potential resident`s wishes and expectations of the service (or their representatives) because this is important in deciding if the placement would be successful. When a new manager is appointed it would be sensible to give early attention to the quality assurance systems and their effectiveness because they have not been reviewed for some time. The recruitment process should ensure that there is written verification of the reasons for applicants leaving previous care posts. This helps in checking their suitability to work with vulnerable adults.

CARE HOMES FOR OLDER PEOPLE Hazelhurst Nursing Home Bishopswood Ross-on-wye Herefordshire HR9 5QX Lead Inspector Wendy Barrett DRAFT Unannounced Inspection 09:30 05th June 2007 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 Nursing Home DS0000027679.V332973.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 Nursing Home DS0000027679.V332973.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hazelhurst Nursing Home Address Bishopswood Ross-on-wye Herefordshire HR9 5QX 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) 01600 890600 01600 890926 Hazelhurst Nursing Home Limited Hazlehurst Nursing Home Ltd (Previous) Vacant Care Home 45 Category(ies) of Dementia (45), Dementia - over 65 years of age registration, with number (45), Old age, not falling within any other of places category (45), Physical disability (45), Physical disability over 65 years of age (45), Terminally ill (45) Hazelhurst Nursing Home DS0000027679.V332973.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th July 2006 Brief Description of the Service: This service is provided at an Edwardian country house 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 who may have care needs arising from ageing, physical disability, and dementia. On the outskirts of the village of Bishopswood, the property is approached by a long drive and is in a peaceful rural position. The registered Care Manager, Mrs. B. Cooper, accepted terms for her early retirement and left her post the week prior to the inspection visit. The Provider confirmed fees ranging from £481-95pence to £700 in April 2007. Additional charges are dependent on individual contracts and are defined in them. A brochure is handed to all enquirers. This contains information about the service and advises how additional information can be obtained e.g. full version of the home’s Statement of Purpose. All potential residents receive a copy of the Service User Guide. Hazelhurst Nursing Home DS0000027679.V332973.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been written with reference to information about the service and held by the Commission, a pre-inspection questionnaire completed by the Care Manager, comments received in survey forms and an inspection visit to the service. What the service does well: What has improved since the last inspection? Regular meetings of the management team with the Provider have strengthened the communication at all levels through the home so it is easier to identify any work that needs doing to make life comfortable for the residents. There have been fewer complaints about the service and none received recently by the Commission for Social Care Inspection. There is a new computerised system of recording the care given to each resident. This will be very useful in helping staff plan the care they give and to know what each resident needs from them each day. Hazelhurst Nursing Home DS0000027679.V332973.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. The summary of this inspection report can be made available in other formats on request. Hazelhurst Nursing Home DS0000027679.V332973.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 Nursing Home DS0000027679.V332973.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents or their representatives have the information they need to choose a home that will meet their expectations. The prospective resident’s care needs are fully assessed by senior staff at the home so that only residents whose needs can be met are admitted. This work should also check out what things are important to the prospective resident in making life as comfortable as possible. EVIDENCE: A Statement of Purpose is available at the home for anyone to read on request. This document gives a full description of the service and how it is managed in order to meet its aims and objectives. There is also other information literature e.g. Service User Guides, brochures. Copies of these documents are handed to enquirers. Hazelhurst Nursing Home DS0000027679.V332973.R01.S.doc Version 5.2 Page 9 Every resident has an accommodation agreement that explains how the fees are made up and what service the resident can expect to receive. Any services that attract extra charges are specified in the agreement e.g. hairdressing, chiropody. The Care Manager meets prospective residents before any agreement is made to admit them. This gives her an opportunity to find out what the individual needs from the service and decide if the placement would be suitable for them. An example of an initial assessment record confirmed a thorough piece of work although there should be more reference to the wishes of the potential resident and/or their relatives. Hazelhurst Nursing Home DS0000027679.V332973.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9, and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A new, computerised system of care planning has made it much easier for staff to keep comprehensive, up to date records of each resident’s care. Medication is very carefully managed with regular checks of stock and records to make sure it is being safely handled. Residents feel that staff treat them with respect. EVIDENCE: A new system of computerised care planning has been introduced since the last inspection. This has been a large investment for the Provider but all levels of care staff were enthusiastic about the way it was helping them plan their care of each resident. Care staff and nursing staff were observed using the new care plans during the inspection visit. Hard copies of care plans are kept in bedrooms so that the resident and care staff have ready access to it. There are also plans to introduce a ‘named nurse’ system so that every resident gets individual attention to their overall comfort. Hazelhurst Nursing Home DS0000027679.V332973.R01.S.doc Version 5.2 Page 11 Care plans were well written with clear guidance to help staff work effectively with the individual e.g. a plan advised staff to avoid overloading the resident with information because he found it difficult to cope with too much detail and may respond to this by becoming verbally aggressive. Health care professionals who work with the home have confidence in the staff and residents are happy with the way staff treat them. Medication is very carefully managed with regular audits of stock and records by management staff. There are nightly audits of controlled drugs and general monthly audits of medication systems, with checklist records of findings. A relative of a resident who has Parkinson’s was particularly pleased with the regular reviews of his mother’s medication regime. A resident said she felt safe when staff transferred her from her wheelchair. She also felt they came to her promptly when she requested their help in maintaining her dignity. Hazelhurst Nursing Home DS0000027679.V332973.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is better attention to helping residents live their lives in the way they prefer and encouraging staff to work in a way that respects each resident’s individuality. Residents enjoy their meals and the way these are planned is carefully monitored to be sure each resident receives a well balanced diet. EVIDENCE: Residents are helped to pursue their social interests through a regular programme of group activities. These are well advertised with good use of pictures, colour and large print to help residents access the information. A Welfare Officer is employed part time to organise this aspect of the residents’ care. She is a very much-valued member of the staff team. A comment in a health care professional survey form described the Welfare Officer as ‘very good with the residents and with liaising with us’. Hazelhurst Nursing Home DS0000027679.V332973.R01.S.doc Version 5.2 Page 13 Two relatives were met during the inspection visit and they felt welcomed into the home. Visitors are able to sit and have meals with their resident whenever they wish as long as the catering staff have advance warning. The new care planning system includes attention to residents’ social and emotional needs and the Welfare Officer was due to do some development work with junior staff to help them with these aspects of the overall care. Residents generally feel able to exercise choice and control although one survey response stated ‘sometimes they tell me what’s good for me’. Although another resident said she would like more variety on the menu e.g. curries, Chinese food, the staff had already noted her wishes and were arranging for her to be supplied with a Chinese meal in the near future. Menus describe an attractive variety of dishes and residents are generally happy with the catering service. The cook has many years experience and was managing the kitchen well e.g. cleaning schedules, regular health and safety audits. Food stocks were inspected. There was a satisfactory supply of fresh produce and dry goods. Stock rotation was being well managed. There were proposals to ask qualified nurses and care staff to monitor each resident’s intake of food. This is a good idea because many of the residents are very frail and may find it difficult to maintain an adequate nutritional balance without additional support from the staff. Hazelhurst Nursing Home DS0000027679.V332973.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The number of complaints and allegations has significantly reduced since the last inspection because the Provider and senior management team have strengthened the way they work together to protect residents and respect their individuality. EVIDENCE: The service was generating an above average number of complaints and allegations – mostly relating to personal care practices. This unsatisfactory situation has resulted in a considerable amount of work by the Provider and the management team at the home to make sure residents have a positive experience. Recruitment and supervision/support systems for junior staff have been strengthened and there has been additional training in abuse awareness. The management team have been meeting regularly to share their observations and ideas for developing the service in the best interests of the residents. Hazelhurst Nursing Home DS0000027679.V332973.R01.S.doc Version 5.2 Page 15 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): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents’ accommodation is kept safe. There has been a lack of attention to a programme of redecoration and refurbishment and although this is already receiving attention, some areas are not looking very smart at the moment. EVIDENCE: The residents’ accommodation has recently been subject to a thorough health and safety audit to make sure residents live in a safe environment. There is also a regular programme of maintenance to essential services and specialist equipment e.g. water quality, hoists, fire safety system. There were indications that routine decoration and refurbishment has not been receiving the attention it should e.g. stained carpets, badly chipped paintwork, Hazelhurst Nursing Home DS0000027679.V332973.R01.S.doc Version 5.2 Page 16 some soft furnishings looking rather well worn and past their best. It was reassuring to hear that the management team had identified this shortfall and the Provider was already developing and implementing a refurbishment programme. The staff receive training so they know how to reduce the risk of infection. They are supplied with the equipment they need e.g. laundry facilities, protective clothing, and they have written guidance on infection control. Recommendations arising from a kitchen inspection by an Environmental Health Officer in April 2007 had been addressed. Hazelhurst Nursing Home DS0000027679.V332973.R01.S.doc Version 5.2 Page 17 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): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are enough staff to care for the residents and they receive the training they need to work safely with the residents. Applicants for work at the home are subject to careful checks to be sure they will be suitable to work with vulnerable adults. EVIDENCE: Staff duty rotas show a satisfactory number of staff employed to care for the residents and this was confirmed through the number of staff at work when the inspection visit took place. There is always at least one qualified nurse on duty at the home. Agency staff are used to maintain this level, as it has been difficult to attract suitable, local staff into permanent positions. The staff receive the training they need to work safely e.g. manual handling, food hygiene. The care assistants are supported in obtaining a National Vocational Qualification in care – over half the care assistants have already obtained a level 2 or level 3 award. 30 staff (including nursing staff) hold a first aid certificate. Two staff recruitment records showed that there is careful vetting of potential new employees to be sure they will be safe to work with vulnerable adults e.g. Hazelhurst Nursing Home DS0000027679.V332973.R01.S.doc Version 5.2 Page 18 criminal records bureau (CRB) checks are carried out and one of the records included a statement of action taken to supervise a new employee until a CRB disclosure was received. It may be necessary to revise the application form to ensure that applicants provide details of the reason for leaving previous care posts. This information is now a requirement and it was not included in one of the sample records seen. Hazelhurst Nursing Home DS0000027679.V332973.R01.S.doc Version 5.2 Page 19 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): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although the service has very recently lost the Care Manager and her husband, the Provider has responded to this event by developing new systems of management to make sure residents receive a good standard of care. The initial impressions are encouraging because the management team is already identifying shortfalls and action is being taken to address them. This is being supported by making sure residents and staff have opportunities to share their views with the managers. There is an annual development plan for quality assurance but this hasn’t been revised since 2002. Once a new manager has been appointed they will need to satisfy themselves that the current quality monitoring systems are effective. The health and safety of residents is maintained through a regular staff training programme and comprehensive audits of the premises. Hazelhurst Nursing Home DS0000027679.V332973.R01.S.doc Version 5.2 Page 20 EVIDENCE: The Care Manager left her post just before the inspection visit but two experienced senior nurses were overseeing her work at the home until a replacement manager was recruited. There has been a lot of work done recently by the Provider to strengthen the overall service for the residents. This has included regular meetings of all senior staff and the Provider so that future plans for the home can be made. This is obviously being effective e.g. a lack of attention to decoration and refurbishment is being addressed, recruitment and staff support and supervision practices have been strengthened. The home doesn’t normally look after residents’ personal money or valuables although the Welfare Officer was supporting a blind resident as a special case. Records of transactions were being maintained. Most residents receive separate invoices for any personal expenditure e.g. hairdresser. There has been an extensive exercise to update health and safety arrangements over the past few months. This has involved reviewing premises safety, health and safety auditing and policies and procedures at the home. The Provider hoped to employ a consultant to oversee this work until a new manager had been recruited. Staff receive the health and safety training they need to help them work safely with the residents. Hazelhurst Nursing Home DS0000027679.V332973.R01.S.doc Version 5.2 Page 21 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 3 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 10 11 2 x x x x x x 3 STAFFING Standard No Score 27 28 29 30 3 3 x 3 3 3 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x x 3 Hazelhurst Nursing Home DS0000027679.V332973.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP3 OP29 OP33 Good Practice Recommendations More reference to the wishes and expectations of potential residents and/or their representatives in pre-admission assessment work. Recruitment procedures should ensure receipt of written verification of reasons for applicants having left previous care posts. The new manager should give priority to reviewing the home’s quality assurance system and its effectiveness. Hazelhurst Nursing Home DS0000027679.V332973.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hazelhurst Nursing Home DS0000027679.V332973.R01.S.doc Version 5.2 Page 24 - 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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