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Inspection on 25/05/05 for Hazelmere Nursing Home

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

This inspection was carried out on 25th May 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

Hazelmere nursing home provides a good level of nursing care to residents in a home like environment, and which is delivered in a caring manner. Residents and visitors spoke very positively of the home and the service provided by staff, comments from them included `staff are very nice and caring` `they treat me very well` `staff are nice and good to you`. One relative said that the staff were `patient and kind` and that she would not want her relative to be anywhere else. This relative also said that staff provide care and support to visiting relatives. They also complimented the food provided and said it was `very good`. Hazelmere nursing home provides a home like environment where visiting is encouraged with some visitors spending long periods of time in the home. The care needs of residents are fully assessed following admission and care is planned and documented.

What has improved since the last inspection?

Ongoing redecoration continues in the home and a new stand hoist has been purchased since the last inspection. Staff were seen to be using this effectively in the communal area. Staff training is being developed with a senior staff member co-ordinating this important area.

What the care home could do better:

As identified at the last inspection the individual social needs of residents are not fully assessed and responded to, although it was noted that the spiritual needs of residents are well responded to. During the inspection it was noted that the recruitment practice of the home was poor and needs to be improved to ensure the safety of residents.

CARE HOMES FOR OLDER PEOPLE Hazelmere 9 Warwick Road Bexhill on Sea East Sussex TN39 4HG Lead Inspector Melanie Freeman Unannounced 25 May 2005 11:30 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. Hazelmere H59-H10 S13994 Hazelmere V228038 250505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hazelmere Address 9 Warwick Road Bexhill on Sea East Sussex TN39 4HG 01424 214988 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) Mr & Mrs Gadsden Mrs C Gadsden Care Home with Nursing (CRH) 23 Category(ies) of Old age, not falling within any other category registration, with number (OP) 23 of places Physical disability (PD) 23 Hazelmere H59-H10 S13994 Hazelmere V228038 250505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: That the maximum number of service users/residents/individuals to be accommodated at any one time is twenty three (23) That the care home provides general nursing care to older people aged sixty five (65) or over on admission and can provide care to people with a physical disability. Date of last inspection 17.01.05 Brief Description of the Service: Hazelmere Nursing Home is situated in a residential area approximately half a mile from Bexhill town centre. The main-line station, seafront and local bus services are close by.The home has a large, pleasant and well-maintained garden with an ornamental fishpond to the rear of the building. There are car parking facilities on site and unlimited parking facilities outside the Nursing Home in Warwick Road.There is a pleasant lounge overlooking the garden that is also used as a dining room. The home is registered to provide general nursing care for older people and older people with a physical disability. Both private and socially funded service users are cared for by the home.This home is owned and managed as a family business. Hazelmere H59-H10 S13994 Hazelmere V228038 250505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Hazelmere Nursing Home will be referred to as ‘residents’. This unannounced inspection took place on a weekday in May between the hours of 11.30 and 16.30. The manager/owner was on duty and was able to contribute to the inspection process. The inspection focussed on meeting and talking to residents and visitors to the home. The inspector was able to talk to five residents in depth and four visitors. Staff were spoken to and observed as they worked and a tour of the premises and its facilities was undertaken. Records and documentation inspected included: residents care documentation, staff recruitment, supervision and training records and the homes statement of purpose and service users guide. What the service does well: Hazelmere nursing home provides a good level of nursing care to residents in a home like environment, and which is delivered in a caring manner. Residents and visitors spoke very positively of the home and the service provided by staff, comments from them included ‘staff are very nice and caring’ ‘they treat me very well’ ‘staff are nice and good to you’. One relative said that the staff were ‘patient and kind’ and that she would not want her relative to be anywhere else. This relative also said that staff provide care and support to visiting relatives. They also complimented the food provided and said it was ‘very good’. Hazelmere nursing home provides a home like environment where visiting is encouraged with some visitors spending long periods of time in the home. The care needs of residents are fully assessed following admission and care is planned and documented. Hazelmere H59-H10 S13994 Hazelmere V228038 250505 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hazelmere H59-H10 S13994 Hazelmere V228038 250505 Stage 4.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 Hazelmere H59-H10 S13994 Hazelmere V228038 250505 Stage 4.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) 1,3.4 and 6 The homes statement of purpose and service users guide is not complete or up to date and therefore full information is not provided to prospective admissions or residents. Pre-admission procedures need to be improved to ensure that residents admitted are provided with suitable facilities and equipment from admission. EVIDENCE: Although the home provides a combined statement of purpose and service users guide which is available in the office and in the communal dining room/lounge these documents did not include all the information that is required. All prospective admissions to the home are assessed by the manager/owner and although discussions confirmed that this is completed in conjunction with other health care professionals the assessment is not well documented and needs to be further developed. This was confirmed when it was identified that 1 resident was admitted to the home without a pressure relieving mattress when this should have been provided. Hazelmere H59-H10 S13994 Hazelmere V228038 250505 Stage 4.doc Version 1.30 Page 9 Residents living in the home are looked after by staff able to deliver appropriate care. . Intermediate or rehabilitative care is not provided at Hazelmere nursing home. Hazelmere H59-H10 S13994 Hazelmere V228038 250505 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 8 The home was found to be meeting the health and personal care needs of the residents with the support and advice of community health care professionals as necessary. EVIDENCE: The care documentation of 2 service users were inspected in depth and these demonstrated that full assessments are completed and these are used to inform the plans of care generated. These demonstrated regular review. During the inspection it was seen that a recognised pressure area risk assessment tool is used and that a range of pressure relieving equipment is provided. It was however noted that a high risk assessment did not always generate an associated care plan. A clear policy document with guidelines for the care of pressure areas is still not available in the home. The care documentation maintains clear records demonstrating community health care involvement in service users health care needs. Hazelmere H59-H10 S13994 Hazelmere V228038 250505 Stage 4.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 and 13 Resident’s opportunities for stimulation through leisure and recreational activities are not fully developed in the home to meet individual needs. The home facilitates residents to receive visitors in the home. EVIDENCE: When talking to residents and relatives it was clear that the religious needs of residents are well respected and responded to in the home with regular visits and services from religious organisations. A musical entertainer visits monthly and local library also visits fortnightly. Visitors and contact with relatives is encouraged and during the inspection a number of visitors were in the home, some spending long periods of time in the home. During the inspection it was noted that visitors often meet with residents in the communal lounge a separate quiet room is not available. Resident’s interests are not assessed fully and the opportunities for stimulation through leisure and recreational activities are limited. Hazelmere H59-H10 S13994 Hazelmere V228038 250505 Stage 4.doc Version 1.30 Page 12 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 and 18 Procedures and training in the home ensure that complaints and any allegation of abuse made are managed appropriately. EVIDENCE: The home has a detailed complaints procedure, and although there had not been any formal complaints recently, residents and relatives spoken to confirmed that they would speak to the registered nurses on duty, if they had any issues and that these would be addressed by the manager/owner as necessary. Records confirmed that staff were receiving training on adult protection issues. Hazelmere H59-H10 S13994 Hazelmere V228038 250505 Stage 4.doc Version 1.30 Page 13 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) 19,20,23 and 26 The home provides residents with a comfortable environment that has a home like feel. The home had an unpleasant odour in some areas. EVIDENCE: Hazelmere Nursing home is a converted premise that has retained a home like environment. The homes layout and location is suitable for its stated purpose. There is an attractive garden that visitors said that they enjoyed looking at and that it was used in the summer months. There is a ground floor communal space that is used as a lounge and dining room, although during the inspection it was noted that most residents ate their meals at individual tables. The communal space available does not allow for flexible use and one resident said that she did not like going to the lounge as it became too hot. Hazelmere H59-H10 S13994 Hazelmere V228038 250505 Stage 4.doc Version 1.30 Page 14 On arrival in the home, and in some areas around the home, the inspector noted that there was an unpleasant smell that she believed was stale urine. This is unusual for this home and the manager/owner confirmed that she was aware of this problem and was arranging for some deep cleaning. Hand washing was well promoted in the home with appropriate hand washing facilities being found at all sink areas. Hazelmere H59-H10 S13994 Hazelmere V228038 250505 Stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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) 27,28,29 and 30 Staffing arrangements and numbers were satisfactory to meet the needs of the residents living in the home. The homes recruitment procedures were found to be poor and did not ensure resident’s safety. EVIDENCE: On the day of this inspection 21 residents were living in the home. During the inspection residents and visitors made very positive comments about the staff working in the home including ‘staff are very nice and caring’ ‘they treat me very well’ ‘staff are nice and good to you’. One relative said that the staff were ‘patient and kind’ and that she would not want her relative to be anywhere else. This relative also said that staff provide care and support to visiting relatives. Residents confirmed that staff respond to the call bell promptly and are readily available when needed and feel that their care needs are being met in the home. Hazelmere H59-H10 S13994 Hazelmere V228038 250505 Stage 4.doc Version 1.30 Page 16 The home manager/owner is committed to helping and supporting care staff in completing NVQ training and most of the carers have an NVQ level 2 in care. The recruitment records for 2 care staff were reviewed in depth and these were found to be incomplete in respect of one carer recently employed. The records indicated that this carer did not have a current CRB/ POVA first check any references or proof of identity. This was a serious shortfall and the an immediate requirement form was left with the manager/owner who was required to address this shortfall and to ensure that this care staff is fully supervised while working in the home until the necessary checks were completed. Staff training continues to be developed and induction training is documented within records examined in the home. Hazelmere H59-H10 S13994 Hazelmere V228038 250505 Stage 4.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) 32,34,35 and 36 The manager/owner promotes a positive inclusive environment where staff and residents are happy to consult with her. EVIDENCE: The manager/owner is in the home most days and has a regular contact with all staff and residents. Residents and visitors spoken to felt confident that she managed the home well and is readily accessible. The home does not deal with any of the resident’s monies directly and all have appointed representatives. Staff records indicated that staff supervision is provided. Hazelmere H59-H10 S13994 Hazelmere V228038 250505 Stage 4.doc Version 1.30 Page 18 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 1 x 2 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 x COMPLAINTS AND PROTECTION 3 3 x x 3 x x 2 STAFFING Standard No Score 27 3 28 4 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 x 3 x x 3 3 x x Hazelmere H59-H10 S13994 Hazelmere V228038 250505 Stage 4.doc Version 1.30 Page 19 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 1 Regulation 4 and 5 Requirement Timescale for action 1.7.05 2. 3 3. 8 4. 12 5. 6. 26 29 That the registered person provides a Statement of Purpose and a service users guide to fully meet the National Minimum Standards and Schedule 1(outstanding from last 2 inspections) 14(1) That the assessment completed prior to agreeing an admission to the home is improved to ensure full and comprehensive. 13(6) That an up to date procedure and guidelines based on recent research for the care and the prevention of pressure sores is provided and implemented.(outstanding from last inspection) 16(2)m)n) That the current provision and time available for activities and entertainment is improved, to ensure all service users have their social, cultural, religious and recreational interest and needs met. 16(2)j) That the home is free from offensive odours. 19(1) That a thorough recruitment procedure is operated and includes securing two authentic references and the retention of H59-H10 S13994 Hazelmere V228038 250505 Stage 4.doc 1.6.05 1.7.05 1.9.05 1.6.05 1.6.05 Hazelmere Version 1.30 Page 20 7. 30 18(1) documentation as identified in schedule 2.(outstanding from previous 2 inspections) That all staff receive foundation training which meets National Training Organisation (NTO) specifications within the time limits specified in NMS 30.2 & 30.3. 1.8.05 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 8 11 22 Good Practice Recommendations That a means of weighing service users who are unable to stand is provided. That a full policy and procedure for the care of the dying service user is implemented That an assessment of the premises and facilities should be undertaken by a suitably qualified person, or qualified Occupational Therapist, to advise on the suitability of disability equipment and environmental adaptations. Hazelmere H59-H10 S13994 Hazelmere V228038 250505 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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. 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