Inspection on 27/01/06 for Hazelwell Lodge

This inspection was carried out on 27th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

Other inspections for this house

Hazelwell Lodge 07/06/07

Hazelwell Lodge 24/07/06

Hazelwell Lodge 01/09/05

Hazelwell Lodge 12/01/05

Hazelwell Lodge 21/06/04

Hazelwell Lodge 29/01/04

Hazelwell Lodge 14/05/03

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hazelwell Lodge 67 Station Road Ilminster Somerset TA19 9BQ Lead Inspector Barbara Ludlow Unannounced Inspection 27th January 2006 09:45 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 Hazelwell Lodge DS0000016068.V271673.R01.S.doc Version 5.1 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. Hazelwell Lodge DS0000016068.V271673.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hazelwell Lodge Address 67 Station Road Ilminster Somerset TA19 9BQ 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) 01460 52760 01460 52384 MISS FEDILIA MAXWIN MRS NICOLA ANN OVERD Care Home 35 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0) of places Hazelwell Lodge DS0000016068.V271673.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. REGISTERED FOR 35 OLDER PERSONS IN CATEGORIES OP AND DE (E). 1st September 2005 Date of last inspection Brief Description of the Service: Hazelwell Lodge is a late Victorian property with a purpose built extension to the rear and an enclosed garden to the side. The home is situated at the edge of the small town of Ilminster, close to local amenities. The home accommodates 35 people in two separate areas of the building. The Bay provides personal care for older people and specialises in care for older persons with dementia care needs. The Lilies provides personal care for older people with dementia care needs and is accredited by Somerset Mental Health and Social Care Partnership under the Specialist Residential Care (SRC) arrangements. The Lilies is supported by a development nurse from the mental health care services. Platinum Care operates the home on behalf of the proprietors. Hazelwell Lodge DS0000016068.V271673.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection reports on some but not all of the key standards, it is therefore advisable to read this report in conjunction with the announced inspection report of 1st September 2005; in order to gain a full picture of the service provision. This unannounced inspection was undertaken by two inspectors for CSCI. The homes Registered Manager was on leave and an experienced Care Supervisor was in charge, who was most helpful and assisted with the inspection process. There were thirty one service users in residence and all were seen. All service users looked well cared for. A tour of the premises was made; service users and staff were seen and spoken with both in private and in the communal areas of the home. One visitor was seen and spoken with. Records were sampled which included the weekly fire testing and care planning. This was a positive inspection. Attention had been given to the matters arising at the last inspection and the environmental improvements were seen. What the service does well: What has improved since the last inspection? Hazelwell Lodge DS0000016068.V271673.R01.S.doc Version 5.1 Page 6 Requirements were made at the last inspection for the upgrading and attention to health and safety of the rooms on the first floor. This has received attention and has improved the bedrooms. Attention to other matters arising has been carried out, such as the care of the toaster in the dining room. The care supervisor said a new caged bird had been placed in the quiet lounge for the benefit of the service users. The garden continues to improve and is looking very pleasant and received praise from service users, comment heard, ‘beautiful garden’. Of the home, ‘a nice place to live’. 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. Hazelwell Lodge DS0000016068.V271673.R01.S.doc Version 5.1 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 Hazelwell Lodge DS0000016068.V271673.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5,NMS 6 does not apply. The home provides a good level of clear information about the home to aid prospective service users and their families/carers to make an informed choice of care home place. Pre-admission assessments are made. EVIDENCE: Information for prospective service users is available at the home. The home displays the Statement of Purpose and Service User Guide and a copy of the last report in the entrance to the home. There is also an A-Z of Services Directory serving as a Service User Guide. The home has a dedicated administrator who works each day and deals with all invoices, personal monies held and contracts. The home has fifteen block contracted Special Rate Care (SRC) beds for dementia care clients in The Lilies. No contracts were examined at this inspection. Hazelwell Lodge DS0000016068.V271673.R01.S.doc Version 5.1 Page 9 Care plans were sampled, there was evidence of pre admission assessment and of the community single assessment documentation held on file. The layout of the home has been designed to provide for service user’s needs whilst providing an appropriately secure environment. There are keypads to external doors, between The Bay and The Lilies and at the top of the stairs. Service users are able to have the keypad code where appropriate. Orientation cues have been developed to assist people to find their way around the home. There are handrails and aids available to assist daily living. Visiting family members were seen during the inspection, the inspectors observed them to be welcomed and encouraged with being involved with the care of their relative. Hazelwell Lodge DS0000016068.V271673.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10, The home offers a good level of specialist and personal care for its dementia care clients. Medications are generally well managed. EVIDENCE: Four care plans were sampled including service users from The Bays and The Lilies. There was good evidence of information gathered at the point of admission to the home. Life histories were recorded and any aids for communication were documented. Personal care information and health care information was recorded to a good standard. The Specialist Care Development Nurse (SCDN) visiting to support the home and advise on care in The Lilies. Specialist dementia care input was recorded. There was good evidence of life skills assessment, which covered basic tasks for example, making a drink. One person displaying unsettled behaviour did not have a documented strategy for staff to cope with this, nor was there a care plan for ‘going out’. There was Hazelwell Lodge DS0000016068.V271673.R01.S.doc Version 5.1 Page 11 a danger that the approach would be inconsistent and detrimental to the service user. All care plans had been reviewed and were otherwise up to date. Medication management was sampled, all administration records were satisfactory. Controlled drugs were appropriately stored. Storage and the medications fridge were satisfactory. The administration time of the dispensing of Bi phosphonates and the rationale for this was discussed. It is recommended that the administration time be monitored to ensure that it is administered at the optimum time. It was noticed that eight female service users had bare legs, it was a cold day and no blankets were in use for these service users who were sitting in the conservatory lounge area of the home. Staff asked suggested this was due to the night staff having assisted these service users to dress. Care must be taken to ensure these ladies are fully dressed where they require staff assistance and that they are dressed warmly enough for sitting in the conservatory lounge area, especially where the service users are not able to move around independently. Hazelwell Lodge DS0000016068.V271673.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,15 Family are welcomed and are encouraged to take part in daily life at the home. The menu served at lunchtime was satisfactory. EVIDENCE: The home has a welcoming homely environment. The home is securely maintained for the safety of all service users who have a level of dementia care need. Activities were not as evident at this inspection. The inspectors heard about trips out and of trips planned. Lunch was observed served in the dining areas of the home. The main dining room seated 16 together for lunch, fish in parsley sauce, peas and chips were served, and the alternative choices were cottage pie or sausages with tomato or brown sauce. It was noted that trays were not used to transport meals out to the tables laid in the conservatory. The food looked appetising. The kitchen was not seen at this inspection. Hazelwell Lodge DS0000016068.V271673.R01.S.doc Version 5.1 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 the following standard(s): The home has policies in place to protect service users from harm. There is a complaints procedure. EVIDENCE: There are whistle blowing policies and recruitment policies in place to protect service users from harm. The home has a complaints procedure in place. The procedure is displayed in several areas of the home. No complaints have been made to CSCI. Hazelwell Lodge DS0000016068.V271673.R01.S.doc Version 5.1 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 the following standard(s): 19,20,21,22,23,24,25,26 The home is comfortable and homely. The environment is secure and is decorated to aid service users orientation. The home is suitably adapted and is kept clean and tidy. Attention has been paid to the health and safety deficits noted at the last inspection. EVIDENCE: Individual bedrooms can be personalised and were made homely with pictures and personal items. It was noted that one bedroom had two suitcases in view and gathering dust, it was recommended that these could be stored in a less obvious place, as they may detract the service user from feeling settled. Hazelwell Lodge DS0000016068.V271673.R01.S.doc Version 5.1 Page 15 The last inspection reported: The Manager reported in her pre-inspection questionnaire that a further two en-suite facilities have been built since the last announced inspection. Redecoration was reported to be ongoing in bedrooms. The dining rooms have been redecorated and new dining furniture was purchased. The kitchen was identified for re-decoration at the last Environmental Health Inspection; this work was confirmed as having been undertaken. The communal areas were clean and nicely presented. They provide a good choice of comfortable areas for service users. The bathing and toilet facilities are satisfactory, not all en-suite toilets have handrails to aid independence. One bathroom on the first floor is in poor condition; the radiator in this room is uncovered but is kept switched off. Two bedrooms on the first floor have been redecorated and the shower cubicles have been removed and the spaces tidied up and made safe. The garden development has continued since the last inspection and is attractive and will offer a good outdoor space for use in warmer months. The grounds provide a pleasant outlook at all times. The home does not have a sluice room with a bedpan washer. This will remain as a recommendation for infection control good practice. Hazelwell Lodge DS0000016068.V271673.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 The home was adequately staffed to meet the needs of the service user group, however, it was evident that some personal care needs are met by the night staff. A review of staffing in line with service user dependency is recommended. EVIDENCE: The home had an NVQ qualified senior carer in charge at this inspection. There appeared to be a sufficient staff number seen on duty. During discussions about the care of more dependent service users who are waiting for nursing home placement. It was evident that there can be a time delay during which higher level care needs have to be met. This can impact on care delivery for example when care needs require the help of two staff. Staffing levels must be linked to dependency levels and be sufficient to meet the extra care demands in such situations. A review of staffing linked to the dependency of service users is recommended to determine adequacy of current staffing levels and to have as a reference point for subsequently changing needs. Other departments such as domestic and catering services were sufficiently staffed. There are vacancies at present, on nights and staff have been recruited. Agency staffing was being used to cover the vacant night shifts. Hazelwell Lodge DS0000016068.V271673.R01.S.doc Version 5.1 Page 17 Service users or visitors raised no issues with the inspectors about the staffing levels. Staff interactions with service users were friendly, helpful and kindly. Staff have training opportunities and NVQ training is promoted and is supported by the homes three NVQ assessors. The inspectors asked staff if they have training in the Protection of Vulnerable Adults (PoVA) and it was not clear that all staff have received this training. It is recommended that staff receive training to ensure all staff are aware of PoVA and of the county procedures in place. Hazelwell Lodge DS0000016068.V271673.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37.38 The home has policies and procedures in place to meet the running of the home and the safety and protection of service users. Attention had been paid to health and safety matters since the last inspection. A requirement is made for keeping the regular weekly fire alarm check up to date. All records were seen to be appropriately and safely stored. EVIDENCE: The registered manager was taking annual leave at this unannounced inspection. There was a senior carer in charge of the home at this inspection and the home appeared to be running smoothly. Hazelwell Lodge DS0000016068.V271673.R01.S.doc Version 5.1 Page 19 The management company acting on behalf of the proprietors have made regular Care Home Regulation 26 visits to the home for monitoring purposes; the last was reported to have been on 20.01.06. The certificates were displayed and the home has current employers liability insurance. The health and safety requirements and recommendations made at the last inspection have been addressed having been promptly attended after the inspection. The weekly fire alarm tests had not been made since 09.01.06; this is normally undertaken by one of two designated staff. Regular monitoring tests of the alarm is required and this recent deficit is highlighted for attention. Hazelwell Lodge DS0000016068.V271673.R01.S.doc Version 5.1 Page 20 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 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X 3 2 Hazelwell Lodge DS0000016068.V271673.R01.S.doc Version 5.1 Page 21 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. 1. 2. Standard OP38 OP8 Regulation 23(4)(c) (v) 15 (1) Requirement The regular weekly fire alarm tests must be carried out. Care plans must have documented strategies and risk assessments that have been individually designed where there is unsettled behaviour, to ensure staff deal with the service user in an appropriate and in a consistent way. Service users must be fully and appropriately dressed each day. Timescale for action 18/03/06 18/03/06 3. OP10 12 (2) 18/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP26 Good Practice Recommendations It is strongly recommended that a sluice room including a bedpan washer be installed following consultation with Somerset and Dorset Health Protection Unit. This recommendation will remain ongoing. More appropriate storage for the suitcases of long stay service users should be found. DS0000016068.V271673.R01.S.doc Version 5.1 Page 22 2. OP19 Hazelwell Lodge 3. 4. OP27 OP18 Staffing levels should be reviewed taking into account the impact of the dependency of service users. PoVA training should be made available for all staff. Hazelwell Lodge DS0000016068.V271673.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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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