CARE HOMES FOR OLDER PEOPLE
Hazelwood House 58-60 Beaufort Avenue Kenton Middlesex HA3 8PF Lead Inspector
Sue Mitchell Unannounced 10 August 2005 11.00am 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. Hazelwood House G62-G11 S54194 Hazelwood House v212114 100805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Hazelwood House Address 58-60 Beaufort Avenue Kenton Middlesex HA3 8PF 020 8907 7146 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 Ramnarain Sham Mr Ramnarain Sham Care Home 15 Category(ies) of OP, MD(E) 15 registration, with number of places Hazelwood House G62-G11 S54194 Hazelwood House v212114 100805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Accommodation of 15 older people with mental disorder Date of last inspection 25.11.04 Brief Description of the Service: Hazelwood House is a registered care home providing personal care and accommodation for a maximum of 15 older people aged over 65 years with mental disorder. .The home is located in a quiet residential road in Kenton. It is fairly close to shops, pubs and other community facilities in Kenton. The home is on two floors and was originally 2 semi-detached houses. It has a passenger lift. The home offers a mixture of shared and single bedrooms. Most have en-suite facilities.The home has gardens to the rear that are well maintained and accessible through the building. Hazelwood House G62-G11 S54194 Hazelwood House v212114 100805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out during the morning and afternoon when the residents had finished their morning coffee break. The inspector toured the premises and spoke to a number of residents. One relative was visiting her mother and spoke at length to the inspector in a positive way about the quality of care provided. There were three staff on duty as well as the manager. The inspector spoke to two staff that were very positive about the way the home was run and the training opportunities provided. The inspection focused on following up progress on the requirements set at the last inspection, medication, needs assessments and care plans, staff training, and employment records and health ad safety matters. What the service does well: What has improved since the last inspection?
The home had complied in full to all but one of the requirements set at the last inspection, which is commendable. Staff have benefited from a range of core training and three staff are due to undertake NVQ2 training. The deputy is due to start her NVQ 4. Care plans were up to date and recording was detailed. The information, which had been required to be included on the care plans, had now been added. Monthly evaluation is now taking place with attention to detail on all aspects of the resident’s lives. Good attention is paid to ensuring that residents physical and mental health care needs are supported and reviewed regularly.
Hazelwood House G62-G11 S54194 Hazelwood House v212114 100805 Stage 4.doc Version 1.40 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. Hazelwood House G62-G11 S54194 Hazelwood House v212114 100805 Stage 4.doc Version 1.40 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 Hazelwood House G62-G11 S54194 Hazelwood House v212114 100805 Stage 4.doc Version 1.40 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 The residents and their families are given clear information about the home and its services to make and informed choice. New residents are assessed prior to admission and have care plans in place. EVIDENCE: The home had changed its conditions registration in January 2005 to accommodate older people with mental health conditions. The proprietor must amend the homes Statement of Purpose to reflect the new registration status. It was positive to note that there were copies of the service users guide in each residents’ bedrooms. Two care files of the newest residents admitted to the home were sampled. An assessment had been carried out on each person by the home. There was information from social services and a placement review for one person. Another person had been a hospital discharge with little information being made available to the home. Both people had had risk assessments on falls, mental health, nutrition, behaviour, tissue viability and physical health. Care plans were in place and noted to be evaluated on a monthly basis Hazelwood House G62-G11 S54194 Hazelwood House v212114 100805 Stage 4.doc Version 1.40 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) 7,8,9 All the residents have personalised care plans, which reflect their care, and mental health needs and how these are to be met. They have regular access to all health care professionals that come into the home. The home’s medication policy ensures that resident’s medication needs are met. EVIDENCE: Two care files were sampled. The home uses a booklet system where the majority of information is kept apart from health care appointments. Care plans were in place for each person. These were noted to be evaluated on a monthly basis. Some of the records had not been signed off. The manager should ensure that staff completing any records relating to the residents signs and dates each document. The two care plans also contained risk assessments, which were noted to be carried out on a six monthly basis as part of the homes review system. Each file sampled contained correspondence relating to heath care appointments. A record of all health care appointments and visits from the GP etc and their outcomes was seen to be recorded in the home’s handover book. The GP visited the home during the inspection as staff had had concerns about a resident’s health. The relative of this resident was present during the GP visit and said that the home was being supportive of her relative. The manager stated that there was ongoing support from the Community
Hazelwood House G62-G11 S54194 Hazelwood House v212114 100805 Stage 4.doc Version 1.40 Page 10 Psychiatric Nurse and the consultant psycho geriatrician should there be any concerns about the residents’ mental health. The medication cabinet and records were sampled. Some errors were found on the medication record sheets, which must be addressed. Staff must not use one initial when signing for medication. The manager must ensure that there is a record of the signatures and initials of those staff that are authorised to administer medication. Staff must be more vigilant when copying out medication dosages on the MAR sheets. The MAR sheers must have a list of the abbreviations, which can be used to record when residents have refused medication, are ill or in hospital etc. There were a number of bottles of liquid medication in the cabinet. The manager must ensure that staff date the bottles in order of use. The inspector advised the manager that she would ask the CSCI pharmacy inspector to make a visit to the home to review the medication system as matter of good practice and advise him if there needs to be any changes. Hazelwood House G62-G11 S54194 Hazelwood House v212114 100805 Stage 4.doc Version 1.40 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 Residents’ interests are recorded and they are offered the opportunity to participate in activities or interests of their choice. Relatives are made welcome by the home. EVIDENCE: The home had been required to record the resident’s interests, hobbies etc in the care plans. This was noted to have been carried out on the care plans sampled. On the day of the inspection there were no activities planned. It was a very hot day and some residents were out in the garden, some were chatting to each other. Music was playing quietly in the background. Staff were observed to sit with the residents and chat with them during the afternoon. The manager stated that he had now purchased a mini bus, which he planned to use to take small groups out on trips to the seaside, parks, go shopping etc. Invitations to the home’s forthcoming barbecue at the weekend were on display. Residents spoken to were aware of the event. One person complained to the inspector that he couldn’t go out for a walk into Harrow on his own when he wanted to. The manager explained that this person had some mobility problems and needed support to go out. He explained to the person that the social worker was aware of this issue and was following this up. This was one reason for buying a mini bus so that trips out could be arranged for the residents to go out more often. Another person told the inspector that due to her poor mobility she preferred to stay in her room but
Hazelwood House G62-G11 S54194 Hazelwood House v212114 100805 Stage 4.doc Version 1.40 Page 12 was happy with her books, listening to the radio and watching sport, gardening and make over shows on TV. She said that staff popped in regularly to see her and that as her room looked out onto the garden she could watch what was going on as well. The relative who spoke to the inspector stated her family were made very welcome by the home and they were kept fully informed of all events affecting her relative. They were also invited to all the social events organised by the home. Hazelwood House G62-G11 S54194 Hazelwood House v212114 100805 Stage 4.doc Version 1.40 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 residents are protected from harm by the home’s complaints and adult protection policies. Staff have abuse awareness training to assist them in the protection of the residents. EVIDENCE: There had been one anonymous complaint made about the home in December 2004. This had been investigated by the manager, there was no evidence to uphold complaint. There have been no complaints since that time. There had been a POVA investigation carried out by social services which was now completed. A copy of the outcome and actions to be taken had been sent to the home. Staff spoken to said that they had received abuse awareness training, which they found helpful in their work with the residents. Hazelwood House G62-G11 S54194 Hazelwood House v212114 100805 Stage 4.doc Version 1.40 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) 19,26 The residents live in a comfortable, homely and well furnished environment. It is free from odours in all but one room EVIDENCE: The inspector toured the premises with the manager. The home had complied with the premises requirements set at the last inspection. The communal areas were found to be pleasantly decorated with flowers, pictures etc. There was also a large fish tank in the lounge. The resident’s rooms were noted to be clean and tidy with some having personal possessions and furniture of their own. One ground floor double room was found to have an unpleasant odour. The manager stated that this was an ongoing problem that was not easily resolved even with regular cleaning and shampooing. He was considering replacing the carpet with a washable floor for hygiene reasons. He was advised to contact the relatives and ask them and the residents if this was their choice. He was also advised that when the room was to be used by new residents they should be asked if they wished to have carpet instead The rear garden was very well kept with the lawns mowed and colourful flower beds and pots of flowers. Some of the residents were out enjoying the
Hazelwood House G62-G11 S54194 Hazelwood House v212114 100805 Stage 4.doc Version 1.40 Page 15 sunshine in the garden. One resident, whose room was facing the garden on the ground floor, said that the view into the garden was wonderful and that it was always very well looked after. The home has regular gardeners who come to do the work. Hazelwood House G62-G11 S54194 Hazelwood House v212114 100805 Stage 4.doc Version 1.40 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) 27,29,30 The residents are cared for by a stable staff group that have benefited from a range of skills training. The resident are protected by the home’s recruitment policies EVIDENCE: The rota was made available for inspection. There were four staff on duty plus the manager that morning. Three staff were scheduled to work that evening. The rota indicated that staff have two long days and three short days with two days off per week. The deputy was on a long day. She stated that she had had an hours break. The manager is supernumerary to the care staff. He stated that he does the shopping and other tasks that help the care staff to carry out their role. Two staff files of the most recent appointments to the team were made available for inspection. They were seen to contain all the information and checks required as per Schedule 4.6. The inspector was informed that three staff were due to start their NVQ 2 in September. The inspector spoke to one staff member who said she was looking forward to the training. She also said she had had a range of training since starting work in the home including mental health awareness. There was a record of training in place. Courses included; health and safety, medication, infection control, food hygiene, fire safety and mental health awareness. The deputy said that the next round of core training was being planned based on staff supervision and appraisal. The two staff files sampled indicated that staff had had a comprehensive induction programme, which was confirmed by the staff member spoken to. The manager has recently completed his NVQ4 and the deputy is due to start her NVQ4 training. The manager said that he was
Hazelwood House G62-G11 S54194 Hazelwood House v212114 100805 Stage 4.doc Version 1.40 Page 17 applying for the Investors in People award. Team meetings were held regularly (minutes seen) and staff confirmed that they received regular supervision. Staff were able to demonstrate through discussion with the inspector their understanding and knowledge of the care and mental heath needs of the residents. The residents who spoke to the inspector were also very complimentary about the staff as was the relative who was visiting the home Hazelwood House G62-G11 S54194 Hazelwood House v212114 100805 Stage 4.doc Version 1.40 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 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) 38 The resident’s health and safety is protected through the homes regular health and safety checks and staff training. EVIDENCE: All certificates relating to equipment and appliances used in the home were made available for inspection. These were seen to be up to date with no works outstanding. The home had been required to carry out quarterly fire drills. The last drill was recorded in March 2005. The manager must ensure that these are carried out quarterly. All other weekly fire safety checks are carried out and recorded. The fire risk assessment had recently been reviewed. Risk assessments in respect of safe working practices had now been written. Staff training records showed that they had received regular training in all aspects of health and safety. Hazelwood House G62-G11 S54194 Hazelwood House v212114 100805 Stage 4.doc Version 1.40 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 2 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 3 x x x x x x 2 STAFFING Standard No Score 27 3 28 3 29 3 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 x x x 2 Hazelwood House G62-G11 S54194 Hazelwood House v212114 100805 Stage 4.doc Version 1.40 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. Standard 1 Regulation 4 Requirement The proprietor must amend the homes Statement of Purpose to reflect the homes new registration status Staff must not use one initial when signing for medication. The manager must ensure that there is a record of the signatures and initials of those staff who are authorised to administer medication. Staff must be more vigilant when copying out medication dosages on the MAR sheets. The MAR sheers must have a list of the abbreviations, which can be used to record when residents have refused medication, are ill or in hospital etc. The manager must ensure that staff date the bottles of liquid medication in order of use The manager must contact the relatives and ask them and the residents if a change to the type of floor covering was accecpable. Fire drills must be carried out Timescale for action 30.9.05 2. 9 13(2) from 10.8.05 and ongoing 3. 26 16(k) 30.9.05 4. 38 23(4)(e) From
Page 21 Hazelwood House G62-G11 S54194 Hazelwood House v212114 100805 Stage 4.doc Version 1.40 quartely. (Previous timescale of 25.2.05 not met) 10.8.05 and ongoing 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 7 26 Good Practice Recommendations The manager should ensure that staff completing any records relating to the residents signs and dates each document. The manager is advised that when theground double floor room was to be used by new residents they should be asked if they wished to have carpet instead Hazelwood House G62-G11 S54194 Hazelwood House v212114 100805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 4th Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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