Inspection on 18/12/08 for Hazlewell

This inspection was carried out on 18th December 2008.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hazlewell 03/03/10

Hazlewell 02/06/09

Hazlewell 23/06/08

Hazlewell 16/01/08

Hazlewell 16/07/07

Hazlewell 21/04/06

Hazlewell 26/08/05

Hazlewell 14/04/05

Hazlewell 01/09/04

Hazlewell 22/04/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Hazlewell 29-31 Hazlewell Road Putney London SW15 6LT Lead Inspector Louise Phillips Unannounced Inspection 10:30a 18 ,19 and 22 December 2008 th th nd 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 Hazlewell DS0000019097.V373143.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. Hazlewell DS0000019097.V373143.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hazlewell Address 29-31 Hazlewell Road Putney London SW15 6LT 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) 020 8788 8753 020 8248 5954 Mr D Patel Rosemary Carmen Molloy Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Hazlewell DS0000019097.V373143.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. 3. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 29. However, please see point number 3, below. There shall be no further admissions of service users to Hazlewell care home without prior written agreement of the Commission for Social Care Inspection. 15th September 2008 Date of last inspection Brief Description of the Service: Hazlewell is a care home providing nursing care for older people. The property consists of two semi-detached Victorian houses that have been joined together to make one home. The home is on three storeys and has been extended to the rear with a large conservatory. There is a large rear garden with a patio area available. Hazlewell is situated in a quiet residential street reasonably close to available shops and transport links in Putney. Information about the home is provided to residents in a written guide. The current fees are £650.00 per week. Hazlewell DS0000019097.V373143.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. A telephone call was made on the 17th December 2008 to the manager to inform them that an inspection of the service would commence the following day. This inspection took place over three days. On the first day (18th December 2008) a Regulation Inspector was accompanied by a Regulation Manager, where time was spent talking to two staff, two residents and viewing paperwork. A tour of the premises was carried out and care records were inspected. On the second day (19th December 2008) the inspector spent a short time at the home inspecting the gas safety certificate and fire systems checks, all of which were evidenced to have been carried out since the visit the previous day. At both of these visits the regulation inspector informed the manager that a CSCI pharmacy inspection would take place the following week. On the third day (22nd December 2008) the Pharmacy Inspector carried out an inspection of the medication systems at the home. All visits to the service involved looking at compliance with recent Statutory Enforcement Notices served by the CSCI to address non-compliance issues at the service. Since the previous key inspection in June 2008, enforcement action has been taken by the CSCI to ensure the owner of the service addresses a number of areas of concern. This action is called ‘Statutory Requirement Notices’ (SRN’s). In September 2008 a follow up visit was carried out to check compliance with the SRN’s. At the time some improvements were noted to have taken place, with a number of outstanding issues still needing to be addressed. At this inspection two of these areas were found still to be outstanding, and not carried out, representing a poor response to the findings of the inspection, and of enforcement action taken. Further enforcement action is currently being considered by the CSCI, which could result in prosecution. Due to the continued non-compliance issues, and risks to residents, at the time of inspection the CSCI was in the process of imposing a condition on the service to ensure that no further residents were admitted to the home, unless agreed with the CSCI. On the 23rd December 2008 the CSCI placed a condition on the registration of the service to ensure the health and welfare of service users. This was due to the continued non-compliance of inspection report requirements and Statutory Hazlewell DS0000019097.V373143.R01.S.doc Version 5.2 Page 6 Requirement Notices, where it had become necessary for the commission to impose this condition to the registration to protect vulnerable people using the service. The condition imposed is that: No further admission should be made without prior written agreement of the Commission for Social Care Inspection. At the time of the inspection fourteen residents were accommodated at the service. On the 14th January 2009 a meeting was held between the Registered Provider (Mr Patel), and the CSCI to discuss the findings of this inspection and discuss further actions to be taken. Mr Patel was asked to bring the business plan and financial information for the service, which he did not bring, but said he would provide the following week. This had not been received at the time of writing the report. Following the meeting with Mr Patel a Warning Letter has been sent to him regarding areas where the service has continued to not meet requirements or SRN’s. Part of the warning letter asks that Mr Patel provide the CSCI with monthly monitoring reports to detail what progress is being made at the service. The ‘statutory requirements’ section (starting on page 28 of this report) outlines the areas detailed in the Warning Letter. What the service does well: 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. The summary of this inspection report can be made available in other formats on request. Hazlewell DS0000019097.V373143.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 Hazlewell DS0000019097.V373143.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): 3 and 6 Quality in this outcome area is good. People who live at the home have their needs assessed and kept under review to ensure relevant care is provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager said that in assessing any potential new residents to the home, she would visit them to carry out an initial assessment and also invite them to look around the home. Since the last inspection the service has taken steps to re-assess the needs of each person living at the service to ensure the care plans match their current needs. The care plans are evaluated monthly to ensure that they are relevant, and amendments seen to be made as necessary. Intermediate care is not provided at the service. Hazlewell DS0000019097.V373143.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. Residents feel that the staff are caring, and the care planning helps ensure that their needs are met. However, medication systems and practices at the home do not ensure that medicines are handled, administered or recorded appropriately and safely to the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As stated earlier in the report, each person living at the home has had their needs re-assessed by the manager and nursing staff, and appropriate care plans put in place. Over the past six months positive improvements have been made to the care plans to ensure that they are much more up-to-date and informative. The care plans are now more individualised to the needs and wishes of each person who lives at the home. Where applicable, the resident or their representative has signed the care plan to show their agreement with the care to be provided. Hazlewell DS0000019097.V373143.R01.S.doc Version 5.2 Page 10 Monthly weight checks are carried out on each person living at the home and assessments are in place covering areas such as incontinence, use of ‘cotsides’ and moving and handling. The manager said that most staff are trained in continence care, diabetes and tissue viability. Evidence of this was seen in some staff files of trained nurses. The manager said that she has good links with relevant health professionals in the community, and that she can access their support and advice on relevant care issues. This information had been referred to in the care plans as necessary. A photo of each resident needs to be added to their care plan to ensure care is provided appropriately. Each person living at the home has a risk assessment that is individualised to their needs and also regarding any electrical equipment they keep in their bedrooms. At present the bath on the top floor of the home is broken and people living on this floor have to be assisted to use facilities on the first and ground floor. The manager said that the staff ensure they wear dressing gowns when being assisted, to maintain their dignity. Throughout the inspection the staff were seen being respectful and polite to the people living at the home. Following findings at the previous key inspection of the service, the manager said that there have been no incidents of unexplained bruising. The care files seen, accidents and incidents books do not record any incidences of this. The recording in the daily notes has improved, though could be developed further to give more of a picture of how the resident has spent their day, what they have done, food consumed, and interactions they have had, as the terms currently used, such as ‘…washed and dressed…’ and ‘…ate well…’ do not adequately describe this. A visit by a CSCI Pharmacy Inspector was carried out as part of this inspection, to determine whether the Statutory Requirement Notice of 7/8/08 had been met, and their findings are detailed below. The notice of 7/8/08 required that the home ensures arrangements are in place for the recording, handling, safekeeping, safe administration and disposal of medicines received into the home. We audited medication in each unit by checking the stock held against recording on the medication administration records (MAR). Hazlewell DS0000019097.V373143.R01.S.doc Version 5.2 Page 11 We noticed on two MAR that the medicines had not been signed as given the morning of the inspection. The medicines were not in the monitored dosage system and when we asked the nurse we were told that they had been given but she had forgotten to sign because she had to attend to another matter. We noticed that the recording of administration of paracetamol was confusing for five residents and that it looked as if it was being recorded twice and that residents could be receiving a double dose. We were not able to audit the tablets because the quantities carried forward from a previous cycle were not always recorded. One resident only had 4 tablets left to last the second two weeks of the medicines cycle. We were told that more was on order. The home were sometimes using the code NR and we did not know what this meant. One resident was prescribed mirtazepine and it was prescribed to be taken in the morning. Nurses had changed the time - to be given at night, but had already signed to say that they had given it the morning of the inspection. We were not sure whether it had been given or not. We looked at the recording of a tablet for nausea and dizziness for one resident and wondered why the MAR had been completed with the code ‘refused’ until the 31/12/08. There was no stock of this medicine in the trolley or the cupboard. We looked at the previous months chart for this resident and noticed that the medicine was recorded correctly. We noticed that when we counted three other residents’ medication which included calcium tablets, alendronate and mirtazepine that the balances were correct. We also observed that when a variable dose of medication was prescribed that the actual dose given was now documented. One resident was having difficulty taking medicines by mouth and there was evidence of review of the medication by a multidisciplinary team. Together with the family they all agreed that the medicines could be crushed. We were concerned though at the use of tippex on this MAR to blank out the 12pm dose of quetiapine on 8/12/08. The tablet was not in the blister so we did not know if it was given. On the back of the MAR it was recorded that this resident was asleep at 10 pm on 8/12/08 so did not have the evening doses of three medicines. The correct endorsement was not written on the MAR, just a line. It was recorded though that he had two tablets of paracetamol at 10pm on 8/12/08. We discussed medication training in the home and we were told that it had been postponed again and was now due in January 2009. This is the third time that the pharmacist has been told that medication training has been arranged and then postponed. We asked to see the regular audits of medication and noticed that there had not been one since September 2008 and it did not identify recording errors. The pharmacist inspection of 15th September 2008 demonstrated that the statutory enforcement notice of 7/08/08 had not been fully met. This inspection further demonstrates that the accurate recording of medication does Hazlewell DS0000019097.V373143.R01.S.doc Version 5.2 Page 12 not fully support the requirement that medication is being handled safely in the home. A code B notice was left at the home and copies of medication administration records taken to further consider the action to be taken. These findings represent a poor response to the findings of the inspection, and of enforcement action taken. Further enforcement action is currently being considered by the CSCI, which could result in prosecution. Following the meeting held between the Registered Provider and CSCI on the 14th January 2009, the provider is required to send the CSCI evidence of monthly medication audits being made at the service. These must include details of errors identified and actions taken to address these. Hazlewell DS0000019097.V373143.R01.S.doc Version 5.2 Page 13 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 adequate. Residents have the opportunity to be involved in some activities provided by the service. Residents generally like the meals provided, though improvements need to be made to ensure that suitable and nutritious food is provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: “…my family visit very regularly…” “…I enjoyed the party…” These were comments received from two people who live at Hazlewell. The manager described that the service was very busy with Christmas celebrations at present, with the Christmas party having been held yesterday. During the inspection residents were seen being involved in Holy Communion, and being entertained by carol singers who visited the home. The manager said that she has also arranged for children from a local school to visit and sing to the residents next week. She also explained that two residents are being supported to attend a Rotary Club dinner over the festive period. Hazlewell DS0000019097.V373143.R01.S.doc Version 5.2 Page 14 Some residents are also due to spend Christmas day away from the service, with their relatives. Over the past six months, since the last key inspection of the service, improvements to activities have been made. The manager has said that two residents attend a day centre, and other residents are involved in parties at the home, spending time on their bedroom or in the lounge area. Representatives from the Church of England and Catholic churches also visit the home. The care plans have improved to accommodate individual preferences on how they like to spend their day. Examples of this include where one resident enjoys the company of their dolls and soft toys, whilst another describes that they like to read the newspaper. The manager said that people who live at the home can get involved in aromatherapy, balloon games and colouring pictures. Further work could be done in this area to ensure that people living at the home are more involved in the community or more structured daily activities within the home, eg. arts and crafts, book reading, flower arranging, bingo, card games or conversation groups. Two people who live at the home commented that the “…food is ok…” and that the “…food is reasonable…”. Improvements appear to have been made to the food provided at the service, with more fresh fruits and fresh vegetables observed to be available, as well as more variety in frozen and chilled foods that can be prepared. The fridge contained some opened jars of food that did not have a label on to state when they had been opened. Similarly, food in one cupboard that had been decanted into different containers (raisins, flour and rice) did not have labels on as to when the food should be used by. The manager was advised to put labels on these containers of the date that they are to expire. During the inspection a container of glace cherries was found to have an expiry date of the end of October 2008, and this was pointed out to the manager for them to be disposed of immediately. Hazlewell DS0000019097.V373143.R01.S.doc Version 5.2 Page 15 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 poor. There are systems in place to deal with complaints, though improvements need to be made to ensure all staff understand safeguarding issues. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has a complaints procedure that is displayed at the service. This currently contains previous contact details of the CSCI and needs to be updated to include current contact information. Feedback from one person living at the home is that they would talk to the manager if there was something they were not happy about. Since the last inspection the complaints log details that some issues have been raised by residents, for example, an uncomfortable chair, or their glasses hurting them, and of the actions taken to rectify these. At the time of inspection the training record indicates that most of the staff team had received recent training in abuse awareness. However, one staff member spoken to during the inspection demonstrated little understanding of abuse issues, or whistle-blowing procedures. They said that they are doing NVQ (National Vocational Qualification) training and that abuse awareness is included in this. However, the records indicate that they had been working at Hazlewell DS0000019097.V373143.R01.S.doc Version 5.2 Page 16 the home since the start of the year, and although had received some training in abuse during their induction, had not attended abuse training. A requirement has been made to address this. It was observed that up-to-date information from Wandsworth local authority is displayed on the wall in the manager office, providing step-by-step guidance on what staff should do if they suspect abuse, or in the event of an allegation being made. The pharmacy inspector also observed a resident being moved in a wheelchair without footrests attached, and the resident was ‘squealing’. The wheelchair was tipped backwards onto two wheels by one nurse so that the residents feet did not get caught on the floor. When the manager was asked about this practice she replied that the resident did not like footrests. However, mobilising residents in this way is poor practice and can increase the risks of accidents and injury to residents. A requirement has been made to address this. Hazlewell DS0000019097.V373143.R01.S.doc Version 5.2 Page 17 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, 20, 22, 25 and 26 Quality in this outcome area is poor. The staff help create a calm atmosphere throughout the home. However, little improvement has been made to the environment, which is poorly maintained and can present as a risk to people who live at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the previous key inspection in June 2008, enforcement action has been taken by the CSCI to ensure the owner of the service addresses a number of areas of concern. This action is called ‘Statutory Requirement Notices’ (SRN’s). In September 2008 a follow up visit was carried out to check compliance with the SRN’s. At the time some improvements were noted to have taken place, with a number of outstanding issues still needing to be addressed. At this inspection most of these areas were found still to be outstanding, and not carried out, representing a poor response to the findings Hazlewell DS0000019097.V373143.R01.S.doc Version 5.2 Page 18 of the inspection, and of enforcement action taken. Further enforcement action is currently being considered by the CSCI, which could result in prosecution. At this inspection we looked at the environment in relation to the outstanding issues from the SRN’s. Our findings are as follows: Top floor: In bedroom 22 the hook on wall near the head end of the bed has been removed. The carpet in the hallway has been cleaned. In room 27 the curtains have been removed, though the wallpaper on the ceiling shows damp spots. This bedroom is not currently in use. On the stairs leading down to the first floor opposite room 27 the carpet remains stained and in need of replacing. First floor: In bedroom 10, new curtains have been installed. In the bathroom next to bedroom 11 the flooring has been cleaned. Ground floor In bedroom two the wallpaper is still coming away from wall where it meets the ceiling. In the toilet next to room one there are still scuff marks and paint is still peeling away around the skirting boards and walls. The conservatory still remains hot in the summer months. There is still no ramp available for the step from the conservatory out to the garden. In addition, the following areas were identified as needing to be addressed: One broken glass window in conservatory that needs to be repaired. Hazlewell DS0000019097.V373143.R01.S.doc Version 5.2 Page 19 The windows in the conservatory are sealed and not able to be opened. These need to be able to be opened to allow ventilation into the room. An air conditioning unit needs to be installed in this area for use in the hot weather. The bathroom on the top floor of the home has a bath that is broken and cannot be used. The bath panel has been removed and there is exposed pipework and wires. The manager said that the toilet is used by residents. However, if residents are being taken into this area, the bath panel needs to be secured back onto the bath, to minimise risks to people living at the home, or the bathroom sealed off and not used at all. The service needs to remove old and broken furniture from the garden area. There is a hole in the carpet outside the toilet next to bedroom 27. Around this doorframe to there are also exposed wires and screws. In the bathroom next to bedroom 11 there are damp spots on the ceiling. All the areas listed above can present as a risk to the people living at the service, and do not promote a homely and comfortable environment for them to live in. The requirement has been restated, with areas removed that have been identified to have been met. It was observed that new carpet had been installed on the ground floor hallways and in the manager’s office. The home was observed to be tidy and pleasant smelling. Hazlewell DS0000019097.V373143.R01.S.doc Version 5.2 Page 20 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 adequate. Improvements have been made to demonstrate that relevant checks are carried out on staff employed at the service. Staff undertake training to enhance their skills and knowledge for working with residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Hazlewell has a consistent staff team, some whom have worked at the home for many years. Comments from two residents spoken to during the inspection are: “…the staff are very good, they do what they can…” “…the staff are very helpful and very nice…” The manager said that although the deputy manager has recently left the home, they are not currently recruiting any new staff, and that staff hours have been cut, due to a reduction in residents accommodated at the service. The home holds recruitment information for the staff. Improvements have been made to the information contained in these, since enforcement action taken earlier on this year. During the inspection we looked at six staff files, Hazlewell DS0000019097.V373143.R01.S.doc Version 5.2 Page 21 which were found to contain appropriate information regarding their recruitment, such as proof of identification, evidence of a Criminal Records Bureau check, two references and record of the interview of staff. Some files do not contain a colour photo of the staff member, and these must be added. Staff do not have a contract for their employment at the service. All new staff receive an induction to the service which covers areas such as health and safety and introduction to the staff and residents. As identified earlier in the report, this needs to include training around abuse awareness and safeguarding issues. The manager said that she is in the process of working with staff to ensure that copies of certificates to evidence training they have done, are held at the home. In the six staff files looked at, it was evident that progress is being made in this area, with certificates seen to evidence recent training in moving and handling, first aid, basic food hygiene, health and safety and wound care. The staff training record on display in the manager’s office demonstrates which staff have completed what training during the year. However, it is recommended that the actual training dates are added to this to provide a more accurate record of training undertaken. The manager said that the staff have to fund, of part-fund a lot of their own training and do this in their own time. She said that they have to access free courses so that staff do not have to use their own money to fund training. All staff should receive a minimum of three paid days training per year. The service does not promote a modern working environment for staff, or promote up-to-date ways of working with residents to improve their care, health and welfare. This is because there are no computer or internet facilities at the home to enable staff to access resources and keep up-to-date with relevant guidance, policies, procedures and legislation relating to their work. There are no photocopy facilities at the home. This, along with staff having to fund their own training and do this in their own time, reflects that the Registered Provider chooses not to invest in the staff, their training and development, or in the promotion of a competently skilled workforce. Therefore not promoting the quality of life, health and welfare of the residents. Hazlewell DS0000019097.V373143.R01.S.doc Version 5.2 Page 22 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 poor. The manager is caring and respected by the staff. However, there are a number of areas still requiring improvement at the home, and appropriate health and safety checks are not carried out. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager was present for the inspection and provided relevant information to assist us during the inspection. She conveys a very warm and genuine caring approach towards the residents. However, findings from this inspection indicate that the ethos of the service is one of reactive as opposed to being proactive, and whilst reflecting some improvements at the home, the findings also highlight a number of areas that Hazlewell DS0000019097.V373143.R01.S.doc Version 5.2 Page 23 should, though have not been met, despite having been identified at a number of inspections. And now, even following enforcement action, the findings are that the service is still not meeting these, and still not providing a service that meets the minimum standards for care homes for older people. The home carries out an annual quality assurance survey with people who live at the service, and the manager carries out regular audits of health and safety hazards around the home. A medication audit has recently been carried out by the pharmacist who supplies medication to the home. The manager said that these occur every three months. At the start of the inspection there was no evidence of monthly visits being carried out by the Registered Provider (in accordance with Regulation 26 of the Care Homes Regulations 2001). During the inspection the provider faxed two of these to the home, for the months of November and December 2008. It is unclear and confusing as to why these were not readily available at the home, as the Registered Provider would have needed to visit the home to carry this out, and complete the form whilst at the home. Evidence of these monthly visits must be kept at the home at all times for inspection purposes. The Registered Provider must also send a copy of the record of these visits to the CSCI monthly. Following the meeting held between the Registered Provider and CSCI on the 14th January 2009, the provider must send the CSCI monthly reports on progress being made at the service. The manager says that she looks after the ‘pocket money’ for two residents. She said that she keeps this at her home, as there is nowhere safe to keep this at the service. We informed the manager that this practice must stop, and any monies relating to residents must be held at the service. A lockable cabinet was identified in the manager’s office that could be used for this purpose, and the manager could hold the key to this. Due to the money, records of transactions and receipts being held at the manager’s home, we were unable to assess this standard properly, though a requirement has been made regarding this. A record is maintained of water temperature checks taking place weekly The fire points around the home are tested regularly, with records indicating that a different one is tested each week. The last fire drill was recorded to have taken place in August 2008, and the manager said that these take place every six months. These should occur more frequently to promote the health and safety of the residents, and it is recommended these take place at least every three months. The fire extinguishers around the home were dated as last having been checked in June 2006. The manager was unable to produce any evidence that these had been checked more recently, or that the fire system had been serviced since this time. An Immediate Requirement was made for this to be addressed, for the fire systems and extinguishers to be serviced by an Hazlewell DS0000019097.V373143.R01.S.doc Version 5.2 Page 24 appropriately trained and competent person, and evidence available to demonstrate this had been carried out, by the 24th December 2008. During the inspection the manager was observed telephoning the owner of the home to inform him of the Immediate Requirement. At the inspection on the 19th December 2008 the manager showed that the fire extinguishers now had stickers on them to demonstrate that the have been checked on the 19th December 2008, along with a sticker on the fire panel. The portable appliances around the home were seen to have a sticker on the plugs to state that they had been tested on the 18th September 2008. A report of this testing, dated the 19th September 2008, reflects that this work has been carried out. A gas safety certificate was not available for inspection and evidence could not be presented to demonstrate that the appropriate checks had been made. There was no evidence on the boiler of recent testing having taken place. This was the subject of enforcement action by the CSCI earlier on this year. A Code B Notice was issued informing the manager that we believe the requirement has not been met. On the 19th December 2008 evidence was available at the home to demonstrate that the gas safety systems had been checked on the 18th December 2008. Hazlewell DS0000019097.V373143.R01.S.doc Version 5.2 Page 25 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 X 2 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 1 X 1 X X 2 Hazlewell DS0000019097.V373143.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES 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 OP9 Regulation 13(2) Requirement To ensure the proper recording, handling, safekeeping, safe administration and disposal of service users medicines that are received into the care home. Previous timescale of 14/02/08 and 08/08/08 not met. Further enforcement action is being considered. This is the subject of a Warning Letter sent to the provider following this inspection. 2. OP9 13(2) The Registered Provider must send the CSCI evidence of monthly medication audits being made at the service. These must include details of errors identified and actions taken to address these. This is the subject of a Warning Letter sent to the provider following this inspection. Hazlewell DS0000019097.V373143.R01.S.doc Version 5.2 Page 27 Timescale for action 18/12/08 31/01/09 3. OP15 16(2)(i) The Registered Person must ensure that opened jars of food are labelled with the date opened. Food decanted into alternative containers must be labelled with a date of expiry. Any ‘out of date’ food must be disposed of immediately. This is to ensure that people using the service are provided with suitable and nutritious food. The complaints procedure must include the contact details of the CSCI. 18/12/08 4. OP16 22(7) 31/01/09 5. OP18 13(6) All staff must receive appropriate 28/02/09 training in abuse awareness, that includes the local authority guidelines. Footrests must be used on all wheelchairs at all times when mobilising residents, to ensure they are not put at risk of injury. 31/12/08 6. OP18 13(4) 7. OP19 23 (2) (b) (c) (d) (j) 18/12/08 The Registered person shall having regard to the number and needs of the service users ensure that the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally. All equipment provided at the care home for use by service users or persons who work at the care home is maintained in good working order. A programme of redecoration must take place throughout the home to replace the worn and stained carpets the stained wall paper/paint. Broken bath panels must be fixed. Adequately functioning bathroom facilities must be provided for service users on the second floor. These facilities must be in DS0000019097.V373143.R01.S.doc Version 5.2 Page 28 Hazlewell good working order. The home must be kept clean and hygienic. Previous timescale of 01/10/07, 01/05/08 and 01/09/08 not met. Further enforcement action is being considered. This is the subject of a Warning Letter sent to the provider following this inspection. 8. OP30 18 Copies of certificates to evidence all training undertaken by staff must be kept at the home. The Registered Provider must carry out monthly visits to the service, in accordance with this regulation and copies of the report must be held at the home at all times. The Registered Person must supply a copy of the report to the Commission every month. This is the subject of a Warning Letter sent to the provider following this inspection. 10. OP33 24 The Registered Provider must supply the Commission with a monthly progress report of developments being made at the service. This is the subject of a Warning Letter sent to the provider following this inspection. 11. OP35 16(2)(l), Sch 4 (9) All resident’s monies held by the service must be kept in a secure, lockable area at the home, and DS0000019097.V373143.R01.S.doc 31/01/09 9. OP33 26 31/01/09 31/01/09 18/12/08 Hazlewell Version 5.2 Page 29 full records maintained of all transactions carried out, with receipts maintained. 12. OP38 23(3)(4)( a)(c)(iv) The fire systems and extinguishers must be serviced by an appropriately trained and competent person, and evidence available to demonstrate this. Immediate Requirement made at inspection. 24/12/08 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 OP7 OP9 OP12 Good Practice Recommendations A photo of each resident needs to be added to their care plan to ensure care is provided appropriately. There should be a current BNF in the home for information purposes. The service should improve in-house activity provision to ensure that people living at the home have the opportunity to be more involved in the community or more structured activities within the home. All staff should receive up-to-date training in abuse awareness issues. It is recommended that a walk-in shower be provided for residents on the second floor. Staff files should contain a colour photograph of each staff member. The actual training dates should be added to the training record displayed in the manager’s office, to provide a more accurate record of training undertaken. 4. 5. 6. 7. OP18 OP21 OP29 OP30 Hazlewell DS0000019097.V373143.R01.S.doc Version 5.2 Page 30 8. 9. OP30 OP31 All staff should receive a minimum of three paid days training per year. There should be clear lines of accountability at the service to ensure that the management of the service is conducted responsibly. The service should adopt a proactive approach towards meeting the National Minimum Standards for Older People to ensure the service works in the best interests of the residents. The home should consider installing a printer and computer facilities with internet access to improve communications at the home and to ensure staff can access up-to-date health and social care information that will benefit the residents. The home should look at the possibility of holding regular residents meetings. The fire drills took take place at least every three months, and records maintained to demonstrate this. 10. OP32 11. OP33 12. 13. OP33 OP38 Hazlewell DS0000019097.V373143.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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. 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