Inspection on 23/06/08 for Hazlewell

This inspection was carried out on 23rd June 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 18/12/08

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Hazlewell 29-31 Hazlewell Road Putney London SW15 6LT Lead Inspector Sharon Newman Key Unannounced Inspection 10:30 23rd June 2008 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.V363475.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.V363475.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.V363475.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. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 29 16th January 2008 Date of last inspection Brief Description of the Service: Hazlewell is a twenty-nine bedded 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.V363475.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. This unannounced inspection took place on 23rd June 2008 and was carried out by two regulation inspectors. The deputy manager was present during the visit and staff members and two people who live here were also spoken to. The manager was not present during this inspection. I spoke to the manager in a telephone conversation a week after the inspection. She reported feeling “frustrated and upset” that many of the issues at this home have not been addressed. Records looked at included care planning documentation, health and safety information, medication records and staff files. We also looked at the premises. Staff were helpful and friendly during the visit. The manager also completed a self-assessment of the home which is called an AQAA. Surveys were sent to the home for staff, and residents to complete. None were received from residents or staff members before this report was completed. There are many areas across all sections of this report that need attention and many requirements have not been met from the previous inspection. If these area are not addressed than enforcement action will be taken in relation to those areas of concern. What the service does well: What has improved since the last inspection? Training is continuing to improve at the home for example many staff have now attended training in continence and diabetes care, however there were no certificates available for us to see. Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hazlewell DS0000019097.V363475.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.V363475.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 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Although residents are assessed before admission there is not enough evidence to show that they are re-assessed to see if their needs have changed. EVIDENCE: Initial assessments had been completed by the manager prior to admission which is good practice and we saw that agreements had been drawn up by Wandsworth Social Services in the files that we looked at. In their AQAA (self assessment) the manager states that prospective relatives/residents are invited to come to visit the home for a tour and are given a copy of the service users guide. The manager wrote that she then visits the prospective resident either in hospital or at home to carry out a full assessment to ensure that the home can meet their needs. Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 9 In the files that we looked at there was no evidence to show that these individuals had taken part in a formal re-assessment of their needs. The deputy manager told us that those who are not paid for by social services do not have their care formally reviewed. This is not acceptable - all the people who live here must have a full care review at least once a year and when their circumstances change to ensure that they receive the care that they need. In her AQAA under the section ‘What we could do better’ the manager acknowledges that improvement is needed in assessing these private individuals and has written: “Special care and attention must be given to a needs assessment for self funding potential service users if making private arrangements for admission.” The home was issued with an up-to-date registration certificate this year. However, the registration certificate displayed in the entrance hall was not upto-date and was issued by the National Care Standards Commission. The correct certificate must be displayed. In her AQAA (self assessment) the manager writes that the home aims “to continue to maintain a calm peaceful, happy atmosphere so residents feel secure and contended in the evening of their life.” Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans contain a lot of information but they are not easy to follow and much of the information needs updating. Some risk assessments also need updating as they have not been reviewed and may place the people who live here at risk. Dignity cannot always be respected due to the bathroom arrangements at this home. The people who live here cannot always be assured that the appropriate medical advice will be sought or that advice from health professionals will be followed. The controlled drugs cupboard does not meet current legal requirements. There are issues with medication that cause concern including inappropriate finger-pricking devices in use. EVIDENCE: Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 11 There are still many issues with the care plans (see below). This requirement was made at the previous inspection and enforcement action is being taken. The four care plans that we looked at contained a lot of information but much of it was difficult to follow. They are still not person centred and are very task orientated, there is very little information in them about how residents likes, dislikes and interests are facilitated. The information in the daily records was very basic and contained entries such as ‘cheerful, ate well, no problems,’ ‘comfortable in a chair, ate well, medication given as prescribed. ‘After lunch get to bed,’ and ‘cheerful ate well, usual day.’ There was information in their files dating back to 2005 which should be archived. The documentation was also disorganised and difficult to follow. It is important that any new staff members can easily follow the care plans so that they know what care to give and what each residents likes, dislikes and preferences are without having to look through lots of paperwork. It was difficult to see how they would be able to follow these. Some of the nursing care plans – although detailed - were confusing as it was indicated on them that they had not been updated since 2006. However there was then another sheet entitled ‘evaluation of planned care’ which appeared to be a more up to date assessment of the whole content of the care plans each month. Each care plan needs to be reassessed separately to show how each issue is being monitored and addressed. The assessment charts within the care plans do not contain enough detail as there are only small boxes to complete for important areas such as continence, tissue viability, pain and nutritional needs. All these areas need to be assessed in more detail. There was a chart labelled ‘incontinence direction’ in the care plans but there was no evidence of a full continence assessment. One care plan looked at again contained only brief information for example: the mobility assessment states ‘needs aids/ immobile’ – ‘hoist or two staff.’ The communication assessment states ‘glasses for reading’ only. The psychological/ emotional assessment states ‘greek orthodox’ and ‘confused’ only. The ‘activities of living assessment’ states the following under the eating and drinking section– ‘excellent appetite’ – nothing is written about what they like/ do not like to eat, personal cleansing and dressing section states ‘requires 1-2 staff.’ The sheet for death and dying wishes just states ‘not discussed, require family permission’ The physiotherapy assessment is not referred to in the care plan, as it states ‘encourage to mobilise, walking with standing hoist’ we did not see this in evidence at the time of inspection. The occupational therapy assessment states ‘independent in washing face, head and neck’ and again this information is not referred to in the care plan. Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 12 A care plan for self care was very vague and states ‘two members of staff to undertake all aspects of personal hygiene’ for the individual – no other instruction than that, apart from ‘assess the capability to undertake any small mobility task’ and ‘if hoist is used make sure care staff are proficient in its use’. This care plan was again disorganised and did not give any clear instructions on such thing as what hoist to use or what mobility tasks the resident is expected to undertake. The moving and handling assessment chart was not completed. Although risk assessments were found in the care plans we could not find evidence that these have been reviewed regularly. One risk assessment was not detailed and just states ‘can ring his bell’. One regarding risk of ‘silent aspiration’ indicated that it had not been re-assessed since January 2005. One ‘cotside’ (bedrail) risk assessment that we saw indicated that a health professional such as a physiotherapist or occupational therapist had not been involved in the assessment, two other ‘cotside’ risk assessments did not state whether these professionals had been consulted. Bedrails are a form of restraint and the home must ensure that appropriate advice is sought prior to their use as they may cause harm. They did indicate that relatives had agreed to their use, however one of these was dated 2005 and the other 2006 and there was no evidence that these have been reviewed. The commission considers this of serious concern and enforcement action is being taken. We could not find evidence of body mapping or photographs for an individual stated to have unexplained bruising. (See the Complaints and Protection section of this report) This documentation must be completed to ensure that an evidence and audit trail is kept and the progress of any injury can be monitored. The training charts we looked at recorded that most staff have received training in wound care. We were informed that staff training has also been undertaken in diabetes care and continence care and this is an improvement. However there were no certificates available to demonstrate this was the case. (refer to the ‘Staffing’ section of this report). The manager indicated in her AQAA (self assessment) that this area is a high priority. The accident book that we looked at did not contain details about whether medical support had been sought in the cases recorded since our previous inspection. (See the Complaints and Protection section of this report). The manager acknowledges that improvements still need to be made in certain areas such as dignity. In her AQAA she writes “discussions are in hand and ongoing to hopefully improve the bathing facilities on the second floor which will avoid bringing a service user down to the first floor in an undressed state. I believe the present plan is to use a portion of the grant allocated by Wandsworth Borough.” (Please refer to the Environment section of this report). Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 13 Most of the medication requirements made by the pharmacist at their last inspection of this service have not been met. The record of medication received into the home is on the medication administration chart (MAR chart) only and there is no separate audit trail. The medication policy has not been updated since the last inspection and this requirement will be re-stated. ‘Checked 2008’ has been written on it however there is no evidence that it has been updated. This requirement was made at the previous inspection and enforcement action is being taken. The thermometer in the fridge is a plastic one, the home should purchase an electronic one that records minimum and maximum temperatures. The medication fridge in use at the home is an old minibar. The controlled drugs (CD) cupboard remains unchanged since our last inspection – it is not properly attached to wall and is loose - it needs resituating. This requirement was made at the previous inspection and enforcement action is being taken. The date of opening was not written on eye drops in the fridge. These must be labelled for the safety of the people who live here. This requirement will be restated. This requirement was made at the previous inspection and enforcement action is being taken. No new finger pricking devices/ lancets have been purchased since the last inspection as found at the previous inspection these were not lancets for professional use. These are necessary to prevent the risk of infection from blood borne diseases both in the residents and the nurses. The British National Formulary (BNF) at the home is dated March 2007 and should be updated to ensure that the home has access to the most up-to-date information. Two topical creams were labelled “use as directed by your doctor”/ “as directed” the correct specific directions must be on the label to ensure that the correct dose is given. Where variable doses have been indicated on medication for example: “take one to two twice a day” - the actual dose given is not being recorded on the MAR chart. The commission considers this of serious concern and enforcement action is being taken. A list of staff signatures is kept at the home and a record is maintained of medication disposed of returned/ wasted in a book to help ensure that there is an audit trail and all medication is accounted for. The amount of medication is checked at the start and end of each shift – this was all correct. Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 14 New waste bins are in place since our last inspection and we were informed that the home has a contract with a local pharmacy. The pharmacy collect the bins every three months. We were told that medication training is given to staff by this pharmacy. Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 15 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, 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Activity provision continues to remain limited. The people who live here are able to maintain contact with family and friends. Individuals are not always offered choice with regard to meal times. This service does not provide sufficient quantities of fresh food for residents including fruit and vegetables. This may have an impact on their health. EVIDENCE: During our visit no organised activities were observed to be offered to the people who live here. The television was turned on for them to watch the Wimbledon tennis if they wished. One individual said that they enjoyed watching it however; other residents just stared ahead of them or slept. The deputy manager told us that they did not have time to take the residents out to activities in the community. He said that they were sometimes taken out into the garden if they wished to sit out there. He also told us that one staff member was responsible for providing support with activities twice a week and Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 16 this involved putting music on so that the people who live here can listen or sing along. In the AQAA (self assessment) the manager states “ the outside wider world concept must be explored to try and involve appropriately chosen residents to integrate into suitable community activities”. The manager obviously acknowledges that the people who live here need to be given the choice to participate in activities outside. However all the people who live here need to be supported in this choice and not just those who have been “appropriately chosen.” The requirement relating to a lack of activities has been repeated twice and enforcement action is being taken. One individual told us that “never go out anywhere” and “there is not much to do here.” Another said that they enjoyed watching the tennis in their room, but “there is nothing else really.” Meetings are not held at the home for the people who live here. It is strongly recommended that the home looks into ways of involving the residents in the running of their home. Although no relatives were observed visiting the home on the day of inspection, the deputy manager told us that relatives are encouraged to visit the home. No issues were found regarding this area at the previous inspection visit. There was also some indication in the care plans that some relatives have been consulted regarding the care of their family members. The deputy manager reported that more choice is now given regarding when individuals wish to rise or retire to bed and no issues were raised in this area by any of the people spoken to on this visit. However he reported that they “cannot give choices” regarding mealtimes as “the night staff have to start serving breakfast at 6am to help the day staff out.” The people who live here must be offered more choice as to meal times it must not be related to staff preference. This requirement was made at the previous inspection and enforcement action is being taken. There is no formal dining area at the home and people eat their meals on hospital style tables whilst sitting in their armchairs which adds to the intuitional feel of the home. The manager reported in her AQAA (self assessment) that the home will “explore the possibility for a more formal dining area.” When we looked at the food available in the cellar we found tinned fruit cocktail, tinned pineapple, tinned pear halves and peach slices. The only fresh foods seen consisted of onions, cabbage and potatoes, no fresh fruit was seen. Residents must be offered a range of fresh food and vegetables. This requirement was made at the previous inspection and enforcement action is being taken. Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 17 The manager told us in a telephone conversation that the owner “will occasionally bring in a bag of grapes or two to three hands of bananas for the residents to share.” A resident told us that the food was ‘alright’ and another said it was ‘nice.’ As found at the previous inspection visit we again observed that the desserts were plated up alongside the main course on trays at lunchtime. This course should be served after the main course. This is an institutional practice and must stop. Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 18 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, 18 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Although many staff have attended training in the safeguarding of vulnerable adults they do not always take appropriate action in the case of unexplained injury/bruising. Not all staff have immediate access to a copy of the local authority SOVA guidelines. Although complaints are recorded not all complaints are fully addressed. EVIDENCE: A staff training chart indicated that most staff have undertaken training in safeguarding vulnerable adults. However, one of the care plans we looked at contained details about a person who lives here who had been found to have unexplained bruising on the morning of the inspection. This had been documented but no action had been taken. The entry for 23/06/08 in their daily record states ‘two bruises on back, resident doesn’t know how he got them.’ There was no evidence that relatives, a GP or social services had been notified. We asked the deputy manager to alert Wandsworth Social Services using the Wandsworth Local Authority Safeguarding Adults (SOVA) procedures. He reported that he had been waiting to talk to night staff about the incident and he thought it was ‘caused by the cot sides.’ He told us that he could not find a copy of the SOVA procedures. He then said that he did not have time to Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 19 report this and had to leave. He did not have the phone number for the SOVA team in Wandsworth and we gave it to him. He asked another member of staff to report the issue to social services which they did. This should have been reported immediately and staff must be aware of the procedures to follow as the people who live may be placed at risk of harm. This requirement was made at the previous inspection and enforcement action is being taken. The SOVA procedures must be easily accessible by all staff. The accident book recorded nine accidents since our last inspection. Many of these indicated that residents had been found on the floor/fallen, some had sustained injuries or cuts to their head. It did not state in any of the recorded outcomes what medical advice had been sought and whether a GP had been contacted. The complaints log indicated that five complaints have been made since our previous inspection visit. These all contained details of the action taken and the outcome. One of these complaints was concerning a lack of privacy for one individual. An entry indicated that the owner of the home had been informed and then the entry in the outcome section indicated that the owner had not yet taken action to address the issue and had to be reminded. Appropriate action should be taken to address all complaints. Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 20 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, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. As found at previous inspections this service still does not present as homely due to the environment which looks tired, shabby and dated. This home is poorly maintained and decorated. Standards of cleanliness need to improve. EVIDENCE: Although some decoration has taken place to the exterior of the property the interior remains shabby and in need of extensive re-decoration. This requirement has been repeated twice and enforcement action is being taken. The deputy manager told us that they felt ‘ashamed and embarrassed’ by the poor decoration. Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 21 A health professional told us that the home was ‘scruffy and dirty.’ One person who lives here told us that their bed was uncomfortable and they didn’t like it. They said the ‘mattress was creaky and woke them during the night.” They were observed to be sitting in a shabby stained armchair and the chest of drawers on which their TV was situated had two handles missing from the drawers. Additionally the following issues were found at this inspection visit: • Top floor – a ladder, hoist and weight chair were stored in the hallway. Magnolia paint is in almost all rooms and hallways this gives a very institutional feel to the home. Damp marks were observed on the ceiling. Room 22 – there was a stained carpet, damp spots on ceiling, hook on wall near head end of bed – risk to resident of catching face/ arm on this. No lightshade in room. The hallway outside room 24 – there was peeling paint on ceiling damp rust stains and dribbles down the wall. Carpet in hallway was very stained and in need of replacing. Bathroom next to room 24 – bath panel has hole in it and is in need of replacing, the ceiling grill was dusty, the bath stained with limescale, and a crack on wall behind toilet. Room 27 – the curtain was hanging off the rail; the wallpaper on ceiling shows damp spots. The stairs leading down to 1st floor opposite room 27 – the carpet is stained and in need of replacing. First floor – room 10 has no curtains. Room 9 – two large cracks on wall either side of the bay window Bathroom next to room 11 – the flooring was marked and in need of replacing. The medicine cabinet on the wall outside room 14 needs removing as is broken. Toilet opposite room 15, the panel on the lower wall to the left as you enter the room needs repairing as hanging loose – damp spots/ marks on ceiling in hallway outside. DS0000019097.V363475.R01.S.doc Version 5.2 Page 22 • • • • • • • • • • Hazlewell • Shower room – the home needs to remove items hanging on the radiator – including the used gloves, black strip and broom head. The shower is dirty and in need of a clean. Ground floor – In the managers office there were damp marks on ceiling Room 2 – there was wallpaper coming away from wall where it meets the ceiling. Toilet next to room 1 – the radiator guard was not fixed to the wall. There were scuff marks and paint coming away around the skirting boards and walls. No curtains here. Room 5 – no net curtains here, other curtains hanging off. There are many hospital beds throughout home. These give the home a very institutional feel. The beds in rooms 6, 10, 16 and 22 are still hospital beds. This requirement has been repeated twice and enforcement action is being taken. The conservatory is hot – one staff member said “…the residents get too hot in there and prefer to stay in their room…” Garden – there is no ramp for the step out to garden. The home needs to remove the broken furniture, old window frames and glass from the garden. The deputy manager said that a staff member and their friend had mowed the lawn recently as there was no one employed to carry out this activity. • • • • • • • Where areas identified above have been found to be dusty, dirty or stained then these areas need to be cleaned fully. This requirement was made at the previous inspection and enforcement action is being taken. All the above issues must be addressed to help to ensure the comfort and safety of the people who live here. Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 23 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, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. As found at the last inspection staff are appropriately trained to help to ensure that they can carry out their roles. However there is not sufficient evidence in the form of certificates at the home that staff have undertaken all the training indicated on the training log. Residents like the staff. Staff files still do not contain all required information and this may place residents at risk. EVIDENCE: Staffing levels seemed sufficient on the day of inspection, the deputy manager told us that the numbers of people living here has fallen from twenty-two to sixteen since the previous inspection. However he did report that he finds it difficult to carry out the role of manager, care assistant and handling the administrative tasks difficult each day. It was concerning that residents are still not given choice regarding meal times and that the provision of activities is not good. It is recommended that staffing levels are looked at to ensure that there are sufficient numbers of trained, competent and permanent staff on duty at all times. As stated in the previous inspection report this is to help ensure continuity of care for the people who live here and that their needs are met. Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 24 The manager told us in a telephone conversation that there are “no problems with staffing” at the home. Staff were observed to treat the people who live here with respect when they spoke to them. The deputy manager said “I know each one of them like my family.” Two individuals spoken to were very complimentary about the staff, deputy manager and manager. As stated in the previous inspection report there is a clear training log that indicates all the training that staff have undertaken such as moving and handling, first aid, wound care and health and safety. Two staff spoken to said that training provided by the home was good. The training log indicates that most staff have now attended training in continence and diabetes care which is an improvement and may help the staff to carry out care based on up-to-date practice. However the deputy manager informed us that the course had not been paid for and they have not been issued with their certificates yet. Copies of training certificates must be kept at the home to show that staff have attended these courses. We were told that many staff have also undertaken NVQ training. The deputy manager told us that he placed a high importance on staff training. The deputy manager told us that staff are not given contracts at the home. Two new staff files were looked at. Both of them contained a very basic application form, copies of identification and health check forms. Neither of them contained photographs, contracts of employment or details of a start date. One contained a Criminal Record Bureau (CRB) check and one contained a ‘POVA First’ check (an initial security check). However this was dated 31/03/08 and there was no evidence of a returned CRB form. A reference in one file had been written by a staff member at the home although an entry on the application form stated “not employed” in the ‘Previous Employment’ section. Appropriate pre-recruitment checks must be carried to help to ensure the safety of the people who live here. Also contracts must be provided to the staff. This requirement was made at the previous inspection and enforcement action is being taken. Monthly staff meetings are held to allow staff to discuss any issues. We saw the minutes of these meetings – they were difficult to read in places as they are all handwritten due to the staff not having access to a computer. The manager wrote in her AQAA (self assessment) that plans for improvement regarding staff over the next twelve months are: “ inspire motivation among the staff – aspire to a high standard of care – boost morale and maintain an harmonious atmosphere which is crucial to the contentment and wellbeing of the residents.” Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 25 Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 26 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, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are many areas which require improvement throughout the home and this may have an impact on the quality of care at this home. There is a quality assurance programme at this home which helps to take into account the views of the people who live here. There is not enough evidence to show that adequate health and safety checks are carried out. EVIDENCE: Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 27 It was the manager’s day off on the day of inspection. However the deputy manager was very helpful throughout the inspection visit and we saw that he had a good rapport with the people who live here. He said that he ‘cared about them as if they were his family.’ One of the residents said that he was ‘lovely and very kind’. He has achieved the Registered Managers Award and is experienced in care. He spoke highly of the manager and reported that she was ‘very supportive’ and had ‘taught him so much’ since he has worked at the home. There are many issues which need to be addressed throughout the home and this was discussed with the deputy manager who reported that he was aware of this but that they are not given sufficient funds to do anything about tackling areas such as the environment. He reported that an expected government grant of £25,000 would help. As stated in previous inspection reports there are no computer facilities at the home. It is again strongly recommended that these are installed so that staff can access up-to-date health and social care information that will be of benefit to the resident’s health and safety. Staff would also benefit from access to our (CSCI) website for advice and information and also from email to work efficiently with other professionals and organisations for the benefit of the residents. There are also no photocopy facilities at the home. The deputy manager told us that staff have to leave the home to photocopy documents or they are reliant on the owner has to carry out this task. There is a quality assurance programme at the home. The manager completed an audit of care at the beginning of the year and the deputy manager reported that she was again giving out more surveys to the people who live here and the relatives to see if they are happy with the care given. A medication audit has also been carried out this year. However there was no evidence of an annual development plan being carried out and this requirement remains outstanding from previous inspections. There was no evidence in the home of the self-assessment audit visits (Regulation 26) that the owner (registered provider) is required to make to the home each month. Copies of these reports must be kept in the home to help to ensure an open and transparent audit trail and to demonstrate that the registered provider is carrying out these visits. A staff member reported that either social services or individual’s relatives handle their financial issues. She said that if any money is kept on the premises for ‘pocket money’ then this is dealt with by the manager or deputy manager. The manager wrote in her AQAA (self assessment) “None of our service users are capable of handling their financial affairs.” As found at the last inspection there was not enough evidence in the home to show that adequate health and safety checks are undertaken. These include areas such as portable appliance testing (pat), gas safety, electrical installations and fire drills. These checks must be carried out to help ensure Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 28 the safety of the people who live here and the staff. The deputy manager reported that some checks may have been carried out but that he had not been provided with any paperwork by the owner of the home. This requirement has been repeated twice and enforcement action is being taken. A different fire call point is tested each week, however fire drills should to be carried out more frequently the last one recorded was in November 2007. This may place the people who live here and the staff at risk of harm. All fire extinguishers seen were dated as last checked in June 2006 – these should be re-checked to help protect the people who live here. Also as found at our previous inspection decanted food found in the kitchen was not appropriately labelled. These should be clearly labelled with the contents and the date the ingredients were decanted into the containers. This is to help to ensure the safety of the people who live here. Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 29 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 X X X X X X 2 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 3 X 2 X 3 X X 1 Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 30 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 OP3 Regulation 14 (2) Timescale for action All the people who live here must 01/08/08 have a re-assessment of their needs at least once a year or as their circumstances change. This is to help to ensure that the home can meet their ongoing needs. 01/09/08 Care plans must contain details about individual’s interests and social needs. Daily care notes must be detailed and give specific information about how service users social needs are to be met to demonstrate how the home is meeting their needs. Previous timescale of 01/03/08 not met. Enforcement action is being taken. Risk assessments must be regularly reviewed so that service users are not placed at risk of harm. Risk assessments for bedrails must be carried out in collaboration with appropriate trained health professionals. Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 31 Requirement 2 OP7 12 (1) 15 3 OP7 13 (4) 01/09/08 4 OP8 12 (1) 5 OP8 12 (1) 6 OP9 13 (2) 7 OP9 13 (2) 8 OP9 13 (2) Risk assessments must contain sufficient details to ensure that service users are not placed at risk of harm. Enforcement action is being taken. Where injuries or bruising are noted then the appropriate documentation must be fully completed with enough detail to monitor the progress of the injury. Where health professionals have given advice/undertaken assessments this information must be included in the care plan. Arrangements must be in place to ensure that medication is administered as prescribed. In respect of “as required” medication records must be maintained to evidence dose administered. Enforcement action is being taken. Professional finger pricking devices or lancets must be used for testing blood glucose to prevent the risk of infection. Previous timescale of 14/03/08 not met. The homes medication policy must be updated. A copy must be sent to CSCI by the date stated Previous timescale of 01/04/08 not met Controlled drugs must be stored in a cupboard meeting the Misuse of Drugs Act Previous timescale of 01/03/08 not met. Enforcement action is being taken. Arrangements must be in place for the recording, handling, safekeeping, safe administration DS0000019097.V363475.R01.S.doc 01/08/08 01/08/08 08/08/08 01/08/08 01/08/08 9 OP9 13 (2) 08/08/08 10 OP9 13 (2) 08/08/08 Hazlewell Version 5.2 Page 32 and disposal of medicines received into the home. Dates of opening must be written on eye drops and liquids with a short expiry date. Previous timescale of 14/02/08 not met. Enforcement action is being taken. The people who live here must have their dignity respected and the practice of taking them partly dressed from the second floor to the first floor bathroom must stop. An activity programme must be provided to enable residents to engage in local, social and community activities. Previous timescales of 01/10/07 and 01/04/08 not met. Enforcement action is being taken. Arrangements must be put in place to provide in adequate quantities, suitable, wholesome and nutritious food which is varied, properly prepared and available at such time as may reasonably be required by service users. Service users must be offered choice about the times they would like to be served their meals - particularly their breakfast. Fresh food must be offered to service users; this includes a wider choice of fresh vegetables and a wider choice of fresh fruit must be offered to service users daily. Previous timescale of 01/03/08 not met. Enforcement action is being taken. Arrangements must be put in place, by training staff or by DS0000019097.V363475.R01.S.doc 11 OP10 12 (4) (a) 01/07/08 12 OP12 16 (2) (m) (n) 01/09/08 13 OP14 16 (2) 08/08/08 14 OP18 13 (6) 08/08/08 Hazlewell Version 5.2 Page 33 other measures to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. All staff must be aware of and follow the London Borough of Wandsworths Safeguarding Vulnerable Adults Procedures. Previous timescale of 01/03/08 not met. Enforcement action is being taken. Accident records must record 01/08/08 whether an appropriate medical referral was made. The Registered person shall 01/09/08 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 and the stained wall paper/paint. The beds in rooms 6, 10, 16 and 22 must be fit for purpose. Both 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 good working order. The home must be kept clean and hygienic. Previous timescale of 01/10/07 and 01/05/08 not met. Enforcement action is being taken. Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 34 15 16 OP18 OP19 13 (6) 23 (2) (b) (c) (d) (j) 17 OP29 19 (4) (b)Schedu le 2 18 OP30 18 19 OP33 24 Staff files must contain all the information required in Schedule 2 of the Care Homes Regulations 2001. Previous timescale of 01/03/08 not met. Enforcement action is being taken. Copies of certificates must be kept at the home to demonstrate that staff have undergone training. An annual development plan must be put in place for the home. Previous timescale of 01/10/07 and 01/04/08 not met. The Registered Provider must ensure that copies of his regulation 26 visits are kept at the home. The Registered person shall ensure that all parts of the home to which service users have access are so far as is reasonably practicable free from hazards to their safety. Evidence must be kept at the home to demonstrate that all electrical appliances in use have been tested for safety by a suitably qualified person. Evidence that a gas safety inspection has taken place must be available at the home. Evidence that a five yearly electrical installations check has taken place must be available at the home. Previous timescale of 01/08/07 and 01/03/08 not met. Enforcement action is being taken. 08/08/08 01/08/08 01/09/08 20 OP33 26 01/07/08 21 OP38 13 (4) 08/08/08 Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 35 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 OP33 Good Practice Recommendations 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. There should be a current BNF in the home for information purposes. Puddings should not be plated up with the lunch. This course should be offered after the residents have finished their main course. It is recommended that a walk-in shower be provided for residents on the second floor. It is recommended that staffing levels are reviewed to ensure that sufficient numbers of trained and competent staff are on duty at all times. The home should look at the possibility of holding regular residents meetings. All decanted food should be labelled with the date they were decanted and clear expiry dates. They must also be clearly labelled with regard to the type of ingredients in each container. Fire drills must take place more frequently to ensure that staff know the action to take and the people who live here are not placed at risk of harm. The fire extinguishers must be re-checked by a qualified professional. 2 3 4 5 OP9 OP15 OP21 OP27 6 7 OP33 OP38 8 OP38 Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 36 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. Extracts may not be used or reproduced without the express permission of CSCI Hazlewell DS0000019097.V363475.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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