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Inspection on 19/01/06 for Hedgerows Nursing Home

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

This inspection was carried out on 19th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The Hedgerows was clean and free of offensive odours. Staff have been described by service users as kind and caring. They also spoke of how reassured they were to be in this particular home where they considered the care to be very good. The home has a stable staff team and appropriate training is being addressed and undertaken. It has been noted that service users look clean and tidy and their comments about the service they received are very positive. The registered manager ensures that service users are offered opportunities to participate in the day to day running of the home

What has improved since the last inspection?

It was noted at the last inspection that "Person Centred Planning" will be introduced to ensure service users plans are more involving and they can take ownership and responsibility for their own self. This would be seen as good progress but is yet to be implemented. The home operates a work based induction programme which is competency based and has currently been reviewed. The Manager is ensuring the home`s induction programme is to TOPSS standards

What the care home could do better:

The present manager is leaving and a new one will need to be appointed and registered. While improvement has been made to the care planning process some further progress is required to ensure that service users needs are met and that risk assessments are maintained.Some aspects of medication administration and recording was not being addressed appropriately. Restraint training must be addressed as service users were being restrained with lap belts in chairs with no documentation in their plans of care or risk assessments. The screening of double rooms should be reviewed to ensure privacy and dignity to all service users. Structured supervision should be kept up to date along with some of the records in the home predominantly surrounding care documentation.

CARE HOMES FOR OLDER PEOPLE Hedgerows Nursing Home 256a Ongar Road Brentwood Essex CM15 9DX Lead Inspector Helen Laker Unannounced Inspection 19th January 2006 11:00 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 Hedgerows Nursing Home DS0000015538.V274735.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hedgerows Nursing Home DS0000015538.V274735.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hedgerows Nursing Home Address 256a Ongar Road Brentwood Essex CM15 9DX 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) 01277 202270 01277 215520 Outlook Care Mr Simon Chua Kim Chuan Care Home 40 Category(ies) of Dementia - over 65 years of age (6), Learning registration, with number disability (7), Old age, not falling within any of places other category (33), Physical disability over 65 years of age (33) Hedgerows Nursing Home DS0000015538.V274735.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Nursing and personal care to be provided for up to 33 Older People. Nursing and personal care to be provided for up to 7 people with a Learning Disability. Nursing and personal care to be provided for up to 33 Older People with a Physical Disability. Nursing and personal care to be provided for up to 6 people with Dementia over the age of 65 years. Maximum number to be cared for shall not exceed 40. Date of last inspection 14th July 2005 Brief Description of the Service: The Hedgerows is a purpose built bungalow complex sited around a courtyard. Two of the bungalows provide for fourteen service users one provides for twelve service users. Each one has its own attached small well-maintained garden.The bungalows are situated within the grounds of Highwood Hospital, close to the centre of Brentwood. The location is convenient to a local bus service and benefits from having a small parade of shops close by.At present the home provides for six learning disability clients, six service users with dementia, and thirty four physically disabled older people with nursing needs. The home has currently reduced it’s occupancy to a total of forty service users. At the time of this report, four beds were contracted by the Primary Care Team for transitional service users prior to permanent placement in residential or nursing care homes or community based home care. Hedgerows Nursing Home DS0000015538.V274735.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine, unannounced inspection which took place over six hours with one inspector in the home. There was a tour of the grounds and an inspection of records and documentation. Time was spent discussing the care of the service users. The manager in charge of the day to day management of the home and staff were spoken with. Seventeen National Minimum Standards were inspected on this occasion, eleven overall outcomes were met and there were six requirements and one recommendation detailed in the full report. Discussion of the inspection findings took place with the manager in charge of the day to day management of the home at the end and throughout the inspection, guidance was given. What the service does well: What has improved since the last inspection? What they could do better: The present manager is leaving and a new one will need to be appointed and registered. While improvement has been made to the care planning process some further progress is required to ensure that service users needs are met and that risk assessments are maintained. Hedgerows Nursing Home DS0000015538.V274735.R01.S.doc Version 5.1 Page 6 Some aspects of medication administration and recording was not being addressed appropriately. Restraint training must be addressed as service users were being restrained with lap belts in chairs with no documentation in their plans of care or risk assessments. The screening of double rooms should be reviewed to ensure privacy and dignity to all service users. Structured supervision should be kept up to date along with some of the records in the home predominantly surrounding care documentation. 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. Hedgerows Nursing Home DS0000015538.V274735.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hedgerows Nursing Home DS0000015538.V274735.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,4,5 Present and prospective service users and their supporters are given adequate information about the home so that they can make informed choices. The admission procedure includes an adequate assessment which ensures that service users needs can be met. The home provides a caring environment where visitors are made welcome. EVIDENCE: The Statement of terms and conditions of residence was seen to be comprehensive. A sample of care plans seen demonstrated that a full assessment has generally been undertaken prior to admission. Those service users admitted through care management arrangements included assessments from the relevant authorities. Pre-assessments including transitional service users are carried out by the Manager or Senior Staff to ensure that the home can meet prospective service users’ needs. The home benefits from a core group of experienced and qualified staff. Hedgerows Nursing Home DS0000015538.V274735.R01.S.doc Version 5.1 Page 9 Prospective service users are invited to visit the home pre-admission, but many are unable to do so. In addition, staff always visit service users before admission. Emergency admissions are generally discouraged. Hedgerows Nursing Home DS0000015538.V274735.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9,11 Each service user has an individual plan and service users are supported to take risks as part of an independent lifestyle via a process of assessment. While improvement has been made to the care planning process further progress is required to ensure that service users needs are met. The health needs of service users are well met although better documentation would ensure clarity of needs. Personal support is provided in a way that promotes dignity ands propriety. EVIDENCE: Previously it was noted that comprehensive person centred plans currently in draft form are to be finalised and implemented. This has not yet happened. Evidence of two service user care plans indicated that their basic health, personal and social care needs are recorded within an individual plan of care. Instructions for staff to meet service users’ care needs were not always clear and comprehensive. Care plans did not evidence service users’ or relatives’ involvement and had not been reviewed on a regular basis. Daily recording requires improvement to ensure they detail the welfare of the service user, how they spend their day and the progress of the care plan. One new transitional service user had no care plan at all. Risk assessments were not available for some service users but were also noted to require more detail and Hedgerows Nursing Home DS0000015538.V274735.R01.S.doc Version 5.1 Page 11 include potential complications of the risk. Transitional care plans did not always include photos, missing person profiles, assessment tools likes and dislikes, evaluation of care needs thorough monthly review and a more standard approach. The manager was advised of these issues during the last inspection also. The inspector was informed that only trained staff administer medication. Completed drug histories should refer to dose changes on the form. All individual entries on the drug sheets should be signed by the transcriber and checked for accuracy. The dose form and strength of medication should be clearly recorded on treatment charts. Covert medication procedures should be clearly documented in care plans where applicable. This was highlighted at the homes previous inspection. Care and comfort are given to service users who are dying, their death is handled with dignity and propriety, and their spiritual needs, rites and functions observed. However more prominence as appropriate should be based on ensuring service users views regarding afterlife issues are recorded in plans of care. Hedgerows Nursing Home DS0000015538.V274735.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected EVIDENCE: Not inspected Hedgerows Nursing Home DS0000015538.V274735.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 The home has effective procedures in place to ensure that service users legal rights are protected. EVIDENCE: Advocacy services are available for all service users and an advocate regularly visits the home. All service users are included in the voter’s register and encouraged to vote. Hedgerows Nursing Home DS0000015538.V274735.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 The Hedgerows was clean, bright and well maintained and provided the service users with safe, homely and comfortable surroundings. Improvements have been made to the décor of the home. Not all staff are aware of the fundamental concepts of restraint. EVIDENCE: The manager previously stated that screening in double rooms did not ensure the total dignity and privacy of service users but was adequate. The manager is currently investigating this and is also at this inspection also. Service users were being restrained with lap belts in chairs previously with no documentation in their plans of care or risk assessments. A strategy regarding the management of this in the home is still to be implemented Hedgerows Nursing Home DS0000015538.V274735.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 The procedures for the recruitment and training of staff have safeguards in place to offer protection to people living in the home. The home has an effective and competent staff team. EVIDENCE: Twenty one staff hold NVQ Level two / LDAF qualifications and seven hold NVQ Level three. In addition, six staff are currently undergoing training at NVQ Level 2, and two staff at NVQ Level 4. Hedgerows Nursing Home DS0000015538.V274735.R01.S.doc Version 5.1 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,34,35,36,37,38 There is guidance and direction to staff and the home has in place practices that will promote and safeguard the health, safety and welfare of the people using the service. EVIDENCE: The Manager has been in post for just over a year and has now made a decision to leave. The inspector was informed that plans to recruit a new manager were imminent but as yet no one has been appointed. The present manager feels he has empowered, motivated, supported and mentored in his role and created an open and inclusive atmosphere. The home has an appropriate business plan and adequate insurance cover. It is judged that procedures are in place to ensure appropriate management of the business. An appointee from the Proprietor’s Head Office is available for service users who cannot manage their finances. Generally, finances are managed by service Hedgerows Nursing Home DS0000015538.V274735.R01.S.doc Version 5.1 Page 17 users’ families. Records and receipts are kept for all transactions for each service user. Supervision planning, forms and records were not all clear and up to date. Staff are aware of supervision. Induction programmes are provided for all employees within the first six weeks. The inspector was informed that new staff are on six month probation and supervised and reviewed on a regular basis. The home does not have any volunteers but are aware of the checks required if any are taken on in the future. It is recommended that all staff receive a minimum of six structured supervisions and one appraisal annually. Records seen throughout the inspection were generally well kept but there were shortfalls in areas. Some have been commented on throughout this report. The Manager is fully aware of his responsibilities for health and safety and staff receive regular training on health and safety. Restraint training must be addressed as service users were being restrained with lap belts in chairs with no documentation in their plans of care or risk assessments. Health and safety checks are regularly carried out by NHS Estates Management Team. Safety certificates were available for gas, electric and fire, call systems, hoists and prevention equipment. Regular checks were seen for hot water and fire equipment. Regular fire drills were seen to be being carried out. A lot of this was covered at the homes previous inspection. Hedgerows Nursing Home DS0000015538.V274735.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 x X X X X X 2 X X STAFFING Standard No Score 27 X 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X 3 3 2 2 3 Hedgerows Nursing Home DS0000015538.V274735.R01.S.doc Version 5.1 Page 19 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 OP7 Regulation 15(1)(2) 17(1)(a)( b) Requirement Timescale for action 27/02/06 2 OP7 13 (4) & 13 (8) 3 OP9 13(2)17(1 )12(1)(4) A detailed service user plan of care must be drawn up including consultation with service user families and significant multidisciplinary personnel, to be reflected in the care plan and reviewed comprehensively monthly. 27/02/06 Risk assessments must be carried out for the example: -use of bed rails and includes details of potential implications of their use for the service users within individualised plans of care. This with regard to all other risk assessments formulated especially those at risk of falls, pressure sores and those for COSHH and environmental health and safety issues. 27/02/06 The registered person must ensure that there is a policy and staff adhere to the procedures for the receipt of recording, storage, handling administration and disposal of medicines, and service users are able to take responsibility for their own medication if they wish, within a risk management framework. DS0000015538.V274735.R01.S.doc Version 5.1 Hedgerows Nursing Home Page 20 4 OP24 13 (7) & (8) 5 OP36 18(1) & (2) 19(1) 6 OP37 17 (1)(3) Service users must not be restricted with lapbelts permanently for any reason or be subject to any form of restraint. Consideration must be given to the issue of formulating individual plans within a riskmanaged strategy. The registered person must ensure that the employment policies and procedures adopted by the home and it’s induction, training and supervision arrangements are put into practice Records required by regulation for the protection of service users and for the effective and efficient running of the business must be maintained, up-to-date and accurate. 27/02/06 27/02/06 27/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP11 Good Practice Recommendations It is recommended that service users wishes regarding afterlife issues be appropriately and sensitively obtained and recorded in care plan documentation. Hedgerows Nursing Home DS0000015538.V274735.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hedgerows Nursing Home DS0000015538.V274735.R01.S.doc Version 5.1 Page 22 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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