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Inspection on 20/07/07 for Hedgerows Nursing Home

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

This inspection was carried out on 20th July 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 Home continues to provide the residents with comfortable well decorated and furnished accommodation. Hedgerows was tidy and bright and provided the service users with homely and comfortable surroundings. The home was able to demonstrate overall via a process of assessment and staff training that service users needs were being met. Staff were 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 good. This was highlighted at the previous inspection also. It was noted that service users seen looked clean and tidy and their comments about the service they received were very positive. The 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?

There is clear guidance and direction to staff and the home does overall have in place practices that will promote and safeguard the health, safety and welfare of the people using the service. Improvement has been made to the care planning process to ensure that service users needs are met and that risk assessments are maintained. A record is kept of food prepared for service users, including special diets. Consideration has been given to the issue of formulating individual plans within a risk-managed strategy. Restraint training is being addressed. A more robust and thorough recruitment procedure is now in place and based on equal opportunities and ensures the protection of service users.

What the care home could do better:

In terms of what this home could better and that they have met all outstanding requirements it is anticipated that the consistency in the standard already met will continue.

CARE HOMES FOR OLDER PEOPLE Hedgerows Nursing Home 256a Ongar Road Brentwood Essex CM15 9EA Lead Inspector Helen Laker Unannounced Inspection 20th July 2007 10:00 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.V342146.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. Hedgerows Nursing Home DS0000015538.V342146.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hedgerows Nursing Home Address 256a Ongar Road Brentwood Essex CM15 9EA 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 terri@outlookcare.org.uk Outlook Care Mrs Mary Theresa Pike 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.V342146.R01.S.doc Version 5.2 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 24th August 2006 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 seven learning disability clients, six service users with dementia, and thirty three physically disabled older people with nursing needs. The home has previously reduced its occupancy to a total of forty service users. At the time of this report, one bed was 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. The home was first registered in March 1994. The Service User Guide and Statement of Purpose have been reviewed and the residents and their representatives have been provided with this information and the manager stated that the home would provide them with Commission for Social Care Inspection reports too. At the time of this report the manager supplied a scale of the homes charges and fees these range from £600.00 to £1097.00 per week Hedgerows Nursing Home DS0000015538.V342146.R01.S.doc Version 5.2 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 seven hours with one inspector in the home. This unannounced inspection, was undertaken on the 20th July 2007 with the assistance of the manager. The inspection took place over two days, one spent in the home viewing records and files. There was a tour of the grounds and an inspection of records and documentation. Time was spent discussing the care of the service users. Further feedback was also received from service users and care staff through completed surveys, telephone contact and discussion. Survey responses have been included in the relevant sections of the report. A pre-inspection questionnaire and other reports and correspondence provided by the manager was also used as evidence to inform this report. The present manager in charge of the day to day management of the home and staff were spoken with. Twenty five National Minimum Standards were inspected on this occasion, twenty five overall outcomes were met. 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? There is clear guidance and direction to staff and the home does overall have in place practices that will promote and safeguard the health, safety and welfare of the people using the service. Improvement has been made to the care planning process to ensure that service users needs are met and that risk assessments are maintained. A record is kept of food prepared for service users, including special diets. Consideration has been given to the issue of formulating individual plans within a risk-managed strategy. Restraint training is being addressed. Hedgerows Nursing Home DS0000015538.V342146.R01.S.doc Version 5.2 Page 6 A more robust and thorough recruitment procedure is now in place and based on equal opportunities and ensures the protection of service users. 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. Hedgerows Nursing Home DS0000015538.V342146.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 Hedgerows Nursing Home DS0000015538.V342146.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&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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 does include an adequate assessment which ensures that service users needs can be met. The home provides a caring environment where visitors are made welcome. EVIDENCE: Care records generally evidenced a full assessment had been undertaken by the manager. Full social worker assessments were available for those residents sponsored by local authorities. Pre admission assessments were reviewed for the homes most recent admissions. Wherever possible it is advised that residents or their relatives are informed in writing confirmation of the homes undertaking to meet service users needs and are involved in the assessment process. All prospective Hedgerows Nursing Home DS0000015538.V342146.R01.S.doc Version 5.2 Page 9 residents and their families are invited to visit the home before making a decision. Hedgerows now does not have any transitional beds and does not provide intermediate care. Hedgerows Nursing Home DS0000015538.V342146.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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each service user has an individual plan and service users are generally supported to take risks as part of an independent lifestyle via a process of assessment. The health needs of service users are met, and documentation does generally ensure clarity of needs. Medication procedures are followed appropriately. Personal support is overall provided in a way that promotes dignity. EVIDENCE: Evidence of six service user care plans indicated that their basic health, personal and social care needs are recorded within an individual plan of care. They evidenced an admission care plan and a comprehensive care plan developed during the trial period. A pilot is presently underway to introduce clinically based colour coded care plans and pictorial ones for the LD service users. Care plans seen were to a good standard, clearly identifying residents needs and giving instructions to staff on how those needs should be met. Care Hedgerows Nursing Home DS0000015538.V342146.R01.S.doc Version 5.2 Page 11 plans did not always evidence service users’ or relatives’ involvement and those seen were reviewed on a monthly basis. No resident has been assessed as able to manage their own medication. All medication is administered by nursing staff. Records showed general good monitoring of health needs. The inspector was informed that only trained staff administer medication. All transcribed medication should be signed by the transcriber and another professional and checked for accuracy. Residents were complimentary with regards to the way their personal and health care needs were being met and felt that staff treated them in an appropriate way, respecting their privacy and dignity. Care plans also evidenced that service users are enabled to access all community health services. The home also has an agreed contract for adequate disposal of waste medication. Hedgerows Nursing Home DS0000015538.V342146.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities take place and service users are generally happy with the choices in routine available to them Visitors are made welcome and overall the service users rights and responsibilities are recognised in their daily lives. EVIDENCE: The home now has two activities organisers and a third is currently being recruited. The inspector was previously informed that plans are in place to restructure the activities hours by placing recruited activity workers on each bungalow for a minimum of 20 hours a week. Additional activities are organised by staff presently also but this does not detract from their care duties. A wide range of activities are available inside the home and in the local community. The home has access to a minibus and disabled taxi service. A light and sensory room is available. Activities of daily living are documented in the care plans. The Manager stated that the home operates an open visitor’s policy and encourages relatives to be involved in the home. There is a relatives’ group which meets regularly. The most recent meeting was in July 2007. Hedgerows Nursing Home DS0000015538.V342146.R01.S.doc Version 5.2 Page 13 The home promotes the use of an advocacy service for its service users. An advocate chairs the service users’ meeting and is involved in service users’ care reviews where no relatives are available. There was evidence of service users personalising their rooms to their individual tastes upon a tour of the premises. Each bungalow has its own kitchen facilities and a cook. Individual nutrition assessments are undertaken on admission using the MUST tool. Nutrition records have been maintained and regular checks on the refrigerator and freezer temperatures are maintained. All food is temperature checked before serving. Service users spoken with all said the food supplied was to a good standard and choices were always available. Menus were on display on all bungalows. Hedgerows Nursing Home DS0000015538.V342146.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. The home has effective procedures in place to ensure that service users are protected from abuse, neglect and self harm. EVIDENCE: The home has an appropriate complaints procedure which is displayed in each bungalow. Records are kept in each bungalow and a master complaints log is maintained at the Proprietor’s head office to monitor trends and incidences throughout all the group’s homes. This had been kept up to date and was discussed at the homes last inspection and inspected at this inspection. Up-to-date protection and whistle blowing policies are available in each bungalow. Positive response workshops are available for staff. There are procedures in place for dealing with aggression and challenging behaviour. Staff have received training on abuse on induction and protection of vulnerable adults training for staff has either been undertaken or is planned. Hedgerows Nursing Home DS0000015538.V342146.R01.S.doc Version 5.2 Page 15 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, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Hedgerows was clean, bright and well maintained and provided the service users with safe, homely and comfortable surroundings. EVIDENCE: The home’s accommodation is provided in three self-contained bungalows – “Hawthorn, Bluebell and Foxglove”. Each provides a homely environment for the service users. The surrounding grounds are well maintained with seating provided. The Manager meets with the Estates Manager regarding all maintenance of all the bungalows. Records of maintenance are maintained. Each bungalow has a dedicated lounge and dining areas and carpet has been previously replaced in these areas in Foxglove and Bluebell bungalows previously. All three bungalows have been previously redecorated and new recliner chairs and dining room furniture had been purchased. In addition tracker hoists have been fitted into all rooms and new slings were purchased Hedgerows Nursing Home DS0000015538.V342146.R01.S.doc Version 5.2 Page 16 for individual service users where required. Showers are now wet rooms and a new additional remote nurse call system has been installed incorporating the alarming of fire doors. Offices have been refurbished and new desks purchased. Hawthorne bungalow has a sensory garden and a sensory room has also been developed. Sensor mats have also been purchased for some service users and appropriate consent agreements were in place. All bungalows were seen to be bright and airy. All rooms were naturally ventilated and centrally heated and had adequate lighting. Health and safety inspections are carried out by the NHS Estates Department. Hot water monitoring is carried out on a regular basis monthly by staff. All bungalows were seen to be clean and tidy and odour free. Adequate laundry and sluice facilities are provided. Infection control procedures are in place and regularly reviewed. Hedgerows Nursing Home DS0000015538.V342146.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. Adequate staffing levels are currently maintained to meet the needs of service users. Recruitment practices have improved since the last inspection. Staff training is appropriately developed and undertaken to provide a competent work force. EVIDENCE: Hedgerows are complying with the staffing notice agreed in March 2002 by South Essex Health Authority, the previous regulatory authority. The Manager reviews skill mix and dependency levels as an ongoing process. Agency and bank staff use has decreased slightly and are being used to cover, training for staff vacancies, holidays and sickness. Of the five staff records reviewed it was noted that overall documentation was now in place and the inspector was informed that the manager had reviewed all recruitment files since the last inspection when documentation was missing and records for recently recruited staff were not available to inspect. Criminal Record Bureau checks were available to inspect. The process regarding agency and volunteer recruitment and CRB checks was discussed at the last inspection. The home operates a work based induction programme which is competency based and has currently been reviewed in line with skills for care. Appraisals are used to assess individual training needs. The home’s pre-inspection Hedgerows Nursing Home DS0000015538.V342146.R01.S.doc Version 5.2 Page 18 questionnaire evidenced that staff receive foundation and pertinent training. The present induction programme used in the home needs to comply with, ‘Skills for Care‘ standard. Staff need to complete an adequate induction within the first six weeks of employment. All staff should be involved in the induction so that senior staff can support new and inexperienced staff. New members of staff are encouraged to read policies and procedures. Hedgerows Nursing Home DS0000015538.V342146.R01.S.doc Version 5.2 Page 19 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, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is guidance and direction to staff and the home does overall have in place practices that will promote and safeguard the health, safety and welfare of the people using the service. EVIDENCE: The current acting manager is a qualified RGN and holds the Diploma in General Nursing and a post graduate Diploma in Health Services Management. She has twenty-eight years nursing experience of which thirteen years have been at management level. Outlook Care has achieved ISO9002 accreditation and Investors in People. The Proprietors have in place a steering group for quality assurance monitoring. The inspector was informed that the home holds audits every six months on Hedgerows Nursing Home DS0000015538.V342146.R01.S.doc Version 5.2 Page 20 local standards and an advocacy forum is held on a monthly basis. The home has a development plan and there are still plans to introduce service users and stakeholders’ quality questionnaires but as yet results of these have not been forwarded to the CSCI. An appointee from the Proprietor’s Head Office is available for service users who cannot manage their finances. Generally, finances are managed by service users’ families. Records and receipts are kept for all transactions for each service user. Supervision planning, forms and records were evidenced and generally 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 generally on a 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. Up to date appraisals were seen for six staff. Records seen throughout the inspection were generally well kept. Some have been commented on throughout this report. The Manager is fully aware of her responsibilities for health and safety and staff receive regular training on health and safety. 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 inspections also. Hedgerows Nursing Home DS0000015538.V342146.R01.S.doc Version 5.2 Page 21 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 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 3 3 Hedgerows Nursing Home DS0000015538.V342146.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hedgerows Nursing Home DS0000015538.V342146.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Hedgerows Nursing Home DS0000015538.V342146.R01.S.doc Version 5.2 Page 24 - 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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