CARE HOMES FOR OLDER PEOPLE
Henford House Nursing Home Lower Marsh Road Warminster Wiltshire BA12 9PB Lead Inspector
Susie Stratton Unannounced 16th May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Henford House Nursing Home D51_D01_S15917_HENFORDHOUSE_V197436_160505_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Henford House Nursing Home Address Lower Marsh Road Warminster Wiltshire BA12 9PB 01985 212430 01985 219789 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Barchester Healthcare Homes Limited Mrs Rosemary Osborne Care Home with Nursing 58 Category(ies) of OP Old Age (58) registration, with number PD Physical Disability (6) of places TI Terminally ill (5) TI(E) Terminally ill (5) Henford House Nursing Home D51_D01_S15917_HENFORDHOUSE_V197436_160505_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No more than 5 service users in receipt of terminal care at any one time. 2. No more than 5 service users in receipt of physical disability aged between 50-65 at any one time. 3. The staffing levels set out in the Staffing Notice dated 13 August 2003 must be met at all times. Date of last inspection 28 September 2004 Brief Description of the Service: Henford House is a home which provides nursing care for up to fifty eight people. It is an extended period property and work was completed on a further extension during the summer and autumn of 2003. Accommodation is provided over two floors and passenger lifts are provided between floors. Henford House is situated in its own grounds in a residential area of the town of Warminster. Many parts of the home offer pleasant views over the adjoining area of open countryside. There is car parking on site. The home was acquired during 2002 by Barchester Healthcare, a provider with a number of other care homes in various parts of the country. The manager of the home is Mrs Rosemary Osborne, she is a registered nurse, who has managed this home for several years, she is supported by a deputy and leads a team of nursing, care, activites and ancilliary staff. Warminster is a small Wiltshire market town, to the west of Salisbury Plain. It is situated on the A350 and has a main line station. Henford House Nursing Home D51_D01_S15917_HENFORDHOUSE_V197436_160505_Stage4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place between 9.50am and 4.35pm on Monday 16th May 2005, in the presence of Mrs Rosemary Osborne, registered manager. During the inspection, the Inspector met with three of the registered nurses, four care staff, two activities co-ordinators, the administrator, a catering assistant, the laundress and the maintenance man as well as touring the building and reviewing documents and files. The Inspector met with fourteen residents in their rooms and observed care for a further five residents who were unable to communicate, she also watched a busy coffee morning and observed a lunchtime meal. The Inspector reviewed the files of seven residents in detail, including one recently admitted resident and looked at two other specific areas in different residents’ files. The Inspector looked at all the medicines records, the valuables receipts book and three residents’ administration files. What the service does well: What has improved since the last inspection?
Henford House has improved the area behind the new extension to the building with some landscaping and planting. A separate covered garden room for staff and residents who wish to smoke has been provided at the back of the building. Planning permission has been sought for improvements to the kitchen areas. The system for audit of care plans has been further developed and increased consistency in care planning was observed. The use of net
Henford House Nursing Home D51_D01_S15917_HENFORDHOUSE_V197436_160505_Stage4.doc Version 1.30 Page 6 underwear has been reduced and where it is used, all items are individually named. Of the six requirements identified at the previous inspection, five have been addressed. Of the nine recommendations, all have either been addressed or are in progress. 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. Henford House Nursing Home D51_D01_S15917_HENFORDHOUSE_V197436_160505_Stage4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Henford House Nursing Home D51_D01_S15917_HENFORDHOUSE_V197436_160505_Stage4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, 4 & 5. Intermediate care is not offered in this home. Henford House is able to meet the needs of residents who have complex nursing and care needs. Residents are not given ready access to the inspection reports on the home and so will not have full information how Henford House is meeting National Minimum Standards. EVIDENCE: All residents are provided with a copy of the service users’ guide in their own rooms. A copy is also available in the front entrance and manager’s office. Only the latter two include copies of the most recent inspection report, so all residents do not have ready access to the most recent inspection report. All residents have a contract on file, which has been signed and dated by the resident/representative. Where residents are socially funded, a copy of this contract is also on their file. Residents reported that they, or a family member, had been able to visit the home and view their room prior to admission. All potential residents are assessed by Mrs Osborne or a senior member of staff prior to decision to admit. All assessments had been completed in full, to ensure that the home could meet the resident’s needs. One resident was due to be admitted to the
Henford House Nursing Home D51_D01_S15917_HENFORDHOUSE_V197436_160505_Stage4.doc Version 1.30 Page 9 home shortly and a registered nurse reported that she was ensuring that all required equipment was available for the resident before they came. Where residents are admitted in an emergency, a full assessment is completed as soon as possible after admission. Henford House cares for residents who have a wide range of care and nursing needs and staff have the skills and knowledge to meet these needs. Henford House Nursing Home D51_D01_S15917_HENFORDHOUSE_V197436_160505_Stage4.doc Version 1.30 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 standard(s) 7, 8, 9, 10, 11 Residents are generally protected by full nursing and care plans, this includes frail and dying persons. Residents with risk of skin tears did not have care plans and this puts them at risk. Most systems for management of medicines were met, however service users are put at risk because one of the medicines’ cupboards is not properly secured and not all relevant records have been completed, to ensure that residents are correctly administered their medication. EVIDENCE: All residents have full and detailed care plans drawn up. These were observed to be followed in practice. Staff spoken with were fully aware of the needs of the residents they were caring for. All staff have risk assessments for manual handling and falls. The falls risk assessments did not include an assessment of footwear and as inadequate footwear can be a factor in falling, it is advised that this should be included in assessments. Some residents are frail and one resident described how prone they were to skin tears. Another resident who could not communicate was nursed a bed with metallic safety rails. Neither resident had an assessment for risk of tissue damage or a care plan to reduce risk. All residents are assessed for risk of pressure damage, of the six residents who were assessed as being at high risk of pressure damage, four
Henford House Nursing Home D51_D01_S15917_HENFORDHOUSE_V197436_160505_Stage4.doc Version 1.30 Page 11 had clear care plans detailing how risk was to be reduced, but two did not, although relevant equipment had been provided to meet their needs. Residents who had wounds had care plans in place, detailing how wounds were to be managed. Records showed that residents’ GPs and other professionals are regularly consulted. One service user described how the dentist had visited them in the home and was due to come back again shortly, to complete a course of treatment. Staff, including domestic and catering staff, all knocked and listened prior to entering resident’s rooms. All care was provided behind closed doors. Staff were observed to explain to a resident how they were going to care for them before starting to provide physical care. Some residents are very frail and mainly cared for in their rooms, surrounded by their own possessions. Records of frequent care for these residents are fully completed, to provide evidence that their basic care needs are being met as frequently as they need. All such residents looked comfortable, with clean bed linen, brushed hair and clean night clothes. Some residents are documented as having expressed specific wishes in the event of sudden illness or collapse, for two such records, all relevant persons, including the resident/representative and GP had signed the statement, however for one, this statement had not been signed. Henford House has three clinical rooms where medicines and other clinical items are stored. Two of them have all required cupboards for the safe storage of medicines, however one continues not to do so. This is of concern, as to ensure safe storage of drugs, all medicines must be stored in a metal cupboard, which has been securely fixed to a wall/floor. Generally records of drugs administered to residents were completed in full, however for one floor of the home only, the record had not been fully completed on eight occasions. All medicines records must be fully completed, to provide evidence that the resident has taken their medicines and if they have not, why this is, so that the care plan can be reviewed and their GP advised. One resident was prescribed a drug for regular administration by injection, the resident was not able to inform staff of where they were last injected, therefore to ensure that the resident does not develop tissue damage, due to over-use of one injection site, a documentary system is needed to ensure that administration sites are rotated. Henford House Nursing Home D51_D01_S15917_HENFORDHOUSE_V197436_160505_Stage4.doc Version 1.30 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 standard(s) 12, 13, 14 & 15 There were high standards in meeting residents’ recreational needs, both in and out of the home. Residents exercise choice on how they spend their days. Meals are attractively served and a wide range of choice is offered. EVIDENCE: Henford House employs a team of activities coordinators and a range of activities, both in and out of the home are offered to residents, for seven days a week. Activities are offered in large groups, small groups and individually. One resident said how much they enjoyed the pottery group, another said that they liked the play group readings, another playing Scrabble and another the way staff popped in for a chat. Visitors are encouraged, some help with activities, such as the coffee morning, which was taking place on the day of the inspection. One resident said that they often went out with their relatives, another said that as they had lived in Warminster all their life, they often went into town or had friends visiting them. Residents said that it was up to them what activities they were involved in and that their wishes were respected. Residents also reported that staff respected their wishes on when they wanted to get up in the morning and go to bed at the end of the day, one said “They let me do what I want to do here”. Residents are offered meals in a dining room, a smaller sitting room or their own room. Residents commented on the meals, one said that if they did not like either choice on the menu, they could just write what they would like and
Henford House Nursing Home D51_D01_S15917_HENFORDHOUSE_V197436_160505_Stage4.doc Version 1.30 Page 13 that this was given to them. One resident described the meals as “excellent” and two as “very good”. One resident said that they needed a specific diet and that they and the chef had planned their meals together. One resident who was observed to be thin and frail at the last inspection, had now put on weight, they reported that this was because of the good meals and they were now feeling much better. Residents who need assistance to eat their meals are supported by staff. Where residents need adapted plates to enable them to eat their meals independently, these are homely in style, not plastic and match other crockery. A range of different types of drinks are offered to residents. Henford House Nursing Home D51_D01_S15917_HENFORDHOUSE_V197436_160505_Stage4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 A complaints procedure is in place, which works in practice, to support persons if they have concerns. Where residents show complex care needs, systems are in place to protect them and make them feel safe. EVIDENCE: The home’s complaints policy is displayed in the entrance hall and all residents are given their own copy. Residents spoken with knew how to raise issues of concern, one said of the registered nurse in charge of her floor “If you’re in trouble, she’ll stand up for you”. Another resident said that they felt able to tell any member of staff if they were not happy with how they had cared for them and that staff would accept it and change how they did things. Another said that they would talk to the “matron” and another that they “always went to the top” if they had a problem. One resident said that they had mentioned a matter to the “sister” in confidence and that it had been sorted out, without anyone being upset. Residents who needed equipment to maintain their safety such as lap belts and safety rails had signed written consents on file. Very few mood altering drugs are used and care plans for confused or restless behaviours are clear and were observed to be followed by staff. Henford House Nursing Home D51_D01_S15917_HENFORDHOUSE_V197436_160505_Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24 & 26 Henford House provides an environment which meets the needs of its residents. It is well-maintained, clean and provides comfortable furniture and equipment to give residents a homely setting in which to live. EVIDENCE: Henford House is well maintained and clean throughout. Planning permission has been applied for, to extend and develop the kitchen, this will provide improved storage and staff changing facilities. The plans include a separate area for staff to prepare drinks and snacks for residents. Mrs Osborne reported that they are hoping to commence work in October 2005. The home benefits from well-kept gardens and several residents expressed their appreciation of the work put in by the gardener, one said that the gardener often discussed choice of flowers to be planted with them. The home offers a wide range of larger and smaller sitting and recreational space. All bedrooms are large and much exceed National Minimum Standards. Bedrooms at the front of the house look over the surrounding countryside, however a few of the newer bedrooms at the back of the house in the new extension look straight at a wall, with no views at all. Many residents have brought in their own furniture and
Henford House Nursing Home D51_D01_S15917_HENFORDHOUSE_V197436_160505_Stage4.doc Version 1.30 Page 16 other items, reflecting each resident’s likes and preferences. A range of assisted bathrooms are offered, to meet different residents’ needs. Where residents need specialist equipment, such as pressure relieving equipment, profiling beds and hoists, these are provided. All residents had been left with access to their call bell. Residents reported that staff were prompt in responding when they used them and that there was no variance between day and night staff. The laundry was well-organised and the laundress showed a good appreciation of the importance providing an individualised service to residents. Henford House Nursing Home D51_D01_S15917_HENFORDHOUSE_V197436_160505_Stage4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 A full range of staff with a skill mix to meet service users’ needs are in post. EVIDENCE: Henford House is required to staff the home in accordance with a Condition of Registration set out by the Commission. They were meeting the requirements of this Condition. Each floor of the home is managed by a registered nurse, these nurses are supervised by the deputy manager, who is supported by Mrs Osborne. A range of senior care and care staff are in post. A full team of ancillary staff are employed, including domestic, catering, laundry, gardening and maintenance staff. A team of activities coordinators, an administrator and a receptionist support the home. Staff at all levels showed a sound knowledge of the needs of the service users they were caring for. Henford House Nursing Home D51_D01_S15917_HENFORDHOUSE_V197436_160505_Stage4.doc Version 1.30 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 37 & 38. Henford House does not look after residents moneys so Standard 35 is not applicable. Mrs Osborne is an experienced registered nurse and manager who is able to lead a team of staff to meet residents’ needs. Residents’ health and safety are protected and clear records are in place. EVIDENCE: Mrs Osborne is an experienced registered nurse and manager. She has managed Henford House for several years and prior to that, was deputy manager of the home. All required records are in place. Where residents’ valuables are handed in for safekeeping, clear records and receipts are maintained. Records of charges for sundries are clear and easy to audit. The home does not have a procedure for taking residents out of the home and as this takes place, it is advisable that one should be drawn up, to direct staff and ensure residents’ safety. Records showed that regular maintenance takes place on equipment. The maintenance man performs all required checks on fire safety, to maintain service user safety. Safe systems to prevent risk of fire are
Henford House Nursing Home D51_D01_S15917_HENFORDHOUSE_V197436_160505_Stage4.doc Version 1.30 Page 19 in place where residents or staff wish to smoke. Observations showed that staff understood the principals of prevention of spread of infection. The home had recently successfully treated two residents who had been admitted with an infection and there had been no spread to other residents. Henford House Nursing Home D51_D01_S15917_HENFORDHOUSE_V197436_160505_Stage4.doc Version 1.30 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 4 3 3 3 3 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x N/A x 3 3 Henford House Nursing Home D51_D01_S15917_HENFORDHOUSE_V197436_160505_Stage4.doc Version 1.30 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 5(1)(d) Timescale for action A copy of the most recent report, 31 July or the summary of the report, 2005 must be included in all service users guides. (This requirement was identified at the previous inspection, with a complance date of 30th November 2004, it has been complied with in part.) A written assessment for skin 31 July tears must be made on all frail 2005 service users and where risk is identified, a care plan must be put in place to reduce risk A metal cupboard, which is 31 July securely fixed must be provided 2005 in the drugs cupboard on the lower ground floor. All medicines adminstration 30 June records must be fully completed 2005 at the time of adminstration. If a medicine is not adminstered, the reason why must always be documented. Where a service user needs 30 June regular adminstration of a 2005 medicine by injection and is not able to inform staff of where they were last injected, a documentary system must be put in place, to ensure adequate
Version 1.30 Page 22 Requirement 2. 7 12(1)(a) 13(4)(c) 15(1) 13(2) 3. 9 4. 9 13(2) 5. 9 13(2) Henford House Nursing Home D51_D01_S15917_HENFORDHOUSE_V197436_160505_Stage4.doc rotation of injection sites. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 7 8 11 Good Practice Recommendations Falls risk assessments should include an assessment of the service users footwear. Where a service user is assessed at being at risk of pressure damage, a care plan to reduce risk should always be put in place. Where a service user/representative has expressed wishes about actions to be taken in the event of sudden illness or collapse, all records should always be signed by the service user/representative and their GP. The home should develop a policy and procedure on staff taking service users out of the home. 4. 37 Henford House Nursing Home D51_D01_S15917_HENFORDHOUSE_V197436_160505_Stage4.doc Version 1.30 Page 23 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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