CARE HOMES FOR OLDER PEOPLE
Henford House Nursing Home Lower Marsh Road Warminster Wiltshire BA12 9PB Lead Inspector
Susie Stratton Unannounced Inspection 9:35 2 December 2005
nd X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Henford House Nursing Home DS0000015917.V264833.R01.S.doc Version 5.0 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. Henford House Nursing Home DS0000015917.V264833.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Henford House Nursing Home Address Lower Marsh Road Warminster Wiltshire BA12 9PB 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) 01985 212430 01985 219789 henford@barchester.com Barchester Healthcare Homes Limited Vacant Care Home 58 Category(ies) of Old age, not falling within any other category registration, with number (58), Physical disability (6), Terminally ill (5), of places Terminally ill over 65 years of age (5) Henford House Nursing Home DS0000015917.V264833.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. No more than 5 service users in receipt of terminal care at anyone time No more than 5 service users in receipt of physical disability aged between 50-65 at anyone time The staffing levels set out in the Staffing Notice dated 13 August 2003 must be met at all times. 16th May 2005 Date of last inspection Brief Description of the Service: Henford House is a home which provides nursing care for up to 58 people. It is an extended period property and work was completed on a further extension during the summer and autumn of 2003. There were 49 persons resident on the day of the inspection. Accommodation is provided over two floors and passenger lifts are provided between floors. 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 previous manager of the home retired recently and a new manager, Mrs Charlotte Cox has been appointed by the proprietors, she is currently being assessed by the Commission in accordance with its “fit person” procedure. The manager leads a team of nursing, care, activities, administrative and ancillary staff. Henford House is situated in its own grounds in a residential area of the town of Warminster. There is car parking on site. Many parts of the home offer pleasant views over the adjoining area of open countryside. 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 DS0000015917.V264833.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on Friday 2nd December 2005 between 9:35am and 5:00pm, in the presence of Mrs Charlotte Cox, manger designate. During the inspection, the Inspector met with twelve residents and observed care for five residents who were not able to communicate. The Inspector met with the area manager, the deputy manager, both training managers, two registered nurses, four care staff, one student nurse, the laundress, the administrator, two activities organisers, a kitchen assistant, the maintenance manager and two domestics. The Inspector toured the home, reviewed all three medicines cupboards and a range of records, including four staff records, training records, the statement of purpose and service users’ guide. An additional inspection visit was performed on 8th July 2005 before the previous manager retired. This showed that two requirements from the previous inspection report had been met before their due date, one had been met in full and one showed considerable progress. The previous manager had also confirmed in writing to the Commission that the other requirement had been addressed. What the service does well: What has improved since the last inspection?
Henford House Nursing Home DS0000015917.V264833.R01.S.doc Version 5.0 Page 6 Five requirements were set at the previous inspection, all had been addressed. Four recommendations were advised, two have been addressed, one is in progress and one is yet to be addressed. A copy of the most recent inspection report is now included in the summary of the service users’ guide. Written risk assessments for skin tears are made and where risk is identified, care plans put in place to reduce risk. A metal cupboard, which is securely fixed, has been provided in the medicines cupboard on the lower ground floor. All medicines records had been completed at the time of administration. Where a resident needed regular administration of a drug by injection, a record of injection sites is maintained. This ensures adequate rotation of sites. Residents who are assessed as being at risk of pressure damage have care plans in place to reduce risk. End of life plans have been developed for frail and dying residents. 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 DS0000015917.V264833.R01.S.doc Version 5.0 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 Henford House Nursing Home DS0000015917.V264833.R01.S.doc Version 5.0 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): 1, 3, 4 & 5. Henford House does not offer intermediate care, so 6 is N/A Prospective residents are informed of the services offered by the home. All residents needs are assessed prior to admission and the home encourages preadmission visits. The inspection showed that the home could meets the needs of persons resident in the home. EVIDENCE: Mrs Cox has reviewed the home’s statement of purpose and service users’ guide, since she came into post. These documents and conform to standards. Mrs Cox reported that she is now planning to ensure that this information is made fully available to all users. One person had been admitted to the home a few days prior to the inspection. This person had had a full assessment of their needs prior to admission, including assessments from relevant professionals. Following their admission, a range of care plans had been put in place to direct staff on how to meet their needs. This person said that they had not been well enough to visit the home prior to admission but that family members had on their behalf. Another person said that they already knew the home from previous admissions for respite care. A review of care plans, observations of care and discussions with residents and staff showed that the home could meet the needs of persons resident in the home.
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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, 8, 9, 10 & 11 Residents are protected by care plans, which detail their nursing and care needs. Medicines are safely stored and appropriate records kept. Residents’ privacy and dignity is respected. The home work hard to ensure that residents’ wishes at the end of their lives is respected. EVIDENCE: All residents have assessments and care plans in place. The prospective manager reported that the proprietors are reviewing documentation systems across the group and may introduce standardised documentation across the group in the New Year. This will be of benefit, as the current system means that there is some duplication and lack of clarity as to where to document a range of care needs, so that a person who is not familiar with the documentation system may find relevant information difficult to access. For example, all residents are assessed for pressure damage, some residents have care plans to prevent pressure damage on the risk assessment tool, others have them included on the general risk assessment documentation, others have separate care plans or the information is included within other plans relating to other matters. This also means that some information which is known by staff is not documented, for example, one resident who is assessed as being nutritionally at risk had a care plan in place to reduce the risk which
Henford House Nursing Home DS0000015917.V264833.R01.S.doc Version 5.0 Page 10 did not include all factors known by staff. Additionally some information is duplicated, for example information on blood sugar levels for one resident was included variably on their medicines sheet, a chart in their care plans and their daily records. Several residents are assessed of being at risk of falls. Some of these service users continue to be mobile and it continues to be advised that an assessment of their footwear should take place, as inadequate footwear has been identified as a risk factor in residents falling. Frail residents have frequent care charts in place to ensure that their needs are regularly attended to. Most charts had been fully completed, however a few had not on all occasions. The deputy manager reported that she knew why this was and which staff members were involved. She reported that she was auditing such records regularly to ensure that frail residents’ care needs were being addressed and documented. The home has further developed and individualised its end of life plans for frail and dying residents. Frail and dying residents were cared for in their own rooms with their own possessions round them. Those who were able, were supported and encouraged to join in with activities with other residents. At present daily care records and care plans are mainly completed by registered nurses. The prospective manager reported that she had started to develop a key worker system into the home since she had been appointed. It is planned that key workers will be supported in completing daily records and reviewing care plans, to ensure that the persons who provide the care are responsible for reporting on how care plans are being met. All medicines are safely stored and all records fully maintained. There is a homely medicines policy in place, this should be dated and signed by the resident’s GPs. The home has a documentary system in place for medicines received into the home and sent for disposal. Some care plans document prescribed medicines such as mood altering medicines, so that staff can assess the effectiveness of such medication, however others do not, for example one resident was prescribed a controlled drug to manage their pain but this was not included in their care plan. The prospective manager reported that if the new documentary system is introduced, this should ensure that all such medicine related issues are included in care plans. All care and nursing staff were observed to knock resident doors prior to entry. Residents were called by their own preferred name. One resident said that they appreciated how domestic staff cleaned their room when they were out and another said that they appreciated the way staff were helping them to address their Christmas Cards as they were no longer able to write clearly enough to do this. It was noted that one resident was being bathed with the indicator on the door that the bathroom was vacant rather than occupied, the slider for another bathroom was not in place.
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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): 14 Residents are enabled to exercise choice and control over their lives EVIDENCE: Residents spoken to said that it was up to them when they got up and went to bed. They said that they could choose where they ate their meals and whether they went to the wide range of activities or not. One resident said “I do what I like here”, another said “I’m never bored”. Many of the residents’ rooms were highly personalised, including a range of their own possessions, reflecting their individual likes and preferences. The laundress has clear systems in place to make sure that all residents’ clothes are marked, to ensure that they all wear their own clothes. Henford House Nursing Home DS0000015917.V264833.R01.S.doc Version 5.0 Page 12 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): 16 & 18 The home has a complaints procedure which residents felt worked in practice. Systems are in place in the home to protect vulnerable adults from abuse. EVIDENCE: The complaints policy is on display and available in the service users’ guide. Residents spoken with knew how to bring up issues of concern. One said that they would bring issues up with any of the carers, another said they would tell the registered nurse when she came with their drugs and another said that they would always tell the manager and knew that she would take action. The prospective manager has experience of working within vulnerable adults procedures in both her previous role and currently. A review of the home’s file shows that staff at all levels have worked to ensure that vulnerable adults are protected and correct procedures followed. Where residents need restraints, these are documented, regularly reviewed and consent obtained from the resident or their relative. Staff spoken with had clearly considered the importance of ensuring the balance between resident needs for independence and self determination and use of any restraint to maintain their safety and prevent injury. Henford House Nursing Home DS0000015917.V264833.R01.S.doc Version 5.0 Page 13 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): 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. One example of unsafe use of wheelchairs was observed, this could put residents at risk. EVIDENCE: Henford House is well maintained and clean throughout. One issue identified at the beginning of the inspection, had been noted by the maintenance manager before the Inspector could find him and was rectified. Planning permission has been applied for to extend and develop the kitchen. The plans are being reviewed by the prospective manager at present and works will commence in due course. The home benefits from well-kept gardens. There is a wide range of larger and smaller sitting and recreational space and communal spaces offered to residents which much exceed the National Minimum Standards. All bedrooms are large. Bedrooms at the front of the house look over the surrounding countryside, however a few of the bedrooms at the back of the house in the new extension look straight at a wall, with no views at all. Residents said that they liked their rooms, one said “My room
Henford House Nursing Home DS0000015917.V264833.R01.S.doc Version 5.0 Page 14 suits my needs” and another “I do like this room.” 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. One carer was observed to be pushing a resident in a wheelchair with their legs dangling, although foot-plates were provided to the wheelchair. This is regarded as a risk to the resident, as their feet could be injured without proper protection. All residents had been left with access to their call bells. A member of the domestic staff needed to ring the emergency bell on behalf of a resident during the inspection and it was noted that all staff in the vicinity responded promptly to the call. Residents reported that staff were prompt in responding when they used them. Most commode chairs were new and well-maintained, however three showed signs of rust and if this progresses, they will be complex to maintain at adequate standards of cleanliness. It is recommended that an audit of the condition of commode chairs takes place across the home and that all older commode chairs are replaced. The laundry was well-organised and the laundress showed a good appreciation of the importance providing an individualised service to residents. Relevant equipment is provided to ensure that full sterile procedures can be performed by registered nurses when dressing wounds and performing other aseptic procedures. Henford House Nursing Home DS0000015917.V264833.R01.S.doc Version 5.0 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): 27, 29 & 30 A full range of staff with a skill mix to meet service users’ needs are in post. Residents are protected by the home’s recruitment processes. A wide range of training opportunities are supported by the providers. 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. The new manager reported that the home were now fully staffed, apart from a few hours and that the use of agency staff was very rare. Each floor of the home is managed by a registered nurse, these nurses are supervised by the deputy manager, who is supported by the manager. 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. The prospective manager has reviewed the documentation system for potential employees and devolved this role to a specified person. This person is in the process of auditing all the files, to ensure that all required pre-employment documentation is in place and good progress is being made. The file of one recently employed person showed all required pre-employment checks were made. It was also noted as good practice that an interview assessment tool is used when considering the suitability of all prospective employees.
Henford House Nursing Home DS0000015917.V264833.R01.S.doc Version 5.0 Page 16 Henford House employs two part-time training officers. Both these persons also work as registered nurses in the home in their other roles. Both these staff were very enthusiastic about their roles. They were aware of changes to the induction programme which had taken place recently to conform with guidelines from Skills for Care. All staff undertake an induction programme when they commence their employment and records are maintained. Regular training is provided in areas such as manual handling, health & safety and fire safety and there is a system in place to monitor staff attendance, with evidence of action being taken if staff do not attend. All staff are trained in fire safety twice a year, it was advised that night staff should be trained three monthly as advised by the fire brigade. All staff have an individual training profile completed. Both training officers reported that the provider supports training and that up-take of NVQ amongst staff is good. The training officers co-ordinate courses relating to specific areas of care relating to resident in the home. Some staff lead in specific areas, for example one registered nurse leads on training staff in prevention of pressure damage. The training officers reported that in future, they wish to extend their support further to ancillary and registered nursing staff, particularly those staff from overseas. Henford House Nursing Home DS0000015917.V264833.R01.S.doc Version 5.0 Page 17 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): 32 & 37 The managers of the home work to try to ensure that systems for open management are in place. All required records are properly and securely stored. EVIDENCE: Since she came into post, the new manager has held a range of meetings with staff at all levels, including large group, small group and individual meetings. Staff spoken with reported that they felt able to bring up a range of matters with her. Residents said that they found it easy to talk to staff, one said that the manager always popped in for a chat when she was passing. All required records were properly stored. All confidential records were securely stored. The staff have access to the providers’ polices and procedures. At the previous inspection, it was advised that a procedure on taking residents out of the home needed to be developed, the new manager reported that this was in progress, using a risk assessment format.
Henford House Nursing Home DS0000015917.V264833.R01.S.doc Version 5.0 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 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 4 3 3 3 3 x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 3 x x x x 3 x Henford House Nursing Home DS0000015917.V264833.R01.S.doc Version 5.0 Page 19 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. 1. Standard OP22 Regulation 13(4)(b), (c) Requirement Service users who use wheelchairs must not be transported without foot plates. Timescale for action 31/12/05 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 OP7 Good Practice Recommendations Falls risk assessments should include an assessment of the service users footwear. (This has not been addressed from the previous inspection) Care plans should be consistently completed and avoid duplication. All relevant information known by staff relating to a care plan should be documented in the care plan. Care staff should be supported in learning how to document in care records and evaluate and revise care plans. Audits of completion of frequent care charts should continue, to ensure that all staff are aware of their responsibilities. The homely medicines policy should be signed and dated
DS0000015917.V264833.R01.S.doc Version 5.0 Page 20 2. 3. 4. 5. 6. OP7 OP7 OP7 OP8 OP9 Henford House Nursing Home 7. 8. 9. 10. OP10 OP26 OP30 OP37 by the residents’ GPs. Vacant/Occupied signs on bathroom doors should be in place and always used by staff. An audit of commode chairs should take place and any commode chairs beginning to show rust on their chassis replaced. Night staff should be trained in fire safety every three months. The home should develop a policy and procedure on staff taking service users out of the home. (This is in progress from the previous inspection). Henford House Nursing Home DS0000015917.V264833.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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