Inspection on 06/07/06 for Henford House Nursing Home

This inspection was carried out on 6th July 2006.

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.

Other inspections for this house

Henford House Nursing Home 02/12/05

Henford House Nursing Home 16/05/05

Henford House Nursing Home 28/09/04

Henford House Nursing Home 04/05/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Henford House Nursing Home Lower Marsh Road Warminster Wiltshire BA12 9PB Lead Inspector Susie Stratton Key Unannounced Inspection 6th July 2006 9:35 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.V300488.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. Henford House Nursing Home DS0000015917.V300488.R01.S.doc Version 5.2 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 www.barchester.com/oulton Barchester Healthcare Homes Limited Charlotte Cox Care Home 58 Category(ies) of Old age, not falling within any other category registration, with number (58), Physical disability (5), Terminally ill (5), of places Terminally ill over 65 years of age (5) Henford House Nursing Home DS0000015917.V300488.R01.S.doc Version 5.2 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. 2nd December 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 46 persons resident on the day of the inspection. Accommodation is provided over two floors and passenger lifts are provided between floors. Fees range from £1,200 to £426.01. The home was acquired during 2002 by Barchester Healthcare, a provider with a number of care homes across the country. The manager of the home is Charlotte Cox. She 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.V300488.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit of Henford House took place on Thursday 6th July 2006 between 9:35am and 5:15pm, in the presence of Charlotte Cox, registered manager. During the site visit, the inspector met with twelve residents, two relatives and observed care for seven residents who were unable to communicate. The Inspector reviewed records relating to seven residents in detail, one of whom had been recently admitted to the home. The Inspector toured the home and met with three registered nurses, four carers, an activities coordinator, a domestic and the chef. The inspector observed one mealtime and one activities session. As part of the inspection, questionnaires were sent to residents and nine were returned. Relatives and GPs for the seven residents considered in detail were contacted for their views on the service provided by the home and their comments have been included in the report. The inspection was completed on 24th July 2006 between 9:45am and 1:15pm when the inspector met with the training managers, the administrator, maintenance man and laundress. She reviewed records relating to management of the home, including employment records for six members of staff, training records, supervision records and maintenance records and performed a feedback to the manager. The judgements contained in this report have been made from evidence gathered during the inspection, which included visits to the service and takes into account the views and experiences of people using the service. What the service does well: Henford House provides a supportive environment for residents to live in. The home is very well maintained and if problems occur with the building or fitments, these are promptly dealt with. A wide choice of different communal rooms are provided for residents and the amount of communal space provided much exceeds National Minimum Standards. The gardens are attractive and well maintained. All of the bedrooms also exceed National Minimum Standards and many of the rooms are large enough to function as bed-sitting rooms. A wide range of equipment to support persons with a disability, is provided to meet residents’ assessed needs, this equipment is correctly maintained and as much as possible is domestic in style. There is a well-established team of activities staff who work hard to meet the individual needs of residents, taking into account their previous life-styles and preferences. The home always have a number and skill mix of staff on duty, which exceed conditions set out by the Commission. Henford House has safe systems for the storage and administration of medicines, which fully conform to all current guidelines with Henford House Nursing Home DS0000015917.V300488.R01.S.doc Version 5.2 Page 6 systems for audit, to ensure that residents are fully protected. Where requirements are identified during inspections, these are always promptly addressed by the home’s managers. Residents and their relatives expressed their appreciation of the home and service provided. One resident said “I’m happy here” another said “everything is excellent”, one person described Henford House as “marvellous” and another as “wonderful”. Residents expressed their appreciation of the staff, one said “The staff are so very kind”, another said “You couldn’t ask for a bunch of kinder or more considerate people”, another said “The girls are very helpful” and another “The staff are very, very caring”. One relative reported “I shall always be grateful for the patience, kindness and thoughtfulness of staff.” What has improved since the last inspection? What they could do better: Four requirements and nine good practice recommendations were made at this inspection. Where a resident has a monitoring system in place to ensure that they have their position moved regularly, to prevent risk of pressure damage, this monitoring chart must be kept up to date and be completed contemporaneously, so that staff on different shifts can ensure that the resident has had their position moved when they need it. Where a resident has such a need their care plan should state how often their position needs to be changed, as different residents will need this doing at different frequencies. Where a resident is unable to assist themselves in taking fluids and could be at risk of dehydration, a documented monitoring system must be put in place, so Henford House Nursing Home DS0000015917.V300488.R01.S.doc Version 5.2 Page 7 that staff can assess how much fluid a resident is taking in. Any such records must be completed contemporaneously. These charts should be totalled daily in accordance with the home’s policies. Where a resident may need the use of suction equipment, there must be a care plan in place to direct staff on the actions to take to meet the resident’s individual nursing needs. Precise, measurable wording should be used in nursing and care documentation. The home should document concerns raised, together with details of actions taken and outcomes. All staff who have resident contact must be trained in abuse awareness. The home should ensure that where staff are recruited through an external agency, that a copy of all references are retained on the member of staff’s file. The home should ensure that all induction and training records are fully completed, on every occasion, by all relevant persons. Full written records of supervision offered to staff should be in place. The internal auditors should evidence when audit of service users’ moneys has taken place. Records of valuables handed in for safekeeping should not make reference to their apparent value. 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.V300488.R01.S.doc Version 5.2 Page 8 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.V300488.R01.S.doc Version 5.2 Page 9 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 & 5: The home does not provide intermediate care, so 6 is N/A Quality on this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. Prospective residents are given information about the services provided by the home. A pre-admission assessment is performed on all residents prior to admission, by a person qualified to do so. Prospective residents’ relatives are encouraged to visit the home. Many residents already know about the services offered by the home prior to admission. EVIDENCE: All residents have a copy of the service users’ guide in their bedroom. This includes all relevant information. Seven of the nine residents who responded to the questionnaire said that they had received enough information about the home prior to admission to enable them to make a decision about coming into the home. All residents have a full and detailed assessment of their needs made by a registered nurse prior to admission. The records of one recently admitted person fully reflected what the person told the inspector. Where a resident is admitted from a distance, a registered nurse from a Barchester home close to the person’s domicile performs the assessment and advises Henford House Nursing Home DS0000015917.V300488.R01.S.doc Version 5.2 Page 10 Henford House. If there are any queries in such situations, the parent company will support a registered nurse in travelling a distance to meet with the prospective resident and perform the assessment. Most residents spoken with said that they had been too frail to visit the home prior to admission but that a member of their family had done so on their behalf. One resident said that they lived locally and therefore knew about the home, another said that they had been admitted to the home for respite care and so when they needed permanent care they knew all about the home. One resident said that their setting in period had been “good” and that they had felt supported. Henford House Nursing Home DS0000015917.V300488.R01.S.doc Version 5.2 Page 11 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, 8, 9 & 10 Quality on this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. All residents have care plans, which fully reflect their individual nursing and care needs. Where residents cannot move themselves or give themselves fluids, monitoring charts need to be put in place to ensure the resident is not put at risk of pressure damage or dehydration. If a resident has a specific nursing intervention required, there must be a care plan drawn up, to direct staff on actions to take. The home shows high standards in all areas relating to administration of medicines. Resident’s privacy and dignity is respected. EVIDENCE: All residents have full care plans, which detail their individual nursing and care needs. The home have recently introduced a new record keeping system and all records have been transferred into this new format. Where residents have manual handling needs or are assessed as being at risk, for example of poor diet, care plans are in place, directing staff on actions to be taken. Care plans have been completed together with the resident and/or their representative and all staff involved in caring for the resident have been party to developing the care plan. The deputy manager reviews and audits care plans and supports Henford House Nursing Home DS0000015917.V300488.R01.S.doc Version 5.2 Page 12 staff in developing their approach to care planning. Most care plans are highly individualised, reflecting what the resident told the inspector and what was observed during the site visit. Where a resident’s condition had changed, care plans were promptly reviewed and changed, to reflect the resident’s new needs. Nursing and care staff spoken with had a detailed knowledge of the residents they were caring for, which reflected what was documented in care plans. Many of the care plans included measurable directions, however some did not and words such as “regularly” and “often” should be avoided. Residents who are at risk of pressure damage have care plans in place, but is it recommended that such care plans detail how often the person’s position needs to be moved, according to their own individual needs. Two residents met with were frail and cared for in bed, others had difficulty in changing their positions themselves and were assessed as being at high risk of pressure damage. Only one of these residents had a movement chart in place, and this had not been completed since 6am on the day of the first site visit. By the second site visit, the deputy manager had reviewed systems for documenting when residents were moved and had put monitoring systems into place. One relative commented how in the hot weather staff were attentive in ensuring that their relative had an appropriate water intake. The two residents met with, who were cared for in bed, were reported not to be able to take in fluids without assistance. One of these residents’ daily records indicated that they had been reluctant to drink at times. One of these residents had a fluid intake chart in place but the other did not. Where the resident had a fluid chart, it had not been completed for the day prior to the inspection and was not completed contemporaneously on the day of the inspection. Where residents are not able to assist themselves to take in fluids, a record must be put in place of the fluids they have taken in, so that staff can ensure that risk of dehydration is avoided. These records must always be completed contemporaneously. The charts used by the home, states that night staff should total the amount of fluids at midnight, this had not taken place. Residents who have urinary catheters in place had full records of changes of catheter and the clinical indicator for their use was documented in their records. Where residents have wounds, there were clear care plans and monitoring systems to assess the response of the wound to treatment. One resident met with was fully informed about the progress of their wound and their records fully conformed to what they told the Inspector. One resident was observed to have a suction machine by their bed, staff spoken with knew why this was, but a care plan had not been put in place to direct staff on the resident’s specific needs in relation to use of suction. Henford House Nursing Home DS0000015917.V300488.R01.S.doc Version 5.2 Page 13 Records showed that the home regularly contacted residents’ GPs when needed and other professionals, such as the tissue viability nurse or community psychiatric nurse were called in when relevant. Seven of the eight service users who responded to this section of the questionnaire said that they always got all the medical support they needed. One relative commented on how good staff had been when their relative had been unwell. All medication was safely stored. There were full records of medicines received into and disposed of from the home. All medicines records had been completed in full and where amendments had been made to medicines administration instructions, these had been signed and countersigned by a second registered nurse. All medicines requiring cold storage were correctly stored and the temperature of the medicines refrigerator monitored regularly. All limited life medication was dated when opened. A copy of the home’s policy on medication was kept in the front of each medicines administration folder. All nurses who administer medications complete a signature and initial record, so that the home can verify who gave which drug, on what occasion. Where a resident needed regular administration of a drug by injection, a record of the injection sites was maintained, to ensure rotation of sites and prevent tissue damage. Where residents were assessed as able to fully or partially selfmedicate, an assessment was completed and reviewed regularly. A medicines administration round was observed during the site visit and the registered nurse was noted to safely administer medication. Barchester has put a system for annual assessment for each registered nurse in performing administration of medicines. Where residents need administration of medication which may affect their daily lives, such as aperients or pain killers, these were referred to in their care plans, so that the resident’s response to use of such medications could be assessed. All care was provided behind closed doors. Staff were observed to knock prior to entering a resident’s room. One resident had a door bell to their room, which was used by staff prior to entry. Several residents commented on the laundry service and how well their clothes were washed and ironed. Residents had clean glasses and looked well-presented in clothes they had chosen themselves. As much as possible, residents were cared for by the same group of staff, so that they were familiar with the resident’s individual needs. Residents’ records detailed who they wished to open their mail, if they were unable to do this themselves. Henford House Nursing Home DS0000015917.V300488.R01.S.doc Version 5.2 Page 14 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): 12, 13, 14 & 15 Quality on this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. Henford House shows high standards in the provision of activities. Residents are supported in maintaining contact with their family and the local community. Residents are helped to exercise choice and control over their lives. Residents are offered a balanced diet and they can choose where they eat. EVIDENCE: The home employs a team of four activities coordinators and a member of the activities staff is on duty seven days a week. Most of the residents come from the local community with very few from a wider area. A very varied activities programme is provided, to suit the range of people who are cared for in the home. Several residents said how much they enjoyed the pottery classes, one resident said that they enjoyed the readings and the scripture classes, another mentioned the cooking classes and making cakes for the wild birds and another resident said that they could not join in activities but that they really enjoyed going along and watching what other people were doing. The home has an activities room and this showed several large, attractive collages which had been made by residents. During the afternoon a pianist was playing in the library, which several residents said they really enjoyed and a PAT dog was Henford House Nursing Home DS0000015917.V300488.R01.S.doc Version 5.2 Page 15 visiting. Where residents do not wish or are unable to leave their rooms, one of the activities coordinators performs room individual visits, to chat with residents and support them in activities such as reading, and writing letters. One relative described this activities coordinator as “A great comfort.” Residents’ religious needs are respected and regular religious services are held in the home. Where practicing of religion is important to a resident, this is documented in their records. One resident’s first language was not English and staff were aware of systems for communication with them. All residents have an individual profile of their life completed, this documented a range of matters important to them in their lives before coming in to Henford House. All residents also complete a form to indicate what activities they enjoy. If the home does not currently organise an activity, they work to introduce it. For example they have recently introduced a Bridge circle for card players, at the request of a group of residents. The activities staff are enthusiastic in their role and clearly know residents as individuals. They are also aware of how to source appropriate supports if residents are admitted with specific needs relating to their religion or diversity. One resident described activities staff as “excellent” and “always thinking of us”. One resident’s relative described the “fun” their relative had had at a recent birthday party, which the home had put on for them. Activities staff will take residents out into the local town, individually or in small groups. Residents are also helped to go to external religious services if they wish. Visitors are encouraged to come into the home. One visitor said that they could come when they wanted and commented on how staff contacted them promptly about matters important to their relative. Another relative reported “The staff constantly check on …..’s condition and keep in touch with us as to ….’s condition”. One resident was showing their relative round the home and garden during the site visit. Another resident and their relative ate lunch together at a table in the library. Residents reported that it was up to them how they spent their days. Residents consistently said that they chose when they got up and went to bed. One person said they appreciated being able to lie and watch television after they went to bed. Residents are enabled to bring in items of their own furniture and some rooms were highly personal, reflecting the resident’s likes and preferences. One resident said “Its nice to have all ones own things around”. One resident who said that they liked their own company said they appreciated not being pressurised to go to activities when they did not wish to. Residents generally expressed favorable comments about the meals, describing meals as “good” or “very nice”. One resident described the meals as “Excellent and I’ve got a good appetite”. Only one resident expressed concerns about the meals. One other resident reported that meals had improved a lot recently. There were varying opinions about the temperature of the meals, Henford House Nursing Home DS0000015917.V300488.R01.S.doc Version 5.2 Page 16 some described them as “nice and hot” but other people felt they were cold. This may relate to the layout of the home and the distance of some rooms from where the hot meal trolley is situated. This has been identified and smaller hot trolleys have been ordered for the areas of the home which are more distant from the kitchen. Residents said that if they did not like either choice at a mealtime, that they could ask for something else, like a salad or an omelette. Residents can eat in the dining room, at a table in the sitting room, in the library or their own room, depending on what they prefer. One resident said that they had enjoyed eating outside recently in the hot weather. Meals are served individually. There are currently no residents who need fully liquidised meals, although some need their meat pureeing. The chef has a detailed individual knowledge of what residents like to eat. She meets all new residents soon after admission and will meet with them again when needed. The chef is aware of all residents who need special diets and has accessed information on the internet to up-date herself about some diets. A wide range of different fluids are offered to residents. The second site visit took place on a very hot July day and it was noted that all residents in the communal rooms had drinks placed close at hand and that staff were reminding residents to keep drinking fluids. One relative commented to the Commission on how the staff encouraged their relative to drink enough fluids in the hot weather. Where residents need assistance to eat, a carer sits with them, supporting them in taking in their meal. All residents are regularly weighed and if it is identified that they need additional supplements, these are provided. Henford House Nursing Home DS0000015917.V300488.R01.S.doc Version 5.2 Page 17 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 Quality on this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. Residents spoken with were confident that their complaints would be listened to and acted upon. Henford House has systems in place to protect residents from abuse and where staff had not been fully trained, the manager had already identified this as an issue and put an action plan in place. EVIDENCE: Henford House has a complaints procedure which is available in the service users guide and is on display in the entrance area. Residents who completed questionnaires all knew how to raise issues of concern and make a complaint. Residents spoken with were all confident that they could bring up matters of concern. One said “Of course I can complain”. Several residents said that they had done so and had been listened to and relevant action taken. One said “I have complained in the past & they’ve always sorted it out”. Residents all knew who the manager and the deputy manager were and reported that they could see them whenever they wanted. Two residents said that they had once not been satisfied with the care given to them, that they had told the deputy manager and that she had dealt with it promptly and ensured that it had not happened again. The home maintains records of complaints, however it does not document concerns which may be raised with individual members of staff and might find it useful to do so, so that the manager can assure herself that all staff respond consistency when matters are raised. This would also evidence to senior managers in the provider organisation, the home’s effective systems for acting to ensure that residents’ concerns are addressed. Henford House Nursing Home DS0000015917.V300488.R01.S.doc Version 5.2 Page 18 The home’s manager is fully aware of vulnerable adults procedures and is used to working with local agencies to ensure that vulnerable persons are protected. Allegations raised since the last inspection have all been reported by the manager, in support of vulnerable adults. No allegations have been made by other parties. Where matters have been raised, the home has made a full investigation. This is fully supported by records. Some staff spoken with had a clear concept of protection of vulnerable persons and their responsibility for reporting matters within local procedures. Discussions with other staff and a review of records showed that not all staff who have service user contact have been trained in abuse awareness. The manager had identified this as an issue prior to the inspection, and was in the process of organising training for all staff, to ensure that they were aware of their individual responsibilities for the protection of vulnerable adults. Where residents need protection, for example by use of bed rails, there are full assessments in place for use of such restraints. These are regularly evaluated. Henford House Nursing Home DS0000015917.V300488.R01.S.doc Version 5.2 Page 19 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 Quality on this outcome area is excellent. This judgement has been made from evidence gathered both during and before the visit to the service. Henford House is well maintained. A range of different communal facilities are available to residents. There are sufficient wcs and baths. The home shows high standards in the specialist equipment provided to residents. Residents’ rooms are all large and comfortably furnished. The home is clean throughout and there are effective systems for the prevention of spread of infection. EVIDENCE: Henford House is well maintained. Where issues are identified, they are promptly dealt with. On the morning of the site visit, one small section of the home had experienced flooding. Prompt action had been taken as soon as it occurred and all areas made safe while the area was dried out. One of the domestic staff reported that if carpets need shampooing, they were able to do this as needed and that if a stain could not be removed despite shampooing, the carpet changed. There is a reporting system for “small” matters such as changing light bulbs, which it was reported worked effectively in practice. Henford House Nursing Home DS0000015917.V300488.R01.S.doc Version 5.2 Page 20 Barchester Healthcare ensures that maintenance of the home is regularly reviewed and develops plans for up-grading and development of the environment, to ensure that services are provided to meet the current needs of residents. The home offers a wide range of communal areas, including a large sitting room, library, small sitting room, activities room and dining room. The home also has extensive, well-maintained garden areas. One resident commented that the home was “Very good with the flowers” another person said “Amazing thought that goes with choice of flowers in the troughs” and another “The garden has been so much appreciated.” All residents have their own room, most of which are very large and all of which exceed National Minimum Standards for room sizes. Most of the rooms have wide views over the garden, one resident said “I’ve got a lovely view” and a relative described their relative’s room as “sunny”. 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. Nearly all of the rooms have ensuite facilities. A range of assisted bathrooms and wcs are provided for residents with disability. Equipment is provided to meet residents’ needs. All residents were nursed in variable height beds and many of these beds were electrically profiling. A range of hoists were provided for residents who need manual handling. Recliner chairs and specialist wheelchairs were provided when needed. A wide range of pressure relieving equipment was available and was being used correctly. Where a resident had requested a particular preference in relation to equipment, this was documented. All residents had been left with access to their call bell. Residents commented that staff came when they used their bell, one said “When I ring my bell, they come at once”, another said “If I ring my bell they come, night & day” and another said “I’ve only got to ring my bell and they come”. It was noted as good practice that one resident who could not use their hands had had a particular attachment provided to their call bell, so that they could summon staff when they needed. Henford House was clean throughout. A full team of domestic staff are employed. All the residents who completed questionnaires said that the home was always fresh and clean. The domestic had a clear understanding of her role and was careful in performing her duties. Three of the bath hoists showed limescale developing on the back of the hoist. By the second site visit, this had been addressed in full. There are safe systems for prevention of spread of infection, which conform to local guidelines. The manager is aware of new guidelines from the Department of Health on infection control. There are safe systems for disposal of waste. The laundry service is well organised and there are full systems in place to ensure the separation of different categories of laundry. Henford House Nursing Home DS0000015917.V300488.R01.S.doc Version 5.2 Page 21 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, 28, 29 & 30 Quality on this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. Henford House is well staffed by a range of persons with different skills, to meet the needs of residents in the home. Training is encouraged. Residents are protected by a safe system for recruitment of staff. EVIDENCE: Henford House is required to staff the home in accordance with a Condition of Registration set out by the Commission. A review of their off-duty records showed that the home were consistently exceeding the requirements of this Condition. This included, for example one weekend day when two members of staff were off sick. Each floor of the home is managed by a designated 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. One relative reported “A significant proportion of the staff are long-term, suggesting a harmonious set of circumstances.” Training is encouraged. The activities coordinators are being supported in completing NVQs to train them in their role. The laundress has completed an NVQ in cleaning. Over 50 or care staff are trained to NVQ 2 or equivalent. Henford House Nursing Home DS0000015917.V300488.R01.S.doc Version 5.2 Page 22 Where staff complete NVQ qualifications, this is recognised by Barchester Healthcare. The home employs two part-time training managers. At the time of the second site visit, they were moving their records into a new designated training area. All staff have an induction programme, which is consistent with Skills for Care. Barchester has a range of standard induction programmes, which relate to the member of staff’s role, for example, catering, care staff, senior care staff, registered nurses. Most records had been completed in full, however for some records, the inductee had not signed when they had received training and for others, sections which were reported have been completed, had been left blank. The manager reported that this had been identified as an issue and would be addressed as part of the developments to the staff supervision procedures. All staff have individual training profiles and copies of certificates and responses to training are held on individual staff files. These show that Barchester is supportive of training and that both in-house and external trainers are used to support staff. A range of training equipment is provided, including a computer and flip chart. Six staff files were reviewed during the second site visit. These records were kept in an orderly manner. Records included an application form, proof of identity, health declaration, pova and CRB checks. Staff are interviewed using an interview assessment tool and awareness of vulnerable adults is included in this assessment tool. The manager applies for a third reference if deemed relevant. On one case a reference had been directly sourced from abroad. Barchester Healthcare has systems for recruiting staff from abroad and on one occasion, such a member of staff had only one reference on file, although the manager was aware that two had been returned. She reported that the external recruiters were in the process of improving their service to Barchester Healthcare and that more recently persons appointed had come with full required documentation. The manager and the administrator showed a detailed awareness of legal issues relating to employing persons from overseas. Henford House Nursing Home DS0000015917.V300488.R01.S.doc Version 5.2 Page 23 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, 33, 35, 36 & 38 Quality on this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. Henford House is managed by an experienced manager and registered nurse. There are systems to ensure that residents, their relatives and staff are involved in the home and there are established systems for assessing quality of service provision. There are standard systems within the company for safeguarding residents’ financial interests. Staff are supervised. There are systems in place to ensure the health and safety of residents and staff. EVIDENCE: The home is managed by an experienced manager and registered nurse. The manager regularly up-dates her clinical skills and is in the process of working towards the managers’ award. The current deputy manager has already gained the managers award. Since the manager came into post, she has supported her staff and has introduced new methods of working, to further improve Henford House Nursing Home DS0000015917.V300488.R01.S.doc Version 5.2 Page 24 service provision. There is an established system in the home for regular staff meetings and residents meetings. All these meetings are minuted and indicate that staff feel able to bring matters forward. Barchester has a system for auditing the quality of service provision. Each month one particular area, for example health and safety, catering or medicines is audited, using a self-audit system and a standard scoring system. Where issues are identified, the manager develops an action plan and submits it to Barchester Healthcare’s quality control department. The home is also visited regularly by a senior manager and a report completed every month. Charges for services such as newspapers, hairdressing and chiropody are dealt with using a standard invoicing system and monthly invoices are sent out. These are audited and the administrator reported that the last major audit took place by an external auditor in the autumn of 2005. Internal audits take place as well and it is recommended that a written records of such audits is retained in the home. The home only rarely looks after moneys or valuables for service users. Where they do, there is a full audit trail, with records of items taken in for safekeeping and returned to residents or relatives. Some records make reference to the apparent value of items using terms such as “gold”, rather than “yellow” items, as is advised. The deputy manager continues to work some clinical shifts. When she does so, she works with registered nurses and carers on a 1:1 basis and directly supervises them, supporting them in improving and developing their practice. The manager has set up a clear system, which is auditable to ensure that all staff receive consistent and regular supervision. In talking to staff, it was clear that supervision was taking place, but as records were not consistently maintained, the home cannot demonstrate their practice in this area. Regular mandatory training in health and safety takes place. This is full supported by records. The fire log book is maintained in full. There is evidence of systems for regular maintenance of all parts of the building at frequencies set by the company. Records are clear and fully completed, these show that the boilers, lifts, hoists and other key areas have maintenance programmes in place. Small maintenance matters, such as checks on wheelchairs, hot water temperatures and checks on small electrical items also take place. Henford House Nursing Home DS0000015917.V300488.R01.S.doc Version 5.2 Page 25 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 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 4 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 3 4 4 3 X 3 STAFFING Standard No Score 27 4 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Henford House Nursing Home DS0000015917.V300488.R01.S.doc Version 5.2 Page 26 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 OP8 Regulation 13(4)(c) Requirement Timescale for action 31/08/06 2. OP8 12(1)(a) 3. OP8 15(1) 4. OP18 13(6) Where a service user has a monitoring chart in place to ensure that they have their position moved regularly to prevent risk of pressure damage, this monitoring chart must be completed contemporaneously. Where a service user is unable to 31/08/06 assist themselves in taking fluids and could be at risk of dehydration, a monitoring system must be put in place, so that staff can assess how much fluid a service user is taking in. Any such records must be completed contemporaneously. Where a service user may need 31/08/06 the use of suction equipment, there must be a care plan in place to direct staff on the actions to take to meet the service user’s individual nursing needs. All staff who have service user 31/12/06 contact must be trained in abuse awareness. Henford House Nursing Home DS0000015917.V300488.R01.S.doc Version 5.2 Page 27 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 OP8 Good Practice Recommendations Where a service user has a care plan relating to prevention of risk of pressure damage, the care plan should state how often the service user’s position needs to be changed. Precise, measurable wording should be used in nursing and care documentation. Fluid charts should be totalled daily, in accordance with the home’s policies. The home should document concerns raised with staff, together with details of actions taken and outcomes. The home should ensure that where staff are recruited through an external agency, that a copy of all references are retained on the member of staff’s file. The home should ensure that all induction and training records are fully completed, on every occasion, by all relevant persons. The internal auditors should evidence that audit of service users’ moneys has taken place. Records of valuables handed in for safekeeping should not make reference to their apparent value. Full written records of supervision offered to staff should be in place. 2. 3. 4. 5. 6. 7. 8. 9. OP8 OP8 OP16 OP29 OP30 OP35 OP35 OP36 Henford House Nursing Home DS0000015917.V300488.R01.S.doc Version 5.2 Page 28 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 © 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 Henford House Nursing Home DS0000015917.V300488.R01.S.doc Version 5.2 Page 29 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!