CARE HOMES FOR OLDER PEOPLE
Hepworth House 1, St Georges Road Bedford Beds MK40 2LS
Lead Inspector Nicholas Allen Announced 20th April 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. Hepworth House Version 1.10 Page 3 SERVICE INFORMATION
Name of service Hepworth House Address 1, St Georges Road, Bedford, MK40 2LS 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) 01234 262139 01234 272927 Mr Keith Hepworth - Lloyd Mrs Prima Hepworth -Lloyd Care Home 18 Category(ies) of DE(E) Dementia over 65 - 18, OP Old Age - 18 registration, with number of places Hepworth House Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13/10/04 Brief Description of the Service: Hepworth House is situated in a pleasant residential area of Bedford. It is within easy walking distance of the town centre and close to local amenities such as local shops, schools and Churches.The home is converted from two domestic style properties and does not appear conspicuous within the area. There is a garden surrounding the home which is laid to lawn and flower beds. There is adequate unrestricted road parking in the area for staff and visitors.The home has undergone many internal improvements in the last few years and currently provides accommodation for 18 service users over the age of 65 years. 16 of the rooms are single rooms with 16 having en-suite facilities. There are two lounge/diners on the ground floor and a lounge on the first floor. Communal bathrooms and toilets are located on the ground and first floor. Hepworth House Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The announced inspection was conducted at Hepworth House 20th April 2005. The inspection involved looking at records, a tour of the premises, talking to management, staff, some of the people living there, and visitors. Generally the inspector looked at what was happening in the home. Information was also taken from comment cards that had been filled in. This inspection looked at things that should have been done since the last visit and a number of areas that affect resident’s lives. Residents were content and visitors had commented that the staff were ‘a good bunch’. Residents and visitors to the home were happy with the care given. What the service does well: What has improved since the last inspection?
Hepworth House Version 1.10 Page 6 Generally the work identified at the last inspection had been completed. The home had access to a part time handyperson who was in the process of redecorating some of the bedrooms. Generally the home was clean, odour free and tidy. The owners had worked hard at updating the policies and general documents used to provide staff with information to care for people living at the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hepworth House Version 1.10 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 Hepworth House Version 1.10 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) 1,2,3 Residents had enough information about the home and their rights to help them to make an informed decision about admission to the home. This meant that residents were only admitted once the home had completed detailed assessments. EVIDENCE: The information about the home had been changed since the last visit. There was enough detail to help existing and future residents and their representatives to make an informed choice about admission to the home. Although there was evidence that all residents had been assessed before moving into the home. Not all residents had letters confirming that the home could meet their needs on file. Residents had been given a ‘contract’ and were therefore aware of their rights of residence. One resident had recently changed rooms. A new resident had moved into the old room but the name on the door had not been changed. Hepworth House Version 1.10 Page 9 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) 7,8,10, The standard of care planning for some residents was poor. It did not involve residents, was not generated from the needs assessment and did not show how resident’s needs would be met. This meant that on occasions packages of care would not be developed to meet the individual’s specific needs. EVIDENCE: There was evidence that service users had been assessed as to their individual needs. Some risks had been considered and from talking to residents it was clear they could take risks but not all risk assessments had been included in their care plan. There was one trip/fall assessment on one of the files looked at but not on others. There was no record of the name of the keyworker for each resident. There was evidence that some staff did not write details of how a resident had been during their shift. There was evidence that reviews of service users care had taken place but some residents spoken to knew about their care plans. Relatives felt they were ‘consulted about their care’. One visitor said she was ‘always kept up to date’ and was ‘sure staff would ring if there were any problems’.
Hepworth House Version 1.10 Page 10 Residents told the inspector they were cared for and their privacy was respected. One resident said staff ‘were a good bunch’ another said she was ‘well looked after’. Staff were seen to be friendly, respectful and welcoming to residents and any visitors to the home. Hepworth House Version 1.10 Page 11 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, The home provided a suitable and varied programme of activities to meet the social needs and interest of the residents. There was no detailed record of individual interests on the files inspected. Visitors were made to feel welcome at any time of the day which gave them confidence in the staff team. This meant that at times some individuals missed out on activities that interested them. EVIDENCE: Provision of activities was largely dependent on one person who was employed for two half days each week. Residents had a range of interesting activities to choose from. Staff were seen watching TV and chatting with service users. One lady was having her nails done. A number of residents said they could choose to do as they wished and didn’t ‘feel pushed to join in’. One resident said the home did not provide ‘suitable activities’ whilst another said the activities were fine. There was no information about activities and support in the local community. There were no details recorded in individual care plans. Hepworth House Version 1.10 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 standard(s) 16,18 The home had a satisfactory complaints system with evidence that residents and their visitors felt confident their concerns would be taken seriously and acted on. This meant that the residents felt safe. EVIDENCE: The complaints procedure was clear. There had been no complaints made to the home or to the Commission. Concerns had been recorded by residents and had been responded to. Staff were aware of how to deal with a complaint. There was evidence of training being offered. Two visitors said they knew about the complaint procedure. One visitor said she would be happy to raise any problems with the staff and was sure staff would do their best to sort things out. Residents said they would talk to staff if they had a problem. Hepworth House Version 1.10 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 standard(s) 19,21,22,26 There had been some redecoration internally since the last inspection. Resident’s rooms were individually furnished to meet the needs of those resident. All rooms had either toilets en suite. Overall residents were able to live in a homely environment. EVIDENCE: Individual residents rooms were decorated to meet their needs. Some residents had brought in furniture from home. The owners had checked to see if it met Health and Safety requirements. There was evidence of the home being maintained inside but there was some neglect externally. Most rooms were en suite. To help people move around the home changes had been made, including the provision of equipment. The inspector saw some evidence of washing being left in a downstairs bathroom until it could be taken to the washing machines that were in an outbuilding. The clinical waste bin was overfull and the lid could not be closed. There was anecdotal evidence onlyof a programme of planned maintenance. There were a number of external areas of the home that were in need of either replacement or repair. The external woodwork required painting Inside the home was clean and generally
Hepworth House Version 1.10 Page 14 odour free. Outside the inspector noted that the clinical waste bin was overflowing. Hepworth House Version 1.10 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 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) 27,28,29,3 The staff team was caring and friendly; this had a positive impact on how the residents felt. There was a good recruitment process and a number of staff had worked at the home for some time. There was good access to staff training. This meant that residents were supported by appropriately trained staff. Of the staff files looked at not all contained all the appropriate information. The manager needs to check information contained in the files is not duplicated elsewhere. EVIDENCE: Past rotas were examined. All showed that appropriate levels of staffing had been maintained for some time. There was evidence of the promotion of staff training. The number of staff who had completed appropriate NVQ training was on target. Two staff files were looked at. Both had appropriate details of the recruitment process. One file did not contain all the information required. Other information appeared in a number of places. Hepworth House Version 1.10 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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) 33,35,36, 37 Records required by regulation were up to date and accurate overall. Consultation systems with residents, relatives and others were in place. The manager was aware of how the home needs to improve. A copy of the development plan was in place. EVIDENCE: There was evidence of the home being operated in the best interests of the residents. Records of residents’ finances were up to date. Not all residents finances were checked during this inspection. There was evidence of staff meetings taking place and of individual staff being supervised at least once every eight weeks. Not all the records were stored in the same place. There was evidence of policies and procedures having been reviewed. The format of these policies was not consistent and at times information appeared in a number of places. Hepworth House Version 1.10 Page 17 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 2 x 3 2 x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 3 3 2 x Hepworth House Version 1.10 Page 18 no 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 7 Regulation 15 Schedule 3 (1)(b) Requirement The home needs to complete all care plans for individual residents in line with the model already in use Timescale for action 1 Aug 05 2. 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. 4. Refer to Standard 19 21 26 29 Good Practice Recommendations The home should develop a realistic action plan for the internal and external maintenance of the building The manager should remind all staff that dirty washing should be removed directly to laundry A review of the contract for the clinical waste is recomended It is recommended that all staff files are set out to the same format which includes a content list Hepworth House Version 1.10 Page 19 Commission for Social Care Inspection Clifton House Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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