Inspection on 07/11/07 for Hickathrift House

This inspection was carried out on 7th November 2007.

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

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

Other inspections for this house

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Hickathrift House 217 Smeeth Road Marshland St James Wisbech Norfolk PE14 8JB Lead Inspector Andy Green Unannounced Inspection 7th November 2007 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hickathrift House DS0000069323.V354496.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. Hickathrift House DS0000069323.V354496.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hickathrift House Address 217 Smeeth Road Marshland St James Wisbech Norfolk PE14 8JB 01945 430636 01945 430609 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) Barchester Healthcare Homes Ltd vacant post Care Home 57 Category(ies) of Dementia (8), Learning disability (1), Old age, registration, with number not falling within any other category (48) of places Hickathrift House DS0000069323.V354496.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named resident, over the age of 50 years with physical disabilities, may be admitted for respite care. 14th December 2006 Date of last inspection Brief Description of the Service: Hickathrift House is a care home providing care and support for 57 elderly, people, eight of whom have been assessed as having dementia care needs and one of whom one has learning difficulties. Any nursing or medical care is provided via the local G.P. service. The home is situated in the village of Marshland St. James which is approximately eight miles from Wisbech. The home is owned by Barchester Healthcare Homes Ltd. The home is purpose built. Most of the home is on the ground floor, and there is a lift to the first floor area. There are well maintained gardens and a paved quadrangle area which has benches and flower beds. There is a large car park at the rear of the home . Email:- hickathrift@barchester.com The fees are £343 to £620 per week. Copies of CSCI reports are available to residents and their relatives upon request from the home’s office. Hickathrift House DS0000069323.V354496.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection carried out an unannounced inspection of this service on 7th November 2007. We met with the manager, members of staff, relatives and a number of residents during the inspection. A variety of records were inspected including care plans, risk assessments, staff files, organisational policies and medication records. A tour of the premises was also undertaken. Additional information was received in the AQAA (an assessment document completed by the home) supplied by the home. CSCI surveys were also received from residents and relatives. What the service does well: What has improved since the last inspection? What they could do better: The assessment process needs to be improved to ensure that detailed information is collated to ensure that residents care and support needs can be fully met. Care plans need to be in a more person centred style rather than a nursing/task driven manner. Clearer guidance is needed so that each are area for care and support is in stages to eliminate vagueness. Hickathrift House DS0000069323.V354496.R01.S.doc Version 5.2 Page 6 Staffing in the dementia care unit needs to be urgently reviewed to ensure that there are sufficient numbers of staff to provide care and support. The frequency of formal supervision of staff needs to be improved to ensure that care practice and development needs are monitored. Monthly management visits on behalf of the provider need to be increased to monitor the home’s performance as per the regulation. It is recommended that an activities co-ordinator is employed to ensure that suitable activities are organised for residents with dementia care needs. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hickathrift House DS0000069323.V354496.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hickathrift House DS0000069323.V354496.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Assessments are in place but improvements need to be made to make sure that that the care needs of new residents can be met. EVIDENCE: The manager has recently reviewed and updated the Statement of Purpose and the Resident Guide to ensure information regarding the home and its services are accurate. Assessments are carried out by the manager and/or senior care staff to ensure that needs of residents can be met before they move into the home. Information is received from care managers detailing the person’s primary care and support needs. For those who are self funding an assessment is carried out using the home’s own assessment documents. It was noted however that insufficient details were recorded in assessments regarding residents with dementia care needs. It is recommended that a separate sheet to specifically cover dementia care needs is implemented to ensure that a detailed assessment can be made. Hickathrift House DS0000069323.V354496.R01.S.doc Version 5.2 Page 9 There was also no evidence of a formal diagnosis of dementia, from a qualified healthcare professional, on the files seen during the inspection. Some of the assessments were unsigned and not dated and contained only brief details. One assessment carried out by the home contained “No Problem” in the section regarding Mental State but reference was made to long term mental health issues and treatment in other documents in the file. These issues were discussed with the manager, who has been employed since August 2007. She stated that she also found the assessment process to be insufficient and that she would be reviewing documentation and the quality of information received so that the needs of prospective residents can be adequately met. A requirement regarding assessments will be made Prospective residents and their family/relatives continue to be encouraged to visit the home as part the assessment This was confirmed by relatives spoken to during the day. Hickathrift House DS0000069323.V354496.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents receive appropriate health and personal care to meet their assessed needs. EVIDENCE: Five of the resident’s care files were seen. A variety of information was recorded regarding health, personal care and social care needs. Daily care notes continue to be accurately recorded. It was noted, however, that care plans were in a nursing model and task orientated style rather than a person centred style. A number of entries in care plans gave vague statements such as “give assistance” which did not adequately describe the intervention required. The care plans would benefit from a more ‘step by step’ approach giving clear guidelines to staff regarding the specific care and support that is required. Care plans regarding residents with dementia care needs were also not in sufficient detail regarding the care and support that should be given. A more person centred approach would assist staff’s understanding how dementia Hickathrift House DS0000069323.V354496.R01.S.doc Version 5.2 Page 11 specifically impacts on the individual resident so that they are clear about the support/interventions that should be given. More detailed social history profiles would also assist staff to gain a wider understanding/perspective of the resident. Reviews of care are undertaken but they are infrequent and the manager stated that they have usually been six monthly. The national Minimum Standards state that reviews of care plans should be monthly to ensure that care and support needs are being monitored A requirement regarding improvements to the care planning and review process will be made. The manager also stated that she found care plans too task driven and that she is undertaking a review of the care planning process to ensure that the delivery of care and support is detailed and more person centred. Relatives met during the inspection were positive and complimentary about the staff and the care provided in the home. Surveys also received from relatives were positive regarding the care in the home. Observations during the day evidenced that staff spoke to residents in a sensitive, friendly and social way manner and knocked on bedroom doors before entering. A variety of healthcare professionals regularly visit when required which includes GPs, district nurses, nutritionist, chiropodist and CPN’s. All healthcare visits are recorded in care plans and daily notes. The home is committed to the prevention of pressure sores and district nurses are in regular attendance to ensure proactive treatment is carried out. The manager stated that there were two residents with pressure sores in the home which are being treated and monitored by district nurses via the local surgery. Medication records, including Controlled Medication, were recorded accurately. The manager stated that only senior carers administer medication and that ongoing medication training is organised. Hickathrift House DS0000069323.V354496.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff provide appropriate support to ensure that residents have access to activities appropriate to their needs. EVIDENCE: There are two activity co-ordinators who provide a programme of activities in the home usually held in the ‘residential’ side of the home. Activities include a variety of regular paid musical entertainers, bingo sessions, keep fit, cards, dominoes, jigsaws, knitting, newspapers, quizzes, reminiscence sessions, movement to music, pub trips, day trips and clothes shows. A beautician and hairdresser make regular visits. Birthdays are celebrated in the home and a number of events are being planned for Christmas. There was a cheerful and social atmosphere in the home and residents were having conversations with each other, staff and visitors with plenty of laughter and good humour in evidence. Residents spoken to during the inspection did not raise any concerns and were positive about the services in the home including their care, accommodation and the food provided. They also confirmed that they enjoyed the various activities provided in the home. Hickathrift House DS0000069323.V354496.R01.S.doc Version 5.2 Page 13 It was noted that there were few activities organised in the dementia care unit, however residents do attend activities and events which are held in the residential area lounge. The manager has started to develop ‘memory boxes’ and other dementia care aids recently. As there is only one carer on shift, for up to 8 residents, in the dementia care unit this gives little scope for any quality individual and group time outside of basic personal care and support. The manager must review the staffing levels so that appropriate social time can be provided. A requirement will be made regarding this issue. It was also recommended that an activities co-ordinator is employed with suitable knowledge and skills regarding dementia care so that appropriate activities can be provided. A recommendation will be made regarding this issue. The home continues to provide a comprehensive menu with choice always available if the menu is not suitable, which was confirmed by residents. Residents were seen enjoying the lunchtime meal on the day of the visit. Tables were laid attractively with table decorations and clean cloths. The menus are displayed in the dining room and residents opinions and choices are regularly sought by the kitchen staff. Individual preferences are recorded in care plans and residents can have meals in their bedroom if they so wish. The manager also stated that residents can have breakfast at a time to suit their individual preference. Hickathrift House DS0000069323.V354496.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a clear complaints procedure to make sure that residents have their complaints or concerns listened to and acted upon properly. EVIDENCE: The home has a clear complaints procedure to ensure that any concerns are dealt with and actioned appropriately. The home has received one complaint since the last inspection which has been appropriately responded to. The home is awaiting a response from the complainant. Relatives met during the inspection confirmed that were aware of the complaints procedure and would not hesitate in contacting the manager/senior staff if they had any concerns. Staff confirmed that they receive updates regarding training in the protection of vulnerable adults so that residents are protected from abuse. Evidence of POVA training was seen in a sample of staff training files. Hickathrift House DS0000069323.V354496.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides appropriate premises and accommodation to meet the resident’s needs. Resident’s bedrooms are presented in a style to reflect individual preferences and wishes. EVIDENCE: The home was clean and free from odours. The communal areas of the home are well furnished and decorated to a good standard. Residents can personalise their bedrooms to meet their preferences and this was clearly evidenced by a variety of bedrooms seen during a tour of the building. Residents spoken to were happy with the accommodation and facilities provided and this view was endorsed by visitors to the home. Hickathrift House DS0000069323.V354496.R01.S.doc Version 5.2 Page 16 Decoration to the skirting boards in the corridors of the older part of the home need to be carried out. As these corridors are narrower wheelchairs can often scuff areas of paintwork and the manager stated that she is in discussion with the maintenance person to research how this can be remedied. There have been no significant changes to the environment since the last inspection. The manager, however stated that building work is still planned to redevelop a number of areas in the home. The gardens and grounds are well maintained and accessible to residents and their visitors. Hickathrift House DS0000069323.V354496.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s recruitment policy and processes ensure that residents are protected from harm. Some improvements regarding staffing levels need to be made. EVIDENCE: The personnel files for 5 staff were seen and they contained the required relevant documents including application form, references, CRB checks and contracts of employment. The manager stated that the home is fully staffed and that there are now 7 carers in the morning, 5 carers in the afternoon and 4 night staff. As mentioned previously in this report there is usually only one member of care staff on duty in the dementia care unit which, is unsuitable to meet the resident’s care and social needs. This issue was discussed with the manager and she stated that she would review this with her line manager. A requirement will be made regarding this issue. The manager and Care Manager have implemented a new training programme in the home and all staff have been booked on mandatory courses and updates as appropriate. Staff spoken to confirmed that they had received a variety of training including moving & handling, food hygiene, POVA, dementia and diabetes. NVQ training also continues in the home. Hickathrift House DS0000069323.V354496.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed to ensure that residents receive a good and safe standard of care. EVIDENCE: A new manager for the home was appointed in August 2007. She is currently completing an application to be registered as manager with CSCI. In the short time that she has been in post she has embarked on reviewing the care and policies/procedures in the home. As mentioned previously in this report she is, with her senior care staff, revising the assessment and care planning process, training and staffing. The manager stated that she is in regular contact with her line manager to discuss operational and care issues. However it was noted that monthly checks Hickathrift House DS0000069323.V354496.R01.S.doc Version 5.2 Page 19 had not been regularly made as outlined in Regulation 26 of the Care Homes Regulations 2001. A requirement will be made regarding this issue. It was noted that formal recorded supervision sessions have been infrequent. Staff spoken to stated that they had received supervision on a 3 monthly basis. This issue was raised with the manager and she stated that supervision would become a delegated task within the senior care team so that staff received at least 6 sessions a year as outlined in the National Minimum Standards. Health and safety checks are carried out by/organised the maintenance person including fire safety records, hoists and lift maintenance. Hickathrift House DS0000069323.V354496.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 2 3 Hickathrift House DS0000069323.V354496.R01.S.doc Version 5.2 Page 21 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 OP3 Regulation 14(1) (a) Requirement Assessments must be in more detail to ensure that prospective resident’s care and support needs can be fully met prior to admission. Care plans must be detailed to ensure that care and support guidelines are clearly identified and regularly reviewed. Staffing must be improved to ensure that care and support in the dementia care unit can be suitably delivered. Suitable arrangements must be in place to ensure that staff receive regular recorded supervision. The registered provider must ensure that regular monthly management visits are made to the home. Timescale for action 31/01/08 2 OP7 15(1)(2) (b) 18(1)(a) 31/01/08 3 OP27 31/12/07 4 OP36 18(2) 31/01/08 5 OP37 26(3) 31/01/08 Hickathrift House DS0000069323.V354496.R01.S.doc Version 5.2 Page 22 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 OP12 Good Practice Recommendations It is recommended that an activities co-ordinator is employed to ensure that suitable activities are organised for residents with dementia care needs. Hickathrift House DS0000069323.V354496.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Cambridge & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hickathrift House DS0000069323.V354496.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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