Inspection on 17/03/09 for Hickling House

This inspection was carried out on 17th March 2009.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hickling House 19/08/09

Hickling House 29/07/08

Hickling House 22/05/07

Hickling House 26/09/06

Hickling House 24/02/06

Hickling House 25/10/05

Hickling House 29/11/04

Hickling House 16/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

CARE HOMES FOR OLDER PEOPLE Hickling House Town Street Hickling Norwich Norfolk NR12 0AY Lead Inspector Kim Patience Unannounced Inspection 17th March 2009 09:30 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 Hickling House DS0000027434.V374595.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. Hickling House DS0000027434.V374595.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hickling House Address Town Street Hickling Norwich Norfolk NR12 0AY 01692 598372 P/F01692 598372 info@hicklinghouse.fsnet.co.uk info@glendonhouse.fsnet.co.uk Mr Rhoderick Smart Mrs Frances Smart Angela Marlow Care Home 29 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) Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (28) of places Hickling House DS0000027434.V374595.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Up to twenty-eight (28) service users, over 65 years of age with dementia may be accommodated. One (1) adult with dementia may be accommodated The total number not to exceed twenty-nine (29). Date of last inspection 29th July 2008 Brief Description of the Service: Hickling House is a care home providing personal care and accommodation for 29 older people with dementia. The home is situated on the outskirts of the village of Hickling, close to Hickling Broad and less than 5 miles from the Norfolk Coast. Originally a Victorian Inn, the premises has been extended and modernised to provide residential accommodation on two floors. There is a choice of communal areas to suit the various needs of people living in the home. There are 25 single rooms, 24 of which have en suite facilities, and 2 double rooms, both with en suite facilities. A shaft lift and separate stair lift provide access to the upper floor and there are two outside fire escapes. The weekly fees for care and accommodation are between £404 and £500 a week. Day care is provided to a small group of people and they are accommodated during the day in the general communal areas. Hickling House DS0000027434.V374595.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This site visit was unannounced and took approximately 8 hours to complete. The site visit forms part of the overall inspection of the service. During the site visit we looked at the way in which the home meets people’s health and care needs, which included examination of records relating to people living and working in the home. We took at tour of the premises and looked at people’s private accommodation. We also spoke to residents, visitors and staff. The majority of people living in the home have dementia and whilst we gave people the opportunity to express their views about the service they receive, many were unable to do this. Therefore, observations of people engaged in their daily life were made and included in this report. What the service does well: What has improved since the last inspection? Further improvements have been made to care plans. There is now a system of regular review but care plans are not always updated at this point to reflect changes in people’s needs. Medication management has also improved but there are still some areas that need to be improved. Hickling House DS0000027434.V374595.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hickling House DS0000027434.V374595.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 Hickling House DS0000027434.V374595.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): 3 and 6 Quality in this outcome area is good. People moving into the home do so with the knowledge that the service is suitable and their needs have been assessed and can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a policy and procedure in place for the admission of new residents. A pre admission assessment is completed prior to people moving into the home and people are provided with information about the service and facilities. The manager said that people are invited to view the service and have a trial period to enable them to decide if the home can meet their needs. During the inspection we examined a file relating to one recently admitted resident. The file contained a pre admission assessment and further information was provided by the Social Worker. Hickling House DS0000027434.V374595.R01.S.doc Version 5.2 Page 9 Hickling House DS0000027434.V374595.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 and 10 Quality in this outcome area is poor. People living in the home cannot be assured their needs will be fully assessed and met. Risk assessments may not be completed for all risks associated with their health and care needs and medication management is still in need of improvement. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We examined the care records relating to four people living in the home. We found that they contained detailed information about people and their health and care needs that was individualised, including people’s preferences in respect of daily living. The records showed information about people’s life history and social care plans had been written based on information about people’s previous interests and hobbies. There was also evidence of regular activities being provided. Care plans and associated assessments had been reviewed and there is now a system in place for ensuring that reviews take place on a monthly basis. Hickling House DS0000027434.V374595.R01.S.doc Version 5.2 Page 11 Although the care records seen contained good information, the information was difficult to find as there was not a clear system of care planning, assessing health needs and risks associated with daily living. Some of the records had not been kept up to date and some of the information recorded on documents was inconsistent with information on other records. We also found that care plans did not necessarily cover all care needs. For instance, where waterlow assessments identified there was a high risk of pressure sores, there was no written care plan setting out what care is to be provided to prevent the development of pressure areas. However, we did find that measures had been taken such as the provision of pressure relieving equipment and increasing nutritional intake. Risk assessments had been written for some risks but again did not cover all risks associated with people’s daily life in the home. For instance, two people were experiencing some behavioural disturbances but there was no risk assessment stating what the risks might be with some of the behaviours and how they should be reduced. When we looked at records and compared the information with observations of people engaged in daily life in the home we found that care was not always provided as set out in the records. For instance, the records for one person said they needed two walking sticks to walk with but they did not have their walking sticks with them. Another person’s records stated they wore false teeth but they did not have them in and when we looked in the person’s room they were still soaking in a pot. The same person’s records said they had difficulty with solid food and needed it to be cut into small manageable pieces but they were given pizza and chips for lunch, which was not cut up. This together with the absence of the false teeth would increase the already highlighted risk of choking. When we looked in other people’s rooms it was noted that there were walking aids in some rooms when people were in the communal areas. We also saw a hearing aid in one room and in at least two rooms we saw spectacles. We examined the medication management practices by looking at how medication was administered, examination of records, a random audit of some medicines and discussion with staff responsible for medicine management in the home. We found that since the last inspection the home has made improvements to medicine management. Each person has a medicine administration chart superseded by a laminated card with an identifying photograph of the resident and relevant information such as allergies and special arrangements. There is a system of auditing medicines and audits are conducted on a regular basis. When we audited a sample of medicines by counting the medicines in stock and comparing with what was written on the chart we found that they were Hickling House DS0000027434.V374595.R01.S.doc Version 5.2 Page 12 correct. There were no significant gaps in charts and there was good practice in respect of recording instructions. However, the home should consider properly recording medicines that are carried forward ensuring that they are dated so that they can be audited effectively. The home should also ensure that PRN (as required) medicines with variable doses are properly recorded. In addition the home must ensure that there are care plans for PRN medicines that provide staff with clear guidance on what steps should be taken before administering medicines prescribed in this way. We looked at controlled drugs and found that the home now has a controlled drugs cabinet, which has been secured to the wall in a locked room. The controlled drugs register was easily accessible and the number of controlled drugs held in the cabinet matched the number recorded in the register when checked. We observed medicines being administered at lunchtime and the member of staff demonstrated good practice and safe procedures for administering medicines. Hickling House DS0000027434.V374595.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is good. The home has systems in place that promotes peoples life style choices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has done some good life story work with residents and the residents records we looked at contained detailed information about people’s previous lives and experiences. Social care plans have been written based on this information and each person has a plan of activity based on their interests and hobbies. There was evidence of activity taking place and the activities coordinator maintains a diary of activities people participate in. We spoke with one resident who told us there was always something to do. She had been involved in a quiz earlier in the day, which she said was enjoyable. We observed the lunchtime experience and spoke with the cook about meal planning and how the home caters for special dietary needs. The dining room was nicely laid out with several small tables that seat four people. Each table was dressed with a tablecloth and place settings with cutlery. People were offered a choice of drinks and offered a choice of wearing Hickling House DS0000027434.V374595.R01.S.doc Version 5.2 Page 14 a plastic apron to protect their clothing. The home could offer a wider range of items to protect clothing that promote dignity. Most residents were eating in the dining room but there were some that chose to eat in the small lounges and in their own rooms. Residents were seated in the dining room at approximately 12 o’clock when the meal was served at 12:30. By this time some people were restless and it is advisable that the home considers reducing the time between sitting and serving the meal. We spoke with residents who were seated and asked what they were having for dinner. People did not know what was on the menu and there was nothing in the room displaying the meals for the day as a reminder. The manager later showed us some menus that are being developed using pictures of meals so that people can make a meaningful choice about the food they would like to eat. The manager said there are plans to place menus on the tables. The meal served looked appetising and people appeared to enjoy the food. There was a choice of two meals and puddings. Residents spoken with said the food was good and they always enjoyed it. We spoke with the cook who was able to demonstrate that people’s special dietary requirements were catered for. When we asked for a record of people’s dietary intake, the cook said the records were not retained for any length of time. We also looked in care records and found that there was inconsistent recording of dietary intake. The home is required to maintain records of people’s dietary intake. Hickling House DS0000027434.V374595.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. People are protected by the homes policies and procedures in relation to safeguarding. Staff are trained and people know who talk to if they have any concerns. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy and procedure that is included in the service users guide. Complaints and suggestions leaflets are located by the visitors signing in book and provide people coming into the home with information about how to make a complaint if they wish to do so. Residents spoken with said that if they were not happy with something they would tell a member of staff. Staff spoken with said they would support people to make complaints if needed by informing the manager. The manager said that no complaints have been made since the last inspection. Staff have been trained in safeguarding and refresher training is planned for this year. One member of staff interviewed knew how to deal with any issues concerning the protection of vulnerable adults. Hickling House DS0000027434.V374595.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is adequate. People living in the home have a comfortable clean environment in which to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On entering the home it appeared clean and tidy. There are several communal rooms that cater for people’s various needs and requirements. For instance there are three lounge areas, one with a conservatory attached and a dining room where many people like to sit. The décor, furnishings and fittings are reasonably good but some areas are in need of refurbishment. For instance, the carpet in one of the lounges needs replacing as it is worn and has some ridges in it, which may present a health and safety hazard. Hickling House DS0000027434.V374595.R01.S.doc Version 5.2 Page 17 There is some signage around the home to support people to orientate independently around the home. However, this could be improved by providing directional signage to the lounges and other parts of the home. Some bathrooms were not signposted. However, each bedroom door had a laminated card on it showing pictures that aid recognition of people’s rooms. For instance, old photographs of family members or pets. Resident’s bedrooms appeared homely and there were lots of personal items on display in most rooms entered. In some rooms there were strong unpleasant odours but in general the home was odour free. There were some areas that required a more thorough clean and some carpets and chairs were stained in places. However, most areas of the home appeared clean and tidy. The home employs domestic staff who cover 7 days a week. Hickling House DS0000027434.V374595.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good. People living in the home can be assured their needs will be met by a team of staff with the necessary skills. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs sufficient staff to care for the number and needs of people living in the home. One member of staff interviewed said it would be beneficial to have more staff on duty in the mornings, as sometimes the numbers were low. The home has a training plan, which includes all the mandatory training and a training matrix shows training staff have undertaken to date. There are nine members of staff who have completed NVQ training and the home plans to register more staff on NVQ training in the coming year. We looked at staff files and examined the homes recruitment practice. Files were in good order and contained all the relevant information and pre employment checks. Hickling House DS0000027434.V374595.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is adequate. People can be assured that the home is adequately managed by an experienced manager. However, management systems could still be improved to ensure that aspects of the service provided are continuously monitored and improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a registered manager who has completed a registered managers award. The homes training matrix shows that the manager keeps her knowledge up to date by participating in training up dates on a regular basis. The home has a quality assurance system in place and annual questionnaires are sent to residents and relatives to provide them with an opportunity to contribute to the development and improvement of the service. Hickling House DS0000027434.V374595.R01.S.doc Version 5.2 Page 20 This inspection has identified some areas where requirements made at the last inspection have not been met. These are repeated in this report. This shows that the management and quality monitoring systems are not as effective as they should be. There are systems in place to ensure that the health and safety of people living and working in the home is safeguarded. Fire safety procedures are in place and all equipment is checked and serviced at required intervals. Hickling House DS0000027434.V374595.R01.S.doc Version 5.2 Page 21 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 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X 3 Hickling House DS0000027434.V374595.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES 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 OP9 Regulation 13.2 Requirement Full and accurate records for the administration of medicines including those prescribed with variable doses must be completed at all times when medicines are administered repeat requirement of 29/07/08 inspection remains unmet People living in the home must have their needs in respect of health, care and welfare fully assessed with a plan as to how they should be met. This must include the use of medicines prescribed for occasional (PRN) use. Repeat requirement of 29/07/08 inspection remains unmet. People living in the home must have their plans in respect of health and care needs updated to reflect changes as they occur. Repeat requirement of 29/07/08 inspection remains unmet. People living in the home must have all risks associated with daily living assessed with a plan DS0000027434.V374595.R01.S.doc Timescale for action 17/03/09 2. OP7 15.1 17/03/09 3. OP7 14.2 17/03/09 4. OP8 13.4 17/03/09 Hickling House Version 5.2 Page 23 5. OP7 12.1 6. OP15 17.2 Schedule 4.13 as to what steps should be taken to minimise the risk. Repeat requirement of 29/07/08 inspection remains unmet. People’s health and care needs must be promoted and met in accordance with care and health assessments. The home must maintain records of people’s dietary intake. 17/05/09 17/05/09 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 Refer to Standard OP15 OP19 Good Practice Recommendations The home should continue to develop menus that act as a reminder and promote meaningful choices of food. The manager should continue to develop the environment to ensure it meets the needs of people with dementia. Hickling House DS0000027434.V374595.R01.S.doc Version 5.2 Page 24 Care Quality Commission Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team 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 Hickling House DS0000027434.V374595.R01.S.doc Version 5.2 Page 25 - 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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