CARE HOMES FOR OLDER PEOPLE
Hodge Hill Grange 150 Coleshill Road Hodge Hill Birmingham West Midlands B36 8AD Lead Inspector
Amanda Lyndon Key Unannounced Inspection 6th November 2007 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 Hodge Hill Grange DS0000024855.V353565.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. Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Hodge Hill Grange Address 150 Coleshill Road Hodge Hill Birmingham West Midlands B36 8AD 0121 730 1999 0121 730 1888 hodgehillgrange@ashbournesl.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Ltd 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) Elizabeth Brown (Acting Manager) Care Home 54 Category(ies) of Old age, not falling within any other category registration, with number (54) of places Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Maximum 54 older adults, minimum age 60 years. Care Home with nursing of 51 places, personal care only up to three places. (Currently under review) 2nd June 2007 Date of last inspection Brief Description of the Service: Hodge Hill is a purpose built home providing nursing care for up to 51 and residential care for up to three persons of 65years of age or above. The Home is situated on the perimeter of Hodge Hill, within a pleasant suburb, north of Birmingham. Local amenities include shops and restaurants and there is a regular bus service for access to Birmingham City Centre. Accommodation is provided on two floors accessible by passenger lift. There are communal toilets and assisted bathing facilities strategically located throughout the premises. The Home has an adequate range of pressure relieving equipment and lifting aids to assist with mobilisation and transfers. Bedrooms are single occupancy with en-suite facilities consisting of toilet and wash hand basin. Each floor has two lounge/dining rooms with kitchenette and there is an additional lounge located on the ground floor. Residents are no longer permitted to smoke within the building. The large and airy reception area has comfortable seating and is frequented by residents. The pleasant garden is located at the side and rear of the premises, which is used by residents and visitors. Upgrading work is currently being undertaken in this area so that it is a safe facility for residents to enjoy. A drive enables access to the front of the premises and there is sufficient off road parking for up to ten vehicles to the rear of the building. There is a notice board displaying forthcoming events and other information of interest to residents and their visitors. Copies of our most recent inspection report and newsletter are available. Current fee rates are not included in the statement of purpose or service user guide but can be obtained from the Home. Additional charges include hairdressing, toiletries, newspapers/magazines and private chiropody. Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of our inspection is upon outcomes for people who live in the Home and their views of the service provided. This process considers the Care Home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Information obtained and used in the planning of this field work visit included Regulation 37 notification reports of any accidents or incidents involving residents and a number of complaints, concerns and allegations that had been raised about the care provided at the Home. The deputy manager had completed a self- assessment document, giving some information about the Home, including information about residents and staff which was also taken into consideration. Prior to the visit questionnaires had been sent to residents and their relatives. Positive comments received included: “The nurses are very dependable” “My Father expresses much enjoyment of the food provided” “More meetings are held for relatives to air their views now. Nurses tell me of problems concerning my father” “My father is treated courteously, only medicated to the absolute necessary degree and well fed. Actual nursing care is good, so is the food”. “They have always looked after my mother well. The care ladies always help if Mom or myself have a problem” A number of negative comments were received including: “The standard of care has changed since Mom first came to stay. The care assistants are very dedicated but they are very short of staff most of the time.” “My father gets bored. I wish the carers had more time to chat to him but they seldom do” “Décor is becoming shabby in some areas. More staff are needed. More cleaning would be appreciated, standards are not as high as two years ago” “Staff never have time to take me to the toilet when I want to go” “We go for days with nothing to do. The activities person has to do other things. Weekends are bad there is never anything at all. If the activities person is away or on holiday then we do without until she gets back, it can be for weeks so we just sit and look at the wall” “There are not enough staff and those that are there are not happy and it shows. All that’s asked for is basic care.” “The home needs continuity of care. Frequent change of manager, nurses, staff”. Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 6 “More team working needed, retention and training of staff needed”. The field work visit referred to in this report was undertaken over one day by two Inspectors when there were forty seven residents living at the Home, three of these people were in hospital. The Home was not aware that we were visiting. Information was gathered by speaking with residents, visitors, the deputy manager, project manager and nursing and care staff. An additional method of obtaining information was “case tracking” four residents in order to establish their individual experiences of living in the Care Home. This involved meeting and observing them, discussing their care with staff, looking at care files and focussing on their outcomes. A partial tour of the Home relevant for these people was also undertaken. Tracking residents’ care helps us understand their experiences. At the end of the visit feedback was given to a member of the senior management team and the serious shortfalls in residents’ care identified during the visit were discussed at this time. No immediate requirements were made on the day of the visit however following the visit a statutory notice was sent to the Organisation with regard to ongoing serious concerns about the Home’s failure to provide satisfactory care to residents in respect of wound care. A prompt response was received from the Organisation about this advising that they would ensure that residents received a good standard of health and personal care. What the service does well:
Service user guides are informative and are available on audio cassette on request so that people who are unable to read can access the information. There is a copy of the service user guide in residents’ bedrooms so that they can refer to the information whenever they choose to do so. Residents have the option of retaining their own Doctor on admission to the Home (providing the Doctor is in agreement). Residents have the option of having a key for their bedroom doors so that they can keep their personal items secure. A pay phone is available in the quiet lounge for residents to make calls in private if they wish to do so. A newsletter has been produced and is available for anyone interested to read. Residents’ individual religious beliefs and cultural preferences are respected and opportunities for religious worship are provided as requested. There is an open visiting policy and residents have the choice of where they entertain their guests so that they can meet in private if they wish. Residents are able to exercise control over their daily lives and this promotes their independence and individuality. There are no rigid rules or routines at the
Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 7 Home and residents can choose where they spend their day. One resident said “The staff take me to bed after tea, this is what I like so I can watch TV”. Residents are served a variety of healthy meals that meet any special dietary requirements for reasons of health, cultural background or taste. One resident said “ I like old English food. If they bring me something I don’t like they get something else”. The gender mix of care staff reflects the gender mix of residents so that care should be provided in an understanding manner. Maintenance records are well maintained and equipment is serviced regularly in order to ensure that it is safe to use. Alarm pads are used for residents deemed to be at risk of falling in order to alert the staff team if they get out of bed on their own, thus prevent the risk of accidents occurring. What has improved since the last inspection?
Prior to coming to live at the Home assessments of prospective residents’ care needs are undertaken in order to determine whether they can be met living at the Home. Improvements have been made regarding the administration of medication so that residents should receive their medication in a safe manner. The complaints procedure is now produced in a large print format so that it is easier for people with impaired eyesight to read. The number of complaints received about the Home have reduced recently however a number of concerns are ongoing. The systems in place for pre recruitment checks on all prospective staff members are robust so that residents should be safeguarded. The garden area is currently being upgraded in order to provide a safe and attractive facility for residents’ use. There is a rolling programme of staff training in health and safety issues in place. Staff that are due to attend refresher training are identified in order to ensure that they attend the relevant training. Residents and relatives are invited to regular group meetings in order to put forward their views about the service provided and any suggestions for improvements. Communications between relatives and the Home’s staff have improved so that important information is conveyed between them. Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 8 What they could do better:
The statement of purpose and service user guide should include detail of the costs involved in living at the Home so that prospective and existing residents are aware of this information. Residents must be involved in the planning and reviewing of their care so that they should receive support in the ways that they prefer based on their current care needs. This information must be included within the care plans. Written records regarding food, fluids and position changes must be kept in order to monitor that residents are receiving the appropriate care and support at the times they require. Nursing staff must ensure that they follow the instructions given by Health Care Professionals in respect of wound care and nutrition in order to promote the health and well being of residents. Staff must obtain medical advice at all required times in order to maintain the health and well being of residents. Any delays in obtaining specialist equipment for residents must be followed up in a timely manner in order to promote the health, safety and welfare of residents. Staff must ensure that residents receive assistance to maintain their personal hygiene to an acceptable standard and written records to evidence this must be kept. Arrangements should be made to ensure that all staff are aware of the importance of hand washing in order to prevent the spread of infection at the Home. Arrangements must be made to ensure that residents are supported at mealtimes in a dignified manner. Residents should be encouraged to choose the foods that they would like to eat from the menu choices available. Residents should be able to exercise control over portion sizes and condiments added to their meals. Activities and excursions should be provided that meet the needs and expectations of all residents living at the Home. One resident said “We had bingo twice last week, there is few trips”. All incidents of a possible adult protection nature must be reported to the appropriate authorities without delay in order to protect residents. Arrangements should be made to improve the standard or decoration and state of repair of a number of communal areas throughout the Home. A dining facility should be provided so that all residents who choose to do so can dine together. One resident said “it’s not a happy place here, it’s not a social place”. Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 9 Staff interactions with residents were minimal unless required to do so to perform a task. This does not promote a happy living environment for residents. A report based on the findings of quality monitoring at the Home must be available for residents to view so that they are aware of any actions to be taken and the time scales in which the issues are to be addressed. Any suggestions put forward by residents and their relatives should be acted upon in order to improve outcomes for residents living at the Home. Arrangements must be made to ensure the safety of residents whilst in the main lounge. A review of staff allocation and daily routines must be undertaken in order to improve staff availability so that residents receive care, supervision and support at the times they require. One relative said “There is not enough staff to do what you want them to do, they are rushed off their feet. The carers are very good, it’s not their fault but the residents don’t get the care. I have raised concerns with the social worker.” All new workers must receive initial induction training on the first day of employment in order to work in a safe manner. In order to maintain the health and safety of residents, wheelchairs must not be used without foot plates unless a risk assessment states otherwise. 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. Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 10 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 Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Admission processes are generally thorough and prospective residents have enough information in order to decide whether they would like to live at the Home. The Home does not always identify the full extent of new residents’ care needs and this could place their safety and well being at risk. EVIDENCE: The statement of purpose was available in the Home for prospective residents and their families to refer to. The service user guide had been updated recently and was both informative and easy to read. Copies were available in residents’ bedrooms and on audio cassette for people unable to read the information. Senior staff undertake pre admission assessments for prospective residents in order to establish whether their care needs could be met at the Home. A pre
Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 12 admission assessment sampled during the visit that had been undertaken recently included detail about the person’s preferences in respect of their daily life and health care details, however did not identify the assistance required to safely transfer him within the Home. For example it did not identify that hoisting equipment was required for this person. This may prevent the appropriate specialist equipment from being obtained prior to new residents coming to live at the Home. The deputy manager stated that there are currently eight residents living at the Home with dementia as a secondary care need. A number of staff had undertaken recent training in this area so that they should have the necessary skills and knowledge to provide a good standard of care. Intermediate care is not provided at Hodge Hill Grange. Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 13 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 poor. This judgement has been made using available evidence including a visit to this service. Care planning, health provision and care delivery is very poor and this has a negative effect on the health and well being of residents living at the Home. Residents’ health and well being had as a result of poor practice been compromised. Overall, the arrangements for medication administration were satisfactory with residents receiving medication at the times that they require. EVIDENCE: Assessments of residents’ individual physical and social care needs are undertaken on admission to the Home and care plans are derived from this information. These are individual plans that should be written with the involvement of residents or their representatives that outline the specific support required by staff in order to meet their personal and health care needs in the ways that they prefer. One relative said “I have seen my Mother’s care plan”.
Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 14 A number of care plans included good information about the specific support required by nursing and care staff in order to meet residents’ needs, however others had not been personalised and did not include detail of their preferences in respect of their daily lives. A number of care plans had not been updated and therefore did not reflect the current care needs of individual residents. Care plan evaluations did not always reflect the actual care afforded and any changes to the original care plan. A number of written records in respect of fluid and food intake and change of position were poorly completed and it was not always possible to determine whether individual residents received diet, fluids and care at the times that they required. A number of residents were deemed to be at risk of weight loss however written records did not always evidence that additional snacks and nutritional supplement drinks were given as instructed by the Dietician. The Chef stated that she added extra calories to the food of these residents. During the visit it was of concern that a carer was attempting to feed lunch to a resident who had weight loss without positioning her in a suitable position whilst in bed. As a result of this the carer stated that the resident had “only eaten four or five mouthfuls”. For the past three months this resident was being nursed on a normal divan bed without the use of a head rest or pillow wedges in order to make her more comfortable. A pressure relieving mattress was in place however the bed was not of an adjustable height and this poses a risk to the health and safety of the staff team providing care for her. This was brought to the attention of the project manager. On a positive note, the project manager immediately discussed this with her line manager and a specialist “profiling” bed was ordered for this resident without delay so that she could be more comfortable whilst in bed. This may also encourage her to eat her meals as she could be positioned correctly in order to do so. Prior to the visit a concern was raised regarding another resident who had waited an unacceptable length of time for a “profiling” bed to be delivered. This was still not available on the day of the visit and the project manager advised that she would chase this up. Written records regarding personal care afforded did not always identify that residents were receiving a sufficient number of full body washes, baths or showers. Records identified that one resident had not received a wash on five occasions in August 2007. Daily reports were repetitive and did not include detail of the social activities that residents had participate in during that day or any emotional support given. During previous visits and since our last visit the Tissue Viability Team have raised three concerns about wound care provided at the Home. This includes the wrong choice of wound dressing being used, wound dressings being applied incorrectly and the Home’s staff failure to follow their instructions. A number of these issues had been investigated by the Organisation and the outcomes were not always conclusive. During the visit we saw that the staff had failed to use
Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 15 the appropriate pressure relieving equipment whilst a resident was in bed despite clear written instructions from the Tissue Viability Nurse being available. This may have resulted in the deterioration of the condition of the wound and does not uphold the health and well being of the resident. On the day of the visit three residents had pressure sores (skin wounds). One care record identified that a resident had sustained a small sore on her toe and that it may have been due to a traumatic injury. Whilst the injury was examined by her Doctor, there was no evidence that the cause of this had been investigated. Due to the serious nature and the Home’s failure to improve in this area, following the visit we sent a statutory notice in order for the Home to demonstrate how they will make significant improvements regarding wound care for the benefit of the residents living there. The deputy manager stated that the Tissue Viability Nurse had met with some of the staff team and further training in this area will be arranged. It must be noted however that during the visit one wound care plan sampled included good detail of the specific care to be provided and there was evidence that the appropriate equipment was being used for this resident. Care reviews are undertaken involving residents, their representatives, social workers and the Home’s staff. This provides all present with the opportunity to put forward their suggestions for improvements or amendments needed regarding the care provided. Residents have access to a variety of Health and Social Care Professionals including Opticians, Dieticians, Specialist Nurses and Chiropodists. Residents have the option of retaining their own General Practitioner on admission to the Home (if the GP is in agreement). It was of concern that there was no written evidence that professional advice had been sought in respect of a resident who was experiencing difficulties with urinary catheterisation and it was apparent that there had been a delay in obtaining a diagnostic test for this person. Systems in place for the management of medication were good and medication administration charts were well maintained. Stock balances of medication sampled on the day of the visit were correct with the exception of a drug that had not been signed for on administration on one occasion. Residents have the option of having a key for their bedroom doors so that they can keep their personal items secure. The preferred names of residents were recorded within their care plans and staff were observed greeting them by these names. A pay phone was available in the quiet lounge for residents to make calls in private if they wished to do so. Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 16 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 poor. This judgement has been made using available evidence including a visit to this service. Current arrangements for activities are very limited and as a consequence do not meet the needs, expectations and interests of residents. Failure to provide the required support for residents during meal times does not respect and promote their dignity or health. EVIDENCE: The post of activity organiser was currently vacant however a new person was due to start within this role in the near future. In the interim, all staff were responsible for organising activities, however there were no activities arranged on the day of the visit. The activity programme on display was out of date and on the day of the visit residents sat for long periods of time in either one of the lounges or in their bedrooms with nothing to do. One resident said “We had bingo twice last week, there is few trips”. Another resident said “it’s not a happy place here, it’s not a social place”. Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 17 Written records in respect of activities provided included detail of the individual preferences of residents regarding their hobbies and interests. Recent activities included manicures, quizzes, anagrams and skittles. A hairdresser visits the Home regularly. The latest copy of the Home’s Newsletter was on display for residents and their visitors to read. This included interesting information about our last visit, the Home’s improvement plan and puzzles for residents to enjoy. Residents’ preferences regarding their religion are supported and respected and church services and Holy Communion are held at the Home regularly. Residents of non Christian faiths are also supported at the Home. Since our last visit communication between the Home’s staff and relatives has improved. Written records are kept within the care plans evidencing that relatives are kept informed about residents’ care and a copy of a complaint received about staffing levels with the response from the Organisation was on display in the Home. There is an open visiting policy and residents have the choice of where they entertain their guests so that they can meet in private if they wish. Residents confirmed that they could exercise control over their daily lives and choose how they spend their time. One resident said “The staff take me to bed after tea, this is what I like so I can watch TV”. Menus identified a choice of nutritious meals and both hot and cold menu options were available at meal times and a snack meal was available at bed time. There were a variety of dishes available that should meet the individual tastes of residents. One resident said “ I like old English food. If they bring me something I don’t like they get something else”. Special diets can be prepared for reasons of health or cultural/religious preferences. Fresh fruit was not readily available for residents on the day of the visit. The main lunch time options on the day of the visit were either roast chicken, stuffing and vegetables or cheese and onion flan with salad. Staff stated that normally they would refer to a meal option list that was complied as a result of asking each resident what they would like to eat, however this list had been “mislaid” on the day of the visit. Despite this, none of the residents in the ground floor lounge were asked what they would like to eat, residents were not able to exercise control over portion sizes and condiments were not available. The portions of the pureed diet were served separately so that residents could experience the tastes and textures of each portion and plate covers were used so that food should be served at the correct temperature. Two carers were assisting residents with their lunch wearing plastic gloves. This is not deemed to be necessary and does not uphold residents’ dignity. Despite staff being present in the dining area, one resident had been left to feed himself and it was evident that he was having difficulty doing this. He had not been encouraged to use the appropriate cutlery and a plate guard had not
Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 18 been used, the result being that he was unable to eat his meal and most of the food was on the dining table. Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 19 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 poor. This judgement has been made using available evidence including a visit to this service. Residents and their visitors are now encouraged to put forward their views about the care and service provided however ongoing concerns must be addressed in order to improve residents’ overall quality of life in the Home. Failure to report incidents of an adult protection nature does not safeguard residents. EVIDENCE: A number of “Thank You” cards were on display in the Home about the care provided. A comprehensive complaints procedure was on display in a large print format so that it was easy for all residents and visitors to read. The complaints register included detail of all complaints received by the Home and there was evidence that investigations in to these had been undertaken. Since our last visit the senior management team have strived to be open and transparent in order to resolve any issues raised in a timely manner. As a result of this the number of complaints made about the services provided at the Home have reduced recently however trends regarding ongoing concerns were apparent. For example, since our last visit concerns have been raised about the management of continence, wound care, nutrition and poor staff attitude.
Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 20 Since our last visit a number of allegations of an adult protection nature had been raised and investigated by both Social Care and Health and the Organisation in order to safeguard residents. The majority of staff had undertaken recent training about the protection of vulnerable adults and a copy of the local multi agency guidelines in respect of safeguarding was available so that staff should have knowledge about who to contact in the event of any alleged or actual abuse. This information must now be put into practice. During the visit it was of serious concern that we sampled a care record that identified that a resident had been found in a potentially life threatening situation and there was no evidence that the appropriate authorities had been notified about this and a risk assessment had not been undertaken. We brought this to the attention of the Organisation and Social Care and health in order to ensure the safety of this resident. Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 21 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, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are provided with a generally clean, comfortable and homely place in which to live. However, there are a number of identified areas that require improvement in order to provide good quality facilities in all areas of the Home. The lack of communal dining seating does not promote sociable living for residents if they choose to use this facility. EVIDENCE: The reception area of the Home was warm and inviting and decorated to a good standard. The external garden was currently being upgraded to create raised flower beds and an extended patio area for residents to enjoy.
Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 22 There were a number of communal lounge/diners throughout the Home, however a designated dining room had not been created. As a result of this residents were not encouraged to eat together and individual tables were used for this purpose, residents being sat wherever they had spent their morning or afternoon. Dining seating was available for a maximum of twenty seven residents however the largest room with enough seating for seventeen residents was not in use. The project manager said that she would address this. One resident said “I’d sooner sit at my own table instead of the dining table”. A number of areas throughout the Home were in need of redecoration and the kitchenettes were in need of refurbishment. A number of carpets were badly stained and in need of replacing in order to improve the living environment for residents. Hand washing facilities were available throughout the Home however we observed a carer failing to wash her hands in between caring for two residents (after removing protective gloves). This is considered to be poor practice and may result in cross infection. There is an effective system in place for the hygienic washing of residents’ personal clothing and bed linen. Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 23 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 poor. This judgement has been made using available evidence including a visit to this service. The arrangements for staffing the Home are of concern. Matters raised include staff availability and poor attitude and this will prevent residents from receiving the care and support that they require in a timely and respectful manner. Staff recruitment procedures are robust and this should safeguard residents. Failure to provide new workers with induction training does not uphold the health and safety of residents. EVIDENCE: The deputy manager stated that there are two registered nurses and eight care assistants on duty from 8am to 8pm and two registered nurses and four care assistants on duty from 8pm to 8am. Staffing rotas identified that on occasions one less care assistant was on duty however this was during periods of time when there were empty bedrooms at the Home. The deputy manager stated that the need for agency staff had reduced recently as there were currently no care staff vacancies. This should promote continuity of care for residents. Housekeeping and kitchen staff provide ancillary support so that residents should be assisted in all aspects of their daily lives. Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 24 The gender mix of staff reflected that of the residents living at the Home so that care should be provided in an understanding manner. One resident joked “ The nurses look after me. I really like the staff. I’m not sure if they like me though as I play them up! They had to chase me in my scooter!” Prior to the visit a concern was raised about the lack of staff in the main lounge on one occasion and this is currently being investigated by the Organisation. Prior to the visit concerns were raised about the lack of staff available on occasions. One relative said “There is not enough staff to do what you want them to do, they are rushed off their feet. The carers are very good, it’s not their fault but the residents don’t get the care. I have raised concerns with the social worker.” During the visit we spent time in the ground floor lounge examining records. It was noticeable that staff interactions with residents were minimal unless required to perform a task. This does not promote a homely atmosphere at the Home. Staff recruitment files sampled included all information required by regulations and new workers sampled were deemed to be safe to work with vulnerable people prior to coming to work at the Home. All new workers should undertake comprehensive induction training however it was of concern that on the day of the visit, day one of the induction record for a new worker had not been completed. This may result in unsafe work practices. Staff had undertaken recent training relevant to their job roles including male urinary catheterisation, infection control, basic stoma care, tissue viability, moving and handling, basic food hygiene and managing challenging behaviour. 53 of care staff had achieved a minimum of NVQ level 2 in Care. A number of staff are due to undertake fire safety training and this was scheduled. In addition a number of these people had participated in fire drills so that they should have the necessary skills and knowledge to act safely in the event of a fire. Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 25 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 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. This Home is in need of effective day to day management in order to lead the staff team and improve the outcomes for the residents living there. Residents and relatives are not confident that concerns they raise or suggestions put forward will be acted upon. Health and safety checks of equipment ensure that they are safe to use. EVIDENCE: The home manager had been in post for a short period of time and was not available on the day of the visit. The Organisation had arranged for senior managerial support to be provided for the deputy manager whilst the home
Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 26 manager was away. The home manager holds a “monthly surgery”, giving anyone who wishes to speak with her the opportunity to do so, however she is also available to speak to at other times. One relative said “The new manager will always come to speak to us”. Quality monitoring visits are undertaken regularly by senior external managers in order to improve the services provided at the Home, however despite this support, it was evident that a number of day to day concerns about the Home were ongoing. The minutes of a previous residents/relatives meeting dated was on display for residents, visitors and staff to read. The minutes of the most recent residents/relatives meeting (dated 27 September 2007) was not on display however was available in the Home. Discussions included the poor outcome of our previous visit and the plans in place to address these shortfalls. One resident commented that residents were not offered assistance at mealtimes and that meal choices were not explained to them. Concerns were also raised about the poor attitude and availability of staff on occasions and it was disappointing that these issues had not been resolved at the time of our visit. One resident said “My family come to the residents’ meetings with me”. Service satisfaction questionnaires had been sent to residents in order to obtain their views about living at the Home. Unfortunately we were unable to determine when these had been distributed as they were not dated and a report based on the findings of these had not been written. There had been no changes regarding the management of residents’ money since our last visit. This was a computerised system that identified the money held for each individual resident. The project manager stated that plans were in place to change this system. Accident records were generally well maintained and included detail of actions taken as a result of accidents involving residents. Alarm pads are used for residents deemed to be at risk of falling in order to alert the staff team if they get out of bed on their own. During the visit we observed a resident being transferred in a wheelchair without the foot plates in use and this may result in an injury being sustained. This was brought to the attention of the staff team who confirmed that it was the resident’s choice not to use the foot plates, however written documentation and a risk assessment in respect of this was not available. Maintenance records were well maintained and equipment was serviced regularly in order to ensure that it was safe to use. Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 27 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 2 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 2 2 x x x x 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 2 Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 28 Yes 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 OP3 Regulation 14(1) Requirement Pre admission assessments must include details of any specialist equipment used by individual residents in order to ensure that this is available for use at the Home prior to admission. Each resident must have an up to date care plan outlining the specific support required by staff in order to meet their care needs in the ways that they prefer. Timescale for action 15/12/07 2 OP7 15(1) 31/01/08 3 OP7 12(1) Time scale of 30/08/07 not met Comprehensive records must be 15/12/07 kept in relation to food, fluids and position changes so that care can be monitored effectively and the appropriate care provided based on the monitoring of these needs. Time scale of 30/07/07 not met Recommendations made by external health professionals to ensure the health and well being of residents must be followed in a timely manner; this will ensure that best practice and care is provided appropriately to meet
DS0000024855.V353565.R01.S.doc 4 OP8 12(1) 03/12/07 Hodge Hill Grange Version 5.2 Page 29 the residents needs. This refers to tissue viability and nutrition. 5 OP8 12(1) Time scale of 30/07/07 not met Arrangements must be in place to ensure that staff obtain medical advice at all required times in order to maintain the health and well being of residents. Any delays in obtaining specialist equipment for residents must be followed up in a timely manner in order to promote the health, safety and welfare of residents. Arrangements must be in place to ensure that residents are supported to maintain their personal hygiene to an acceptable standard in order to promote their health and dignity. Arrangements must be made to ensure that residents are supported at mealtimes in a dignified manner. Systems must be in place to ensure that all appropriate authorities are informed about any incidents of a safeguarding nature in order to protect residents from harm. 15/12/07 6 OP8 12(1) 15/12/07 7 OP8 12(1) 15/12/07 8 OP15 12(4) 15/12/07 9 OP18 13(6) 15/12/07 10 OP27 18(1) 11 OP30 18(1) Timescale of 15/07/07 not met A review of staff allocation and 31/12/07 daily routines must be undertaken in order to improve staff availability so that residents receive care, supervision and support at the times they require. Systems must be in place to 31/12/07 ensure that all new workers have the necessary skills and knowledge to work in a safe manner. Time scale of 15/12/06 and 30/07/07 not met Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 30 12 OP38 13(5) Arrangements must be made to ensure that all moving and handling equipment is used correctly unless a risk assessment states otherwise in order to safeguard residents. 15/12/07 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 OP1 Good Practice Recommendations The statement of purpose and service user guide should include detail of the costs involved in living at the Home so that prospective and existing residents are aware of this information. Daily reports should include detail of how the social and emotional needs of residents have been met in order to review the care provided. Activities and excursions should be provided that meet the needs and expectations of all residents living at the Home. Residents should be encouraged to choose the foods that they would like to eat from the menu choices available. Residents should be able to exercise control over portion sizes and condiments added to their meals. Arrangements should be made to improve the standard or decoration and state of repair of a number of communal areas throughout the Home. A dining facility should be provided so that all residents who choose to do so can dine together. Arrangements should be made to ensure that all staff are aware of the importance of hand washing in order to prevent the spread of infection at the Home. Arrangements should be made to ensure that all staff are aware of the importance of good interactions with residents in order to promote homely and happy living environment for residents. Arrangements should be made to ensure that any improvements to work practices are maintained and any suggestions put forward by residents and their relatives are acted upon in order to improve outcomes for residents living at the Home.
DS0000024855.V353565.R01.S.doc Version 5.2 Page 31 2 3 4 OP7 OP12 OP15 5 6 7 8 OP19 OP20 OP26 OP27 9 OP31 Hodge Hill Grange 10 OP33 11 OP35 A report based on the findings of service satisfaction questionnaires should be written so that residents and relatives are aware of any actions to be taken. This should include time scales for the actions to be taken. All financial transactions of residents’ personal monies should include two signatures in order to safeguard both residents and staff. Not assessed on this occasion Hodge Hill Grange DS0000024855.V353565.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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
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