Inspection on 28/04/05 for Homefield House Nursing Home

This inspection was carried out on 28th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Homefield House Nursing Home 03/10/06

Homefield House Nursing Home 05/10/05

Homefield House Nursing Home 01/12/04

Homefield House Nursing Home 14/07/04

Homefield House Nursing Home 10/10/03

Homefield House Nursing Home 22/07/03

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

CARE HOMES FOR OLDER PEOPLE Homefield House Nursing Home Homefield Way Basingstoke Hampshire RG24 9HX Lead Inspector Anita Tengnah Unannounced 28/4/05 10.00am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Homefield House Nursing Home H54 S12132 Homefield V224064 280405.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Homefield House Nursing Home Address Homefield Way, Basingstoke, Hampshire, RG24 9HX Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01256 333433 Shaw Healthcare (Homes) Limited Teresa Anne Mary Packer CRH 24 Category(ies) of DE Dementia-24, MD Mental Disorder- 24 registration, with number of places Homefield House Nursing Home H54 S12132 Homefield V224064 280405.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: N/A Date of last inspection 1-12-2004 Brief Description of the Service: Homefield House is a registered care home providing nursing and personal care for 24 service users in the older person category. the home is situated on the outskirts of Basingstoke and has no amenities close by. Accommodation is all provided on ground level and divided into 4 units. the home has 2 shared rooms and 20 single rooms.there is a variety of aids to assist mobility of service users. The home has adequate communal space and enclosed gardens that are safe and accessible to service users. Homefield House Nursing Home H54 S12132 Homefield V224064 280405.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection was undertaken over one day on 28th of April 2005.As part of the inspection process a tour of the building was undertaken and the inspection took place over 6 hours. The inspector spoke to 5 relatives and 6 staff members and the manager. Care practices were observed; as service users could not actively participate in the inspection process due to their conditions. The process also included examining care plans, service users and staff records and discussions with relatives and staff. What the service does well: What has improved since the last inspection? A programme to refurbish some of the communal bathrooms and shower facilities has commenced. Staffing level with regards to 1 service that requires 1:1 care has been reviewed. Two of the bedrooms have been redecorated and the home has employed a maintenance person. Equipment for the safe manual handling of service users are reviewed and a hoist is being replaced. Homefield House Nursing Home H54 S12132 Homefield V224064 280405.doc Version 1.30 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. Homefield House Nursing Home H54 S12132 Homefield V224064 280405.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Homefield House Nursing Home H54 S12132 Homefield V224064 280405.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3,6 The manager assesses service users prior to admission. The lack of family/ carers involvement in the pre assessment process may not identify all the care needs due to their dementia. EVIDENCE: The manager undertakes pre-admission assessments of service users and service users are admitted from the local NHS trust unit. Domiciliary visits are undertaken for service users admitted for respite care. Prospective service users do not visit the home due to their frailty and mental health condition. However family are given the opportunity to attend the home and information is supplied as per the statement of purpose. Records of the pre-assessment were maintained and assist in the formulation of care plans. Service users are not able to participate in the assessment due to their dementia, the home needs to ensure that family/ carers are involved in the pre- assessment process in order to gain all the information as required. This would further help in the care planning process and ensuring that the home can meet the needs of the service users. The home does not provide intermediate care. Homefield House Nursing Home H54 S12132 Homefield V224064 280405.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,9 There has been improvement in care plans. Risk assessments reviews are inadequate as these do not correlate with care plans. The procedures for recording of all medication received are inadequate as not all are recorded on the MAR sheets. EVIDENCE: Individual care plans were available and some improvement has been achieved. Plans were reviewed regularly including nutritional assessments. However risk assessments were not updated in particular with regards to falls. Further development of risk assessments is required, as these were not were not current and did not correlate with care plans. A service user with history of falls record showed that risk assessment was last reviewed in September 2004. Another service user that smokes, risk assessment was reviewed in September 2004. Another service user was identified as having a tendency to constipation; there was no care plan to demonstrate how this was being managed. Taken into account the mental health status of service users, a personal profile would enhance the care delivery. These were blank and not consistent in 2 Homefield House Nursing Home H54 S12132 Homefield V224064 280405.doc Version 1.30 Page 10 care plans seen. Evidence of relatives’ involvement in the formulation of care plans was not lacking. The home has a policy for the administration of medicine. There was no service user receiving controlled drug at present. Record of medication administered was seen. This was satisfactory except for 1 service user that had ointment in her room that was prescribed on MAR sheet. The procedures for receipt of medication was inadequate as some of these were not recorded on the MAR sheets for three service users. The fridge temperature should record the minimum and maximum temperature to ensure that they are maintained at the correct temperature. This was discussed with the nurse in charge as only one reading was available. Homefield House Nursing Home H54 S12132 Homefield V224064 280405.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15 Social activities and meals are well managed and provide daily variation for service users. Links with the local community are maintained. EVIDENCE: A number of visitors to the home were spoken to as part of the inspection. Positive comments were received regarding the care and the commitment of staff in enriching the lives of people living at the home. The home has an open visiting policy and relatives reported that they could approach staff with any issues and feel confident that these will be addressed. Comments included that “I can come in anytime”. “The staff are very good “. Another service user that has returned to the home following a hospital admission reported that care was good and that it was a relief to be back. It was difficult to gain response from service users due to their mental incapacity, however practices observed show that staff had developed good relationship with service users. The home maintains link with the local church. A visitor from the church was at the home visiting 2 service users and attends the home every Thursday and administer communion to 2 service users. He commented that staff were welcoming and service users well cared for. The local priest also visits on Saturdays and gives communion to other service users. Homefield House Nursing Home H54 S12132 Homefield V224064 280405.doc Version 1.30 Page 12 Meals were observed at lunchtime. Staff were available to offer assistance in a sensitive manner. Meals appeared well balanced and nicely presented. Hot and cold drinks are available at all times. Each unit has its own kitchenette that staff commented is in constant use. Daily activities are organised by staff and a list of activities was displayed. The manager commented that this system appears to work well and forms part of the continuity of care. Activities were planned as 1:1 to include aromatherapy to group activities such as cake baking. Homefield House Nursing Home H54 S12132 Homefield V224064 280405.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Relatives spoken to are confident in using the complaint procedure and feel that their complaints are managed adequately. The procedure for Adult Protection is understood by staff who felt able to implement the procedures for the safety of service users. EVIDENCE: The home has a complaint policy and procedure. A complaint log was maintained. Relatives spoken to said that they felt confident in approaching the staff if dissatisfied and that the manager was always available. The home has received a number of compliments cards/ letters from relatives regarding the care provided. The Hampshire Adult Protection procedure was in place. The manager is aware of the procedure and need to record all allegations of abuse and to report to the appropriate authority. Staff spoken to were also aware of the procedures and felt confident in evoking the procedure as required. Homefield House Nursing Home H54 S12132 Homefield V224064 280405.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,21,24, Some improvements to the décor have been made. The outstanding matters regarding the bathroom and shower facilities do not provide service users with safe and comfortable surrounding. Service users bedrooms are personalised, the lack of screen in shared bedrooms does not promote the privacy and dignity of service users. EVIDENCE: A programme of redecoration has started and two service users bedrooms have been completed. 2 Shower units and 1 bath have been refurbished and these were tastefully done, clean and good flooring that are easily cleaned. However the remainder of showers and baths remains outstanding and are in very poor state of repair. Relative spoken to were dissatisfied with the baths and showers that remain in urgent need of refurbishment. Shower unit were rusty and impersonal and water continues to leak outside the shower trays that pose risk to service users and staff. The bathroom floors are stained and difficult to keep clean. This may pose an infection control risk. Homefield House Nursing Home H54 S12132 Homefield V224064 280405.doc Version 1.30 Page 15 On a tour of the building the inspector found that most of the bedrooms were personalised. Call bells access point was available but not all service users had access to call bells that would be appropriate to their needs. This was discussed with the manager and review is required. One shared room did not have screen available at the time of the inspection. The manager reported that this was following the room being decorated. Screens must be available in all shared rooms to promote and respect the privacy and dignity of service users using these rooms. A programme to fit locks to service users bedrooms is ongoing. There are 9 rooms that remain outstanding at the time. Homefield House Nursing Home H54 S12132 Homefield V224064 280405.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29,30 The recruitment procedure ensures that service users are protected. EVIDENCE: The home has a good recruitment procedure. The manager interviews all applicants. The records of 3 staff were seen as part of the inspection. All records were maintained securely. Checks were undertaken prior to employment including CRB and POVA first checks. Staff are issued with terms and condition of employment and copy was maintained on file. The manager reported that staff undertake a 5 shift induction on commencement of employment. There was no record of this for a newly appointed member of staff’s record seen. Homefield House Nursing Home H54 S12132 Homefield V224064 280405.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,37 There are clear lines of accountability on the part of the manager. The failure to maintain appropriate record and reporting of incidents do not safeguard the welfare and safety of service users. EVIDENCE: Relatives and staff spoken to reported that they felt able to approach the manager with any concerns. She is currently undertaking further studies to enhance her knowledge. Record keeping procedures were followed and records were maintained securely. However record shows that reports of accidents/ incidents (Regulation 37) are not always sent to the Commission. As part of case tracking, the inspector noted that a service user was admitted to hospital following a fall and required sutures. This was not recorded or reported to the Commission. Another service user was admitted to hospital there is no report Homefield House Nursing Home H54 S12132 Homefield V224064 280405.doc Version 1.30 Page 18 of this. The manager must ensure that all incidents that any event that adversely affects the welfare and wellbeing or safety of a service user must be reported. Homefield House Nursing Home H54 S12132 Homefield V224064 280405.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x x 2 2 x STAFFING Standard No Score 27 x 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x x x 2 x Homefield House Nursing Home H54 S12132 Homefield V224064 280405.doc Version 1.30 Page 20 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 7 Regulation 12(1) 15(2) Requirement Risk assessments in particular with regards to falls must be reviewed regularly and care plans instigated from these assessments. Evidence of family involvement in the formulation of care plans should be in place.This is an outstanding requirement of January 05. A record of all medication received must be maintained. The showers and bathrooms that remian outstanding must be refurbished. Action plan is required with timescale. This is an outstanding requirement of August 04, January 05. Call bells must be available in all service users rooms and appropriate to their needs Scrrening must be available for all shared rooms. Records as required for the protection of service users must be maintained. Reports required under Regulation 37 must be maintained at the service and copies sent to the Commission. Timescale for action 15/06/05 2. 3. 9 21 17(1) (a) Schedule 3 13(4) (ac) 23(2) 15/06/05 15/06/05 4. 5. 6. 22 24 37 16(1) (2) 12(4) (a) 37 15/06/05 15/06/05 15/06/05 Homefield House Nursing Home H54 S12132 Homefield V224064 280405.doc Version 1.30 Page 21 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 Good Practice Recommendations Homefield House Nursing Home H54 S12132 Homefield V224064 280405.doc Version 1.30 Page 22 Commission for Social Care Inspection 4th Floor- Overline House Blechynden Terrace Southampton Hampshire National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Homefield House Nursing Home H54 S12132 Homefield V224064 280405.doc Version 1.30 Page 23 - 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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