CARE HOMES FOR OLDER PEOPLE
Homefield House Nursing Home Homefield Way Basingstoke Hampshire RG24 9HX Lead Inspector
Anita Tengnah Unannounced Inspection 5th October 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Homefield House Nursing Home DS0000012132.V256167.R01.S.doc Version 5.0 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. Homefield House Nursing Home DS0000012132.V256167.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Homefield House Nursing Home Address Homefield Way Basingstoke Hampshire RG24 9HX 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) 01256 333433 homefield-house@shaw-homes.co.uk Shaw healthcare (Homes) Limited Teresa Anne Mary Packer Care Home 24 Category(ies) of Dementia (24), Mental disorder, excluding registration, with number learning disability or dementia (24) of places Homefield House Nursing Home DS0000012132.V256167.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28th April 2005 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 with the mobility of service users. The home has adequate communal space and enclosed gardens that are safe and accessible to service users. The service is owned by Shaw Healthcare and has a contracting arrangement with the local NHS trust. Homefield House Nursing Home DS0000012132.V256167.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An unannounced inspection was undertaken over one day on the 5th of October 2005. This was the second inspection for this year. The inspector spoke to 4 relatives, 5 service users, 6 staff members and the nurse in charge. 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. A tour of the building was undertaken as part of the inspection process, as there were some requirements related to the physical environment. Comments from service users and relatives were positive and relatives expressed a high degree of satisfaction with the care that service users were receiving. What the service does well:
The home has a large communal area known as the “street” that runs through the length of the service. This is a bright and spacious and allows the service users to move freely. Seating is also provided, staff said that this was a good way to allow service users to walk freely and being observed at all times. Relatives expressed confidence in the staff and were complimentary with regards to staff commitment and attitude to the service users. Comments from relatives were that their loved ones always appeared well dressed and cared for. Other comments were that meals were always good and staff were always ready to help. Another relative commented that staff are very patient and they feel able to approach the staff with any issues. One relative said that he could not imagine his relative living anywhere else and talked about the commitment of staff in meeting the needs of his wife. Detailed care plans were in place with evidence of regular reviews in order to ensure that any changes are identified. Daily activities and meals are well managed and links with the local church are fostered for the well being of service users. The home has 4 beds that are used for respite care that provides a valuable service for service users and support relatives. The home has a robust recruitment procedure in place and ensures that service users are protected. Homefield House Nursing Home DS0000012132.V256167.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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 DS0000012132.V256167.R01.S.doc Version 5.0 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 Homefield House Nursing Home DS0000012132.V256167.R01.S.doc Version 5.0 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 the following standard(s): 1,3 The pre admission assessment and reviews are appropriate in order to ensure that service users needs are met. EVIDENCE: The manager undertakes pre assessments of service users prior to admission to the home. Prospective service users do not visit the home due to their frailty and mental health condition. The service has a contract with the local NHS trust and service users are admitted from there. The service users’ family are given the opportunity to attend the home and information is supplied as per the statement of purpose. The home provides respite care to a number of service users on a regular basis. Care plans showed that service users needs are assessed on each admission to ensure that any changes are identified and action plan put in place. Homefield House Nursing Home DS0000012132.V256167.R01.S.doc Version 5.0 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 the following standard(s): 7,8,10 The care planning is well managed with regular reviews, ensuring that the assessed care needs are met. The arrangements for meeting the health care needs are satisfactory. Practice observed and feedback received demonstrates that service users are treated with respect and their rights to privacy upheld. EVIDENCE: Individual care plans were in place to demonstrate how the assessed needs of service users will be met. Plans were detailed and assessments included mental health profiles, nutritional assessments. All were reviewed on a monthly basis. Risk assessments were available in particular with regards to falls, manualhandling and pressure sore risks. These were also reviewed at regular intervals to reflect any changes in the needs of the service users. There was some evidence that family/ advocates are involved in the formulation of care plans as service users are unable to participate in this process due to their mental health state. The care plan for one service user who was on respite care showed that the service user’s needs had been re-assessed at this current visit
Homefield House Nursing Home DS0000012132.V256167.R01.S.doc Version 5.0 Page 10 and that his daughter had been involved in the care planning. The care plans has improved since the last visit. It was evident that service users’ needs are assessed at a regular interval. The home has a weekly surgery whereby a Doctor from the trust as part of their contract sees the service users and records of these visits and any changes in treatment are maintained. Staff said that they have good relationships with the multidisciplinary team and are supported by them. Service users were appropriately dressed and appeared well cared for. It was evident from practices observed that staff and service users had good relationships. The views of a number of relatives sought supported this. Comments from relatives included ”marvellous care”. The staff are dedicated and “know the residents well”. “ My husband always looks clean and well cared for” “I cannot imagine my wife living anywhere else”. “ The staff make sure that my husband “is treated with respect”. Screens were available in all shared rooms seen. Staff was observed to knock prior to entering service users’ rooms although all the service users were in the lounge. Homefield House Nursing Home DS0000012132.V256167.R01.S.doc Version 5.0 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 the following standard(s): 12,13,15 The activities at the home are well- managed offering variety and meet the needs of service users. The open visiting policy ensures that service users maintain contact with their family and friends. The meal at the home is in general well managed. However the timing of breakfast and lunch was unsatisfactory. 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 visited at varying times during the day. 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. There is a varied programme of activities for the service users including trips out. Service users were making decoration for Halloween on the day of the inspection. Homefield House Nursing Home DS0000012132.V256167.R01.S.doc Version 5.0 Page 12 Comments from relatives included that the staff always made them welcome and kept them updated of any changes relating to the residents as required. The home has a planned menu that is rotated on a four weekly basis. The chef said that the service was in the process of reviewing the menu and seeking the views of service users/ relatives. Meals are varied, appeared nutritious and well balanced. Staff were observed to be available and offering support with meals as required. It was noted that in one unit, breakfast was being served to five service users at 10:30. This was discussed with the nurse in charge as lunch was then served at 12:00. Staff said that was due to the induction of a new member of staff in the unit on that day. This may have been a period of longer than twelve hours between the evening meal and breakfast. The manager must ensure that meal times are managed appropriately. Staff must ensure that meals are timed and managed to meet the needs of service users. Following discussion with the chef, it transpired that the home does not maintain record of any deviation from the menu. The manager must ensure that a record of all food that are provided to service users is available. Homefield House Nursing Home DS0000012132.V256167.R01.S.doc Version 5.0 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 the following standard(s): 16,18 The procedures for managing complaints and adult protection are satisfactory and ensure that service users are protected. EVIDENCE: The home has a complaint policy and procedure in place. A complaint log was maintained and showed that there has been no complaint recorded since the last inspection. The relatives of service users spoken to confirmed that they were aware of the procedure. Two of them commented that they were happy with the care. They said that they would approach staff or the manager with any issues. One complaint was received on the day of the inspection. The nurse in charge recorded this in the log and will be leaving this to the manager to investigate on her return. The home has in place the procedure for adult protection and the Hampshire Adult protection guidance. Training in adult protection and managing challenging behaviour was available the ten staff have attended in September 2005. Homefield House Nursing Home DS0000012132.V256167.R01.S.doc Version 5.0 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 the following standard(s): 19,23,26 The home is well maintained and clean. However the bedroom identified and work on the outstanding shower units do not provide service users with a safe and homely environment. Service users bedrooms suit their needs and were personalised. There are satisfactory infection control procedures in place to safeguard the welfare of service users. EVIDENCE: The environment was homely and in satisfactory state of décor. Furnishing was clean and in good condition. There is a programme of redecoration in place. The employment of maintenance personnel ensures that refurbishment is ongoing. The home was clean and there was no odour except for one bedroom where offensive smell was present and the carpet was heavily stained. This bedroom was vacant and was discussed with the nurse in charge. Remedial
Homefield House Nursing Home DS0000012132.V256167.R01.S.doc Version 5.0 Page 15 action will be required prior to a new admission. The nurse in charge confirmed that this would be done. The shower unit and two bathrooms have been refurbished and fitted with assisted baths. These were clean and homely in appearance with floorings that were easily cleaned. However two shower units remain outstanding and are in very poor state of repair. Shower units 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. Staff said that work on this is due to start soon but they could not confirm the time. It was evident that service users are encouraged to bring into the home items of personal belongings, most of the bedrooms were personalised. Shared rooms had screening provided and call bells were available in all the service users’ bedrooms. The service has laundry in place and all service users’ laundry is undertaken internally. Washing machines were fitted with sluicing programme and protective equipment was available. The home has procedures in place with regards to marking of service users’ clothing, however there was a number of items in the laundry that were not marked and could not be returned to service users. Staff must ensure that the procedures for the labelling of service users clothing are followed thus ensuring that these can be returned following laundry. Homefield House Nursing Home DS0000012132.V256167.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 The ongoing training programme is satisfactory ensuring that staff have the skills to deliver care appropriately. EVIDENCE: The service has a training programme in place. Staff reported that the company has an internal trainer from the company who attends the home at regular intervals and updates are provided. There are 20 staff members that have competed the NVQ qualification at level 2 and above. The home meets the requirements of NVQ trained staff with 76 of carers with above qualification. Recent updates included dementia care, first aid, adult protection. All staff follow an induction programme that includes a 4 day induction at the head office. The registered nurses undertake regular training / updates in order to meet the requirement of registration with the Nursing and Midwifery council (NMC). Homefield House Nursing Home DS0000012132.V256167.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,38 The home’s has satisfactory system in place to ensure that service users/ relatives’ views are sought. There are good system in place for the regular servicing of equipment and safeguard the welfare of service users. However the lack of fire training can be to the detriment of service users. EVIDENCE: The home has an annual development plan. The manager undertakes monthly meetings with service users and relatives as part of their auditing. Relatives spoken to comment that they try and attend these meetings and find them useful. A Sample of the home’s policies and procedures showed that these are updated at regular intervals taking account any changes in legislation.
Homefield House Nursing Home DS0000012132.V256167.R01.S.doc Version 5.0 Page 18 A sample of servicing certificates of equipment was seen and showed that these are undertaken regularly and records of these are maintained. These included fire equipment, emergency lighting and mobile hoists. Weekly fire alarm testing and fire drills records were in place. The record seen showed that three staff members had not received the mandatory fire safety training since October 2004. The manager must ensure that all staff has appropriate mandatory training in fire safety to safeguard the welfare of staff and service users. Advice should be sought from the fire safety officer regarding the regularity of fire safety training. Homefield House Nursing Home DS0000012132.V256167.R01.S.doc Version 5.0 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 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 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x 3 2 x 3 STAFFING Standard No Score 27 x 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x x x x 2 Homefield House Nursing Home DS0000012132.V256167.R01.S.doc Version 5.0 Page 20 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 21 Regulation 13(4) (ac) 23(2) Requirement Timescale for action 30/11/05 2 24 13(4)(a) 3 38 23(4) (d) The two shower units that remain outstanding must be refurbished. Action plan is required with timescale. This is an outstanding requirement of August 04, January 05, June 05. The provider must ensure that 30/11/05 the bathroom locks are changed so that they can be accessed in an emergency. The locks to the doors from each unit marked as fire doors must be reviewed and ensure that access is available at all times. The manager must ensure that 30/11/05 all staff undertake mandatory training in fire safety and records of these are maintained. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Homefield House Nursing Home DS0000012132.V256167.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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