Inspection on 10/10/07 for Honeyfield

This inspection was carried out on 10th October 2007.

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

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

Other inspections for this house

Honeyfield 23/04/07

Honeyfield 16/05/06

Honeyfield 08/09/05

Honeyfield 21/04/05

Honeyfield 14/09/04

Honeyfield 20/04/04

Honeyfield 23/09/03

Honeyfield 13/06/02

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

CARE HOMES FOR OLDER PEOPLE Honeyfield Honeyfields Rowhill Road Swanley Kent BR8 7RL Lead Inspector Gary Bartlett Key Unannounced Inspection 10th October 2007 9:30 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 Honeyfield DS0000023967.V348927.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. Honeyfield DS0000023967.V348927.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Honeyfield Address Honeyfields Rowhill Road Swanley Kent BR8 7RL 01322 664433 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) www.kcht.org Kent Community Housing Trust Post Vacant Care Home 68 Category(ies) of Dementia - over 65 years of age (68) registration, with number of places Honeyfield DS0000023967.V348927.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users can be admitted from 55 years of age Date of last inspection 23rd April 2007 Brief Description of the Service: Honeyfield is a large purpose built, detached premises with accommodation for older people with a mental infirmity. The home is owned by Kent Community Housing Trust, a charity providing some 1,000 registered care placements across Kent, Medway, Greenwich and Bexley. As part of KCHT and according to its aims and objectives this home provides care and support which promotes independence, provides choice and maintains dignity, particularly for people with dementia, including Alzheimers disease. The home is located in the village of Hextable. There are 13 en-suite bedrooms on the second floor, 33 bedrooms without en-suite facilities on the first floor and 21 bedrooms without en-suite facilities on the ground floor. All bedrooms are single. There is an alarm call system and a passenger lift. There are a number of dining rooms and lounges for communal use. There is a small front garden and larger garden to the rear. There is a large car park to the front of the property. The home employs care staff who work a rota which includes members of staff on waking night duty. In addition to the care staff admin and management support is available at the local area office, which is shared with other homes. Current fees range from £402.26 to £476.69 per week. Honeyfield DS0000023967.V348927.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was conducted by Gary Bartlett, Regulatory Inspector, who was in Honeyfield from 9:30 a.m. until 4:15 pm. During that time the Inspector spoke with some residents, 4 visitors, and some staff. Parts of the home and some records were inspected and care practices observed. Due to the nature of the service provided, it is difficult to reliably incorporate accurate reflections of residents’ views of the service in the report. The Managers had completed an Annual Quality Assurance Assessment prior to the inspection. Some survey forms were received prior to the inspection. Residents and their relatives responded that they appreciated the changes made under the new management . Responses from a health professional also indicated good standards of care. A survey form completed by a relative stated: • “There are too few homes like Honeyfield who do a very good job caring”. Other statements made are quoted in the text of the report. The Care Homes Regulations 2001 and the National Minimum Standards for Care Homes for Older People refer to people who use the service as “service users”. People living at Honeyfield prefer to be referred to as “residents”. Accordingly this shall be done in the text of this report. Since May 2007, Honeyfield the day to day running of Honeyfield has been under the auspices of two acting Managers, Julie Ayers and Beryl Richards. The latter was present at the inspection. The Manager and staff gave their full co-operation. Honeyfield DS0000023967.V348927.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Honeyfield DS0000023967.V348927.R01.S.doc Version 5.2 Page 7 The home is to be commended for the manifold improvements made since the last inspection of 6 months ago. Honeyfield has a much happier and more relaxed atmosphere. Residents’ care plans are more up to date and risk assessments are being improved. There are increased numbers of competent staff on duty. The key-worker system is being used more efficiently. Care practices and records are being monitored closely. Staff training is more effectively managed. Staff use safe systems for moving and handling. All residents’ records are stored securely when not in use. The environment and facilities have been enhanced with some new furnishings and redecoration of bedrooms and communal areas. The Willow unit lounge/dining area has been extensively revised for the comfort and well-being of residents. There are now better facilities for the storage of medicines and a medical room in which residents can meet with their G.P.s and community nurses. Communication between staff shifts and with other healthcare professionals has improved. Standards of hygiene and infection control are improved with better cleanliness around the home, the refurbishment of the laundry and sluices and the provision of extra equipment such as commode washers and cleaning trolleys. Much improved toilet and bathing facilities are available. The front of the house has been made more attractive. The range and diversity of activities available to residents is being developed to be more meaningful for them. Honeyfield DS0000023967.V348927.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Honeyfield DS0000023967.V348927.R01.S.doc Version 5.2 Page 9 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 Honeyfield DS0000023967.V348927.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4, 5 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that they are appropriately placed due to good preadmission assessments and benefit from being able to visit the home prior to admission. EVIDENCE: A Team Leader described how a pre-admission assessment is made of each prospective resident to ensure the home can meet his or her needs. Records show that prospective residents, their families, advocates, and relevant health care professionals are involved in the assessment process. Specialist advice is sought from external sources where required. Honeyfield DS0000023967.V348927.R01.S.doc Version 5.2 Page 11 Visitors said they had been able to visit Honeyfield before their relatives had moved in. They also said staff are very helpful in assisting new residents to make the transition and settle. Whilst Honeyfield offers respite care, it does not provide Intermediate care. Honeyfield DS0000023967.V348927.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ personal health needs are assessed and maintained through their individual care plans and with good liaison with relevant health care professionals. Residents are protected by staff adhering to good practice guidelines in the administration of medicines. Staff treat residents with respect and maintain their privacy and dignity. EVIDENCE: Each resident has a care plan and three were inspected in detail. There are clear improvements to care planning. Those seen are up to date and Honeyfield DS0000023967.V348927.R01.S.doc Version 5.2 Page 13 comprehensive. The standard of daily record keeping is generally better. The Managers are aware that some records need to be more consistently detailed to accurately reflect care given and is addressing this through the regular review of records and by staff training. Risk assessments are being improved and written/reviewed in response to incidents and accidents, although this still needs to be more consistent. There is a key worker system to ensure a good exchange of information about residents’ health and welfare. Visiting relatives said staff are now very good at keeping them informed. The facilities for the storage of medicines are much improved. Whilst the temperature of the drugs refrigerator is being monitored, that of the new treatment room is not. This must be done to ensure medicines are stored at the recommended temperatures. The medicines rooms are clean and well maintained. Records show that all staff administering medications have been trained and signed off as being competent to do so. The Medication Record Administration Record (MAR) sheets inspected had been completed appropriately and medicines were seen to be given in accordance with good practice guidelines. A survey form completed by a Care Manager included the comments: • “Good communication – improvement since change in management”. • “Home manages difficult behaviour of residents well”. The home has a good working relationship with the specialist and local health care professionals. This greatly assists in supporting residents in their health care needs. There are now a medical room in which residents can meet with their G.P.s and community nurses. Residents and their visitors feel that staff are kind and gentle, this was confirmed by observation and discussion with visitors. Staff are considerate of the age and dignity of residents and treat them with courtesy. Honeyfield DS0000023967.V348927.R01.S.doc Version 5.2 Page 14 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can enjoy a fulfilling lifestyle with good outside links maintained and have as much choice and control over all aspects of their lives as their individual abilities allow. Dietary needs of residents are well catered for with a balanced and varied selection of food that meets their tastes. EVIDENCE: A Team Leader described how residents are supported to manage their own affairs for as long as they wish and are able. Due to the nature of the service, most residents are dependant on support. Staff spoken with are aware of the rights of residents to have the opportunity to have choice in daily routines and activities Because of residents’ mental frailties, it is often difficult to consult them about providing a flexible lifestyle Honeyfield DS0000023967.V348927.R01.S.doc Version 5.2 Page 15 that meets their wishes. Consequently, the home is promoting closer links with relatives and/or representatives. Family and friends feel welcome and know they can visit at any reasonable time. During the inspection a number of visitors were seen in the home and the visitors book records regular visits by families, friends and others. The design of Honeyfield provides seating areas within the communal areas where residents can entertain their visitors, in addition to the privacy of their own room. The home encourages individuals and groups from the community to visit. A survey form completed by a relative stated: • “Excellent. I can always keep in touch with my mother”. Two Activities Co-ordinators are employed and the range and diversity of activities available to residents is being developed so as to be more meaningful for them. There is good liaison between the Activities Co-ordinators and care staff. Minibuses are available for outings. Survey forms completed by relatives included the comments: • “Outings are a regular occurrence and this summers fete was very well run and a chance for all residents and their families to get together”. • “The staff do very well with the activities, outings and summer and winter fairs”. • “The entertainers are very good, especially the dog”. It is not clear if the last sentiment is shared by Bruno and Tigger, the two cats that live at the home. It is very apparent that the residents enjoy having the cats’ company. Meal times are set for practical reasons but can be flexible to accommodate activities when necessary. Residents and their visitors are complementary of the food served and say their tastes are met as best possible with a choice of menu always being offered. The meals are generous in portions and look appetising. Mealtimes are relaxed; staff are patient and helpful and allow residents the time they need to finish their meal comfortably. Hot and cold drinks are available through out the day, as well as snacks. Honeyfield DS0000023967.V348927.R01.S.doc Version 5.2 Page 16 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives know their complaints are listened to and acted on. There are systems to protect residents from abuse. EVIDENCE: The complaints procedure is readily available to residents and their relatives. They said they feel confident that they would be listened to and any necessary action would be taken. A survey form completed by a relative stated: • “We have had cause for complaints under the old management back in February/March time. It was dealt with by the new management very quickly”. The Home keeps a record is of all complaints received by them. There have been nine complaints received by the home in the last 12 months. The majority of these prior to May 2007 and have been dealt with within a good timeframe. Honeyfield DS0000023967.V348927.R01.S.doc Version 5.2 Page 17 There are procedures for responding to suspicion or evidence of abuse or neglect to ensure the safety and protection of residents. The Manager and other staff spoken with have a sound understanding of adult protection procedures. Any allegation of abuse would be referred to the concerned agencies without delay. Honeyfield DS0000023967.V348927.R01.S.doc Version 5.2 Page 18 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, 21, 22, 23 and 26 Quality on this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents live in a clean, comfortable and homely environment. EVIDENCE: Substantial investment has been put into the home to improve the environment. Some bedrooms and communal areas have been redecorated and refurbished since the last inspection. Honeyfield DS0000023967.V348927.R01.S.doc Version 5.2 Page 19 The Willow unit lounge/dining area has been extensively revised for the comfort and well-being of residents. Standards of hygiene and infection control are improved with the refurbishment of the laundry and sluices and the provision of extra equipment such as commode washers and cleaning trolleys. Much-improved toilet and bathing facilities are available to residents. Further improvements to the environment are planned. All parts of the home seen are generally clean and free from offensive odours. The gardens are well maintained and the front of the house has been made more attractive. A survey form completed by a relative stated: • “Very please with the gardens at Honeyfield. Lovely to sit and walk with the residents in the sunshine. So restful for them and a lot to talk about and show them”. Honeyfield DS0000023967.V348927.R01.S.doc Version 5.2 Page 20 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recruitment processes are robust and offer protection to people living at the home. Training is available to the staff so they have the skills to meet the needs of the residents. EVIDENCE: A survey form completed by a relative stated: • “They have some very caring staff who know the patients well”. Records seen indicate that robust recruitment procedures are used and the home directly employs only staff that have been properly vetted. There are now more permanent staff employed so the home is less reliant on the use of agency staff to maintain staffing levels. Honeyfield DS0000023967.V348927.R01.S.doc Version 5.2 Page 21 Staff are required to undertake an induction programme. There is also an induction programme for agency staff to complete on their first shift at the home. Each staff member has a “staff training analysis sheet” to record training courses they have attended and a training matrix is used to give a management overview of staff training needs. Survey forms completed by staff members included the comments: • “Training is now very good – up to date”. • “We have all had up to date training”. • “Staff have a greater understanding of our service users”. Staffing levels have been increased and the structure of the senior team revised for more effective working. The staff rosters seen indicate staffing levels are geared to peak times of activity. One example of the recent improvements is the employment of Servers at breakfast and lunchtimes. This gives care staff more time to assist residents with personal care and means residents are served their meals sooner. Honeyfield DS0000023967.V348927.R01.S.doc Version 5.2 Page 22 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, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home benefits from a management team that is experienced, accessible and supportive. Residents’ financial interests are protected. The home is reviewing its performance through a programme of self-review and consultations, which includes the opinions of residents and relatives. EVIDENCE: Honeyfield DS0000023967.V348927.R01.S.doc Version 5.2 Page 23 Since May 2007, the day to day running of Honeyfield has been under the auspices of two acting Managers, Julie Ayers and Beryl Richards. The latter was present at the inspection. They are to be commended for the many improvements made in a short time. This success demonstrates a high degree of knowledge and competency in a range of areas. A survey form completed by a relative stated: • “I could not more heartily endorse and praise the changes. I feel reassured there is care and kindness…”. Survey forms completed by staff members included the comments: • “Beryl and Julie’s door is always open as well if ever we need support/guidance”. • “The support and knowledge is certainly there from the present management team”. • “I think there has been a vast improvement in morale. I feel more happier in my job and feel I am being listened to”. • “Staff are happier because they are involved a lot more”. • “We all have support from the management team if we have any issues”. • “I feel much more confident and happy in my job”. Beryl Richards has recently been appointed Operations Manager for the Trust and as such will continue to have an overview of the running of Honeyfield. It is intended to appoint a permanent Manager at the home in the near future. There is a sound system of holding and recording service users’ cash, which is checked by the Trust as part of their audit process. The home is regularly audited by the Trust and residents and their representatives or relatives are asked for their views. The Manager is monitoring the quality of records made by staff with the aim of achieving a high level of consistency. Records seen are kept in a manner that preserve confidentiality. There are arrangements to ensure all staff receive the supervision necessary to ensure good standards of care practice and those spoken with have a sound understanding of emergency procedures. The standard of cleanliness in the kitchen and surrounding area is satisfactory. The Trust plans to refurbish the kitchen in the new year. There are records of fire systems checks and fire drills/training however, external fire exits must be kept clear of obstructions. Honeyfield DS0000023967.V348927.R01.S.doc Version 5.2 Page 24 The Manager believes all records of maintenance and safety checks are up to date. These were not inspected on this occasion. The Trust regularly reviewes policies and procedures to ensure they comply with current legislation and good practice advice Honeyfield DS0000023967.V348927.R01.S.doc Version 5.2 Page 25 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 3 3 3 2 Honeyfield DS0000023967.V348927.R01.S.doc Version 5.2 Page 26 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 OP9 Regulation 13(2) Requirement “The registered person shall make arrangements for the recording, handling, safekeeping, safe administration of medicines” in that the temperature of all medicines storage areas must be regularly monitored. To be completed by the given timescale, if not sooner and maintained thereafter. “The registered person shall after consultation with the fire and rescue authority take adequate precations against the risk of fire, including the provision of suitable fire equipment” in that fire exits must be kept clear of obstructions and trip hazards. To be completed by the given timescale, if not sooner and maintained thereafter. Timescale for action 30/10/07 2. OP38 23(4) 30/10/07 Honeyfield DS0000023967.V348927.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP7 Good Practice Recommendations It is strongly recommended that daily records are more consistently detailed. It is strongly recommended that risk assessments are more consistently written and/or reviewed soon after incidents. Honeyfield DS0000023967.V348927.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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