Inspection on 21/04/05 for Honeyfield

This inspection was carried out on 21st 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

Honeyfield 10/10/07

Honeyfield 23/04/07

Honeyfield 16/05/06

Honeyfield 08/09/05

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 Ruth Burnham Unannounced 21 April 2005 09:30 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. Honeyfield H56-H06 S23967 Honeyfield V222041 210405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Honeyfield Address Honeyfields Rowhill Road Swanley Kent BR8 7RL 01322 664433 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) Kent Community Housing Trust Care Home 68 Category(ies) of Dementia - over 55 (68) registration, with number of places Honeyfield H56-H06 S23967 Honeyfield V222041 210405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users can be admitted from 55 years of age Date of last inspection 14 September 2004 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 residential accommodation for some 600 people in 14 homes in Kent and Greenwich. As part of KCHT and according to it’s aims and objectives this home provides care and support which promotes independence, provides choice and maintains dignity, particularly for people with dementia, including Alzheimer’s 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 t the front of the property. The home employs care staff who work a rota which includes a 4 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.The registered manager has resigned since the last inspection and there is an experienced service manager in charge of the home whilst a new manager is being sought. There are 2 assistant managers. Honeyfield H56-H06 S23967 Honeyfield V222041 210405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection which was carried out by 3 inspectors who were in the home from 9.30 a.m. to 3 p.m. During this time a tour of the premises was carried out, records were examined and a number of service users were seen and spoken to around the home. The inspectors also had lunch with service users as part of the inspection. 4 members of staff and the manager were also spoken to and other staff were observed as they carried out their duties. What the service does well: What has improved since the last inspection? What they could do better: Honeyfield H56-H06 S23967 Honeyfield V222041 210405 Stage 4.doc Version 1.30 Page 6 Numbers of staff are not always worked out in relation to the needs of service users and there are not enough staff to supervise all service users throughout the day and night. Cleanliness is not always of a good standard. There are still difficulties in maintaining the privacy and dignity of service users and keeping track of personal property. Complaints are not always handled appropriately. The home is in need of refurbishment to maintain comfortable and safe surroundings. Management are slow to take action to meet standards. 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. Honeyfield H56-H06 S23967 Honeyfield V222041 210405 Stage 4.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 Honeyfield H56-H06 S23967 Honeyfield V222041 210405 Stage 4.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) 1&4 in relation to compliance with requirements from the previous report Service users benefit from accessible information about the home however the omission of the qualifications of the acting manager from the Statement of Purpose makes it difficult for prospective service users, relatives and representatives to be sure the home can meet their needs. Honeyfield H56-H06 S23967 Honeyfield V222041 210405 Stage 4.doc Version 1.30 Page 9 EVIDENCE: The registered person has produced a statement of purpose which sets out the aims, objectives, philosophy of care, services and facilities, and terms and conditions of the home. This statement is displayed in the entrance of the home for the information of service users, relatives and visitors however There is still no information about the qualifications of the acting manager to assist service users and their representatives to make a judgement about the running of the home. There is a service user guide provided to current and prospective residents which includes a brief description of the services provided, a description of the individual accommodation and communal space; relevant qualifications and experience of staff and a complaint procedure. Service users have a copy in their bedrooms. Honeyfield H56-H06 S23967 Honeyfield V222041 210405 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,9&11 in relation to compliance with requirements from the previous report Service users can know that their health and personal care needs are reflected in their care plan and potential risks are identified however service users’ personal property, privacy and dignity is not always protected. Service users can be confident that their medication is being handled by competent staff. EVIDENCE: Service users medication is administered by staff who are trained in policies and procedures for the receipt, storage, handling and administration of medication, this training is now accredited. Supervision of service users has been improved by the fitting of coded locks dividing the home into 4 separate units which minimises the risk of service users wandering around the home and grounds without staff knowing where they are. However there are still incidents where service users wander into other people’s rooms, the acting manager is aware that service users privacy and dignity is being compromised in this way but feels that the problem is reducing with the introduction of new working patterns. There are still problems with keeping track of personal property with clothing and valuables regularly lost or misplaced which has resulted in a complaint from a relative. Honeyfield H56-H06 S23967 Honeyfield V222041 210405 Stage 4.doc Version 1.30 Page 11 Observation during the inspection again raised some concerns about the ability of staff to deliver care to service users in line with the homes aims and objectives given the high level of agency cover used and the observed involvement of care staff in a variety of tasks unconnected with direct care which results in some service users not receiving adequate supervision and stimulation. Honeyfield H56-H06 S23967 Honeyfield V222041 210405 Stage 4.doc Version 1.30 Page 12 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) 14 The majority of service users are helped to exercise choice and control over their own lives. However choice for 2 service users was seriously restricted. The meals in the home are good offering both choice and variety. EVIDENCE: There has been some improvement in relation to activities available to service users with the recruitment of an additional activities coordinator. The division of the home into separate units has resulted in 2 service users being able to access their bedrooms at will during the day unless staff are available to take them. The inspectors shared the midday meal with service users, the food was wholesome and well presented, choice was offered. Honeyfield H56-H06 S23967 Honeyfield V222041 210405 Stage 4.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 in relation to compliance with requirements from the previous report. Standard 17 was also examined. Service users are protected by staff trained in adult protection issues However poor planning and supervision place service users at risk of abuse by each other. The complaints procedure in the home is good however, the process for handling informal complaints or negative feedback is poor with no evidence that service users or their representatives views are listened to or acted on. Honeyfield H56-H06 S23967 Honeyfield V222041 210405 Stage 4.doc Version 1.30 Page 14 EVIDENCE: There is a complaints procedure which is simple, clear and accessible to service users and their representatives. Formal complaints are dealt with promptly with records kept . Service users and their representatives are disadvantaged in that where informal complaints are made or negative feedback is given, the home does not use the complaints procedure and has no alternative system for recording this information; any investigation; or providing feedback to the complainant. The formal complaint procedure does not include guidance in relation to investigation and feedback and there is still no methodology for staff to follow. Information is available about how to complain to the Commission.. A relative contacted the CSCI prior to the inspection to express a number of concerns including the loss of clothing and jewellery whilst his mother was staying at the home. There was no record of any contact with the complainant; the management said that this had not been recorded, as the relative had not presented the complaint formally during his mother’s stay. The Service manager at the head office of the Trust is now dealing with the matter, no records of this were available in the home t enable the inspector to make a judgement about the outcome for the service user. This investigation of the complaint highlighted the extent of the problem in that there are numerous items of jewellery which have been found and placed in the safe. These are listed in a book however, information about the location in which items are found or the finder is not routinely recorded. There is no system for recording missing items of clothing even though this is an ongoing problem for service users in the home. Service users are protected through an adult protection procedure and staff checks through the criminal records bureau prior to recruitment. Financial records are maintained wherever staff act on behalf of service users. There are still a significant number of incidents and injuries reported to the Commission including incidents where one service user has assaulted another; one such assault was witnessed by the inspectors during lunch and caused some distress to a number of service users, staff handled the incident promptly and efficiently however the situation could have been avoided. Honeyfield H56-H06 S23967 Honeyfield V222041 210405 Stage 4.doc Version 1.30 Page 15 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) 19,21,22,24,25&26 in relation to compliance with requirements from the previous report. Improvements to the environment would greatly enhance the service users safety and quality of life. Honeyfield H56-H06 S23967 Honeyfield V222041 210405 Stage 4.doc Version 1.30 Page 16 EVIDENCE: The home is located within easy walking distance of village shops, pubs etc. The gardens are beautifully kept by the volunteer ‘Friends’, The home continues to benefit from the hard work and enthusiasm of these volunteers, it was a privilege to meet the Chair of this group during the inspection. Safety has been improved now the car park has been resurfaced however Accessibility to the home remains compromised at night due to the poor lighting in the car park area. The accommodation is arranged on 3 floors with self-contained units on each floor. There are still a number of areas used by service users where replacement, repair or redecoration is needed. Risk to service users in the event of a fire has been minimised by comprehensive risk assessment for the premises which has been drawn up in consultation with the Fire Safety Officer and the home now meets fire safety regulations. Service users comfort continues to be undermined as noted in the previous 3 inspection reports where, several toilets are large, cold and institutional; some rooms are not carpeted although there are risk assessments where alternative flooring has been laid; bedrooms vary in standards of décor, many need redecorating and repair where there is damage; not all rooms have bedside or overbed lighting which service users can control when in bed; there are still unpleasant odours in a number of areas; some corridors are still ill lit which places service users, particularly those with a visual impairment, at risk and lighting in a number of areas is still not domestic in character. Service users who are able to make use of this facility are provided with keys to their bedrooms and individual assessments of each service users room have been made in relation to the furniture and fittings to ensure that they are adequate and meet the needs of the service user. There has still been no assessment of the premises by a suitably qualified person such as an occupational therapist with specialist knowledge of the client group to improve the environment for service users. Honeyfield H56-H06 S23967 Honeyfield V222041 210405 Stage 4.doc Version 1.30 Page 17 There is a suitable water supply and ventilation which meets the needs of service users. Rooms are individually and naturally ventilated. Pipe work and radiators are guarded or have guaranteed low temperature surfaces to protect service users from risk of burning. Emergency lighting is provided throughout the home. Water is regularly checked and certified free from legionella. Pre-set valves are fitted at outlet to prevent risk of scalding. There are now facilities in sluices for staff to clean their hands and evidence was seen that staff are provided with some training in infection control. The Laundry is well equipped and sited so that soiled articles are not carried through food storage or preparation areas however soiled clothing was seen soaking in a bucket in the sink. Risk of infection is further increased in that in that tablets of soap and personal toiletries were seen in communal bathrooms, a number of toilets did not have lidded bins for the disposal of pads and areas of the kitchen on the first floor were dirty which has been drawn to the attention of the manager at previous inspections. Honeyfield H56-H06 S23967 Honeyfield V222041 210405 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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) 30 in relation to compliance with requirements from the previous report. We also looked at outcomes for standard 27 Only limited progress has been made in addressing staff shortages and as a result service users do not receive consistent care. Honeyfield H56-H06 S23967 Honeyfield V222041 210405 Stage 4.doc Version 1.30 Page 19 EVIDENCE: During the inspection there were times when there was only one member of staff on units supervising up to service users and performing a variety of other tasks which left a number of service users unsupervised. This was highlighted when inspectors had difficulty locating a member of staff to deal with a trail of faeces in a corridor, the only member of staff in the unit at the time was giving morning drinks and a member of staff from another unit had to be borrowed to assist. Several staff take their breaks at the same time which exacerbates the problem. In only one instance was evidence seen that an additional member of staff had been put on shift in response to the identified additional needs of a service users in spite of the fact that there was evidence found in discussion with staff, seen in records and observed by inspectors that there are a number of service users who require increased levels of support and supervision to maintain their safety. There are more than 10 staff vacancies, which are being covered by bank and agency staff. The home is experiencing difficulties recruiting suitable permanent staff to fill these vacancies which means that service users are often not being cared for by staff who know them or who they know. The manager confirmed and records reflect that all permanent staff receive formal induction training within 6 weeks of appointment including care principles, safe working practices, roles and relationships and the specific needs of the client group. All permanent staff receive foundation training within the first 6 months which relates to meeting service users needs as defined in the care plan. Where in house training is provided evidence is available of the qualifications of the trainers to evidence that service users are cared for by competent staff. Honeyfield H56-H06 S23967 Honeyfield V222041 210405 Stage 4.doc Version 1.30 Page 20 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) 33 in relation to compliance with requirements from the previous report. Good safety systems and training protect service users in the home. Failure to comply within reasonable timescales on a number of issues identified within previous Commission for Social Care Inspection reports has negatively affected the comfort and safety of service users. Honeyfield H56-H06 S23967 Honeyfield V222041 210405 Stage 4.doc Version 1.30 Page 21 EVIDENCE: Several requirements from previous reports have still not been addressed. The manager stated that some of these are in process of being actioned. Evidence was seen that the home manager makes requests for action but delays occur further up the organisation which adversely affects the quality of service users lives. Service users are protected through; regular servicing and maintenance of equipment and installations; safe storage and disposal of hazardous substances; a signed health and safety policy; a risk assessment in relation to fire safety; Significant incidents/accidents are reported in line with regulations. Suitable safety procedures are posted; staff training in moving and handling, fire safety, first aid, food hygiene, health and safety and infection control. Security systems are in place and the manager is aware of and complies with all relevant legislation. Honeyfield H56-H06 S23967 Honeyfield V222041 210405 Stage 4.doc Version 1.30 Page 22 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 2 x x 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 2 15 x COMPLAINTS AND PROTECTION 2 2 2 2 3 2 2 2 STAFFING Standard No Score 27 2 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 3 2 x x 2 x x x x x Honeyfield H56-H06 S23967 Honeyfield V222041 210405 Stage 4.doc Version 1.30 Page 23 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. 2. 3. Standard 1 19 21 Regulation Schedule 1 13(4),6 & 18(1) 23(1)(a) & (2)(f)&(j) 23(1)&(2) (a) Requirement The statement of purpose should include the managers qualifications. Service users should be adequately supervised at all times Sufficient numbers of bathrooms and toilets should be available which are suitable to meet the service users needs i.e warm and non institutional An assessment of the premises shall be made by a suitably qualified person, specialising in the needs of older people and people with dementia and that assessment provided to the commission Lighting in residents areas should be domestic in nature All areas of the home should be clean and free from offensive odours. Adequate facilities and procedures should be in place to ensure infection control. Quality assurance systems should be effective in picking up shortfalls where the home is not meeting national minimum standards Timescale for action by 15/06/05 Action plan by 15/06/05 Action plan by 15/06/05 Action plan by 15/06/05 4. 22 5. 6. 25 26 23 13(1)(3)& 16(2)(j) Action plan by 15/06/05 Action plan by 15/06/05 Action plan by 15/06/05 7. 33 24 Honeyfield H56-H06 S23967 Honeyfield V222041 210405 Stage 4.doc Version 1.30 Page 24 8. 9. 24 16 23 12 All areas of the home should be maintained in a reasonable state of repair and decoration, Records should be made of all complaints and should include information about investigation and the procedure should include guidance in relation to investigation and feedback, there should be a methodology for staff to follow. Action plan by 15/06/05 Action plan by 15/06/05 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 25 Good Practice Recommendations Bedrooms should be provided with easily accessible bedside or overbed lighting. Honeyfield H56-H06 S23967 Honeyfield V222041 210405 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection The Oast, Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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 Honeyfield H56-H06 S23967 Honeyfield V222041 210405 Stage 4.doc Version 1.30 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!