Inspection on 16/05/05 for Honister

This inspection was carried out on 16th May 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

Honister 30/05/07

Honister 28/09/06

Honister 09/11/05

Honister 21/02/05

Honister 13/07/04

Honister 11/09/02

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Honister Ellenbrook Lane Hatfield Herts AL10 9RW Lead Inspector Hazel Wynn Unannounced 16 May 2005 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. Honister I52 s19435 Honister v230256 160505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Honister Address Ellenbrook Lane, Hatfield, Herts, AL10 9RW 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) 01707 274918 01707 274918 Mrs Anna C Theanne Mrs Anna C Theanne CRH Care Home 22 Category(ies) of OP-22 registration, with number of places Honister I52 s19435 Honister v230256 160505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21 February 2005 Brief Description of the Service: Honister is a care home providing personal care and accommodation for 22 older people. Service users who meet this category at the point of admission may continue to be accommodated for as long as their needs can be met by the home and community service provision. Mrs Anna Theanne, a private provider, manages and owns the home. The property is a large detached dwelling set in a quiet residential part of Hatfield in Hertfordshire. The house is three-storey building and has a lift for access to upper floors. In recent years the building has been extended to provide extra single rooms on the second floor and the large shaded conservatory is now used as a dining room. Two lounges are available to service users. There are 10 single bedrooms with en suite facilities and three double bedrooms for service users whose preference is to share accommodation. The double bedrooms do not have en suite facilities. There are two communal bathrooms and six communal use toilets. The home is situated near the Galleria Shopping Centre and has easy access to the main road routes, the railway station and local amenities. The home was first registered by the National Care Standards Commission on the 1st April 2002 and was previously registered as a care home in October 2001 under the Registered Homes Act (1984). Honister I52 s19435 Honister v230256 160505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspection officers, from the Commission for Social Care Inspection, carried out this inspection on The 16th May 2005. We spoke to many of the service users (14 in all). We looked at records, systems and made general observations. We interviewed staff and met with the proprietor during the inspection process. We found that most of the National Minimum Standards were met. Some procedures needed tightening up and requirements were made in respect of fire safety and medication procedures. We also recommended that a new fire risk assessment be carried out. Service Users only issue was the lack of sufficient activities, which the proprietor was already aware of and had taken action to remedy. What the service does well: What has improved since the last inspection? The proprietor has purchased new formats for Care Plans and was working on these to transfer information from the old format – these will provide easier to track care plans useful to staff, service users and their representatives (where appropriate). The proprietor has ordered automatic door closures to be fitted shortly which will mean that service users can have open doors (which is their preference, by a method approved by the fire authorities. Honister I52 s19435 Honister v230256 160505 Stage 4.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. Honister I52 s19435 Honister v230256 160505 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 Honister I52 s19435 Honister v230256 160505 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 - 6 Prospective service users are provided with information about the home. Visits are encouraged to be made prior to making a choice. A full assessment of need to ensure it has the capacity to meet that need is undertaken with signed agreement to meet the needs. EVIDENCE: Service Users stated that either they or a representative they trust visited the home prior to them moving in and that they were involved in their assessment and care plan. The Statement of Purpose and Service User Guide provide the information prospective service users will need to feel reassured the home can meet their needs. The home does not provide the specialism of Intermediate Care Honister I52 s19435 Honister v230256 160505 Stage 4.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 -11 Health, personal and social needs are stated in the care plan and health and personal care needs were fully met. Medication procedures needed tightening up. Service users right to dignity, privacy and respect is guarded. The home is very supportive to service users and their families/friends when life is drawing/has drawn to a close. EVIDENCE: The care plans seen had been signed by the service user or their relatives and they were kept reviewed. The care manager for one service user should be written to, to advise her of the review of the care plan and to provide the opportunity for her comments/approval to the changes. The records showed that personal and health care needs were being fully met and service users spoken to further verified this. Whilst awaiting the transfer of information on to the new care plan formats that the new progress sheets should be utilised right away as the daily log in use was not in line with data protection guidelines. A shortfall was in Social Care: service users stated that staff were too busy to provide much in the way of activities and it could get boring. A discussion with the proprietor took place regarding this and the proprietor had already taken action to remedy this by employing an Occupational Therapist to provide exercise and activities. The criminal records bureau and protection of Honister I52 s19435 Honister v230256 160505 Stage 4.doc Version 1.30 Page 10 vulnerable adults records checks were awaited before the new employee would be able to commence work. There were some gaps in the medication record, one bottle of liquid medication had not been rotated in the correct date order and the Warfarin prescription administration instructions, provided by the pharmacy were complex and it was difficult to reconcile the medication balance. Services users stated that the care support approach of the staff is very good and that their dignity and right to privacy is guarded and that the care team respects them. They were especially keen to praise the proprietor who, they said, “no matter what it is, we can talk to her about it and she will sort it out right away”. They said she talks to them every day and gains their views; they said they were very fond of her and of all the staff. The compliments cards and letters provide evidence of the support that the home provides to service users and their families at the time when life is drawing to a close, in the event of death and right up until after the funeral has taken place and even beyond that. The letters and cards state that the proprietor has provided support to service users families and friends even many months after their relative/friend has died. Honister I52 s19435 Honister v230256 160505 Stage 4.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 - 15 Service Users who are able help to run the home and enjoy taking part but there was a lack of structured activities of late caused by a staff vacancy. Contact with family and friends/others is well supported and independence actively encouraged. The food provided is good. EVIDENCE: From discussions with the service users we discovered that structured activities have decreased and Service Users stated that it can get a bit boring. We met with the proprietor who stated that she had already gained this view and had taken steps to remedy it by employing a Occupational Therapist to provde activities and exercise sessions but is waiting for the criminal records bureau and vulnerable adult protection checks to clear before she can start work. We recommend that in the meantime, a bank staff be used to provide for some activities to take place. Service Users stated that their families and friends enjoy visiting and are always made welcome “just as they would be at home”. The Service Users stated that they are encouraged to make decisions and are supported to do as much as they can for themselves and for as long as possible. The Service Users help to run the home and help out doing the things they enjoy – they said it makes it feel more like home. One Service User helps out in the garden and she said this is one of her favourite pass time. Honister I52 s19435 Honister v230256 160505 Stage 4.doc Version 1.30 Page 12 The Service Users stated that they help put the menu together and enjoy the food very much. The menus reflected a nourishing and varied diet and the menu changes according to the season to allow for the use of as many fresh ingredients as possible from local producers. Honister I52 s19435 Honister v230256 160505 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 The home aims to be positively responsive to any complaint and assures service users and relatives that they will readily support a complainant. Legal rights are protected and service users are protected from abuse. EVIDENCE: There had been no complaints recorded. Service users stated that there is never a need to make a formal complaint because if any issue arises its dealt with right away and that the proprietor and staff are always mindful to make sure things are ok. They said the only issue at the moment is that there’s not enough going on but that the proprietor is bringing someone in to put that right. The proprietor invited the Alzheimers Society in to support the needs of a service user where there was a risk of infringement of rights and they have helped with the care plan and guidance to staff to support this service user. Other advocates that the home taps into are Age Concern, service users Solicitors and the home also supports service users to Self advocate (as stated by the service users). The service users are supported to take part in the electoral process and they said they can either go with staff to the polling station and on for an election supper to the pub or they can use the postal voting system. Abuse awareness training is provided and there are policies and procedures in place. The proprietor stated that one newer member of the team will attend abuse awareness training shortly. Honister I52 s19435 Honister v230256 160505 Stage 4.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 - 26 Fire safety procedures need tightening up. The environment is adequately well maintained with access to comfortable indoor and outdoor communal facilities. There are adequate lavatory and bathing facilities and specialist equipment to aid independence. Service users rooms are pleasant, comfortable and personalised according to their preference. The home is comfortable, clean and hygienic. EVIDENCE: Door wedges were being used to keep doors open, as is the service users preference, but this is not a safe nor approved method of maintaining doors in an open position; an immediate requirement was made in this respect. The proprietor provided evidence that automatic door closures were on order and the work is due to commence shortly and in the meantime had put strategies in place for guidance to staff in the event of fire. However, risks remained whilst the work is awaited and a requirement was made for removal of the wedges. The last recorded monthly testing of fire prevention equipment installed was 28.03.05. The proprietor stated that it is checked but the record had not been updated; a requirement was made in this respect. Honister I52 s19435 Honister v230256 160505 Stage 4.doc Version 1.30 Page 15 A portion of food had not been covered and dated when put into the fridge and a requirement was made in this respect. Service users have equipment to meet their specialist needs and the servicing records were seen. Service users own rooms were seen and found to be comfortable, well decorated and nicely personalised with their own possessions. With the exception of the concerns regarding fire safety procedures, mentioned above, the home was otherwise observed to be providing a safe and comfortable environment with accessibility to all communal facilities. The home was observed to be clean, comfortable and hygienic. Honister I52 s19435 Honister v230256 160505 Stage 4.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) 27 -30 A trained team adequately staffs the home and when the Occupational Therapist joins the team the skill mix will be complete. The recruitment practices at the home are robust. EVIDENCE: There were adequate staff on duty at the time of the inspection and the rota provided evidence that this is consistent. The staff were observed to be carrying out their duties in a competent manner. stated that they had had recent training updates and received formal supervision on a regular basis. One newer staff member was awaiting abuse awareness training and the proprietor stated that this would be provided shortly. The staff files seen provided the necessary personal documents for recruitment and adherence to adult protection procedures. All files had CRB, (CRB is the criminal records bureau check). (POVA where recruited post July 2004). Pova is the Protection of Vulnerable Adults register and all new staff will have a POVA check. The staff files also carry two references, the application form and medical fitness declaration as well as other personal identification. The staff-training programme for 2005 was seen and an accredited induction programme is in place for new recruits. Some staff had recently attended BTEC medication training course. Some of the staff team are enrolled/in the process of enrolling for NVQ at various levels from level 2 to level 4. Honister I52 s19435 Honister v230256 160505 Stage 4.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 - 38 The proprietor manages the home and she is fit to be able to manage the home; and has been checked through the fit person procedures, as part of the registration process, set up for the protection of vulnerable adults. The ethos, leadership and management approach of the home benefits the service users who live there and the home is run with their input. Sound accounting support is in place and residents financial interests are safeguarded. Formal supervision is provided to staff and generally the home’s records, policies and procedures offer safeguards for the rights and best interests of the service users (there were exceptions where requirements were made regarding fire safety procedures and medication procedures). Again, generally the health, safety and welfare of service users and staff are promoted and protected with the exception of the matters requiring attention above. EVIDENCE: The proprietor manages the home and is a registered nurse with many years management experience; she has worked through a programme to achieve Honister I52 s19435 Honister v230256 160505 Stage 4.doc Version 1.30 Page 18 Level 4 NVQ Management Award. Part of the registration process for Proprietors/Managers involves a robust check into their background to the current date to ensure they are fit to practice, and these procedures were applied to this proprietor. Service users spoken with stated that the homes staff team and the proprietor are keen to seek their views and put right any issues and involve them in the running of the home; they stated that the home is run in a manner they are very happy with. The proprietor employs an Accountant and manages her plans for the home in light of the quarterly returns, setting her budget in line with her plans for the year ahead. The maintenance programme and plans suggest that the home is financially viable. The maintenance man is currently on long term sick and the proprietor stated that she is looking at alternative arrangements to ensure that the maintenance needs of the home do not suffer. Maintenance did not appear to be an issue from observations made at the inspection. The service users or their elected representative manage their finances and the home manages small amounts of money wanted for day – day use by the Service Users; these small amounts of money are securely and transparently accounted for. Each service users cash flow could be reconciled against the clear accounts, which were being managed in accordance with the policies and procedures in place. Fire records had not been undated to record the monthly checks of the fire safety systems in place and door wedges were in use, which is unsafe and a method not approved by the fire authority for maintaining doors in the open position. Requirements were made in respect of these issues. Medication records showed gaps in recording, bottle of medication had not been rotated in the correct date order and an instruction written by the pharmacy together with different strengths of medication to be used on different days was very complex and it was difficult to reconcile the medication. Requirements were made in respect of the medication procedures. With the exception of the above matters the home has policies procedures in place and is meeting the majority of the National Minimum Standards and providing a very warm, friendly and caring service. Honister I52 s19435 Honister v230256 160505 Stage 4.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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 1 3 3 3 3 3 3 1 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 Standard No 16 17 18 Score 3 3 3 3 3 3 3 3 3 3 1 Honister I52 s19435 Honister v230256 160505 Stage 4.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. 2. Standard OP9 OP9 & 38 Timescale for action 13(2) All medication must be rotated in 30.06.06 date order. 13(2) All administered medication must Immediate be signed for (refers to a gaps in 16.05.05 signing on one medication) A previous similar requirement was made on 21.02.05 because a MAR sheet had not been made up prior to administration of medication from a monitored dose box. 13(2) Ensure that instructions for the Immediate administration for medication are 16.05.05 clear and that any risk of error/misinterpretion is minimalised. 16.(2)(m) Ensure suitable actives and 30.06.05 & (n) exercise are provided according to the Service Users preferences and capabilities. 13(4)(c) Door wedges must not be used Immediate. to keep doors open. (The 16.05.05 23 (4) ( c) proprietor had ordered automatic (iii) door closures as evidenced on a recent invoice). A previous requirement was made on 21.02.05. 13(4)(c) Emergency Lighting must be 20.5.05 23 (4) (v) tested monthly and a record maintained of such tests. (The proprietor stated that the test I52 s19435 Honister v230256 160505 Stage 4.doc Version 1.30 Page 21 Regulation Requirement 3. OP9 4. OP12 5. OP19 & OP38 6. OP19 & OP38 Honister 7. OP26m(2) & 38 had taken place but recording had been ommitted). 16(2)(j) Food stored in the refridgerator, 13 (4) ( c) must be dated on opening and kept covered. Immediate 16.05.05 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 OP7 Good Practice Recommendations Write to the Care Manager, who was unable to attend a review, to give her the opportunity of responding and to make her aware of current needs. Re: use of safety harness, when a named Service User is in wheelchair. This is a form of restraint and requires joint agreements/joint working to agree a care plan with clear guidance to staff. Commence using the progress notes from the new care plan format to improve security of data, which is accessible only to the named individual or where appropriate his/her representative. It is recommended that a review of the current fire risk assessment tailored specifically to Honister is conducted. The weblink details to the Local Fire Authority where an appropriate template for this purpose was provided. 2. OP7 & 37 3. OP38 4. Honister I52 s19435 Honister v230256 160505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City, Herts AL7 3BQ 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. 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