Inspection on 20/04/06 for Hooklands Nursing Home

This inspection was carried out on 20th April 2006.

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

Hooklands Nursing Home 18/09/07

Hooklands Nursing Home 26/03/07

Hooklands Nursing Home 05/10/05

Hooklands Nursing Home 03/05/05

Hooklands Nursing Home 08/12/04

Hooklands Nursing Home 04/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Hooklands Nursing Home West Bracklesham Drive Bracklesham Bay Chichester West Sussex P020 8PF Lead Inspector Miss H Tomlinson Unannounced Inspection 20th April 2006 07:45 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 Hooklands Nursing Home DS0000024158.V291847.R01.S.doc Version 5.1 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. Hooklands Nursing Home DS0000024158.V291847.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hooklands Nursing Home Address West Bracklesham Drive Bracklesham Bay Chichester West Sussex P020 8PF 01243 670621 01243 670621 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) Mr Mohammed Saleem Chaudhry Dr L Ezad Mrs Jeanette Louise McDowell Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Hooklands Nursing Home DS0000024158.V291847.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th October 2005 Brief Description of the Service: Hooklands is a care home providing personal, social and nursing care for 27 service users over the age of 65. It is situated on the seafront at Bracklesham Bay, West Sussex. All rooms are situated on the ground, first and second floor. The home has a vertical lift. There is a garden that has direct access to the beach. Access to the home is via a residential road and the home provides a small number of car parking spaces. There is a ramp for easy access into the home. There are a handful of shops near by and restricted public transport serves the village. Hooklands has been a registered care home for 15 years. Mrs J McDowell is the registered manager who is in charge of the day to day running of the home. The providers are Mr Chaudhry and Dr Ezad. Hooklands Nursing Home DS0000024158.V291847.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by two inspectors. They arrived in the home at 7.45am and left the home at 4pm. The registered manager was present throughout most of the inspection. At the time of this inspection nineteen residents were accommodated. Prior to this visit to the home the inspectors reviewed previous inspection reports and communication from the providers. During the inspection a full tour of the premises took place which included all bathrooms and bedrooms. Five resident’s files were examined in detail and others seen for specific information. Five staff files and the duty rota were seen. Other records were examined as was necessary throughout the inspection. Eight members of staff and the manager were spoken with. Inspectors saw all the residents during the inspection and had detailed conversations with seven of them regarding their experience of living in the home. Three visitors had discussions with the inspectors. What the service does well: Hooklands Nursing Home DS0000024158.V291847.R01.S.doc Version 5.1 Page 6 Staff were polite and kind to the residents who praised the staff team saying they were caring towards them. Staff knew the residents well and worked together as a team. At the time of the inspection there were sufficient staff on duty to meet the needs of the residents. The care practices within the home protected the resident’s dignity and privacy. Residents said their choices were respected when they made them known to staff. Relatives and friends could visit the home at any time. Some residents were assisted to continue links with the local community through trips to church and local amenities. Residents said they enjoyed the food served at the home, which was varied and nutritious. They said there was plenty to eat. What has improved since the last inspection? What they could do better: Residents must not be admitted to the home unless a thorough assessment of their needs has been completed, by a person working in the home, who has the competence to do so. Residents or their representatives should receive confirmation, in writing, that the facilities and services in the home can meet their needs. All residents must have care plans in place which detail how their needs are to be met. All health needs must be assessed and met with reviews of all needs being undertaken and recorded. All residents must be adequately supervised throughout the day. They must have call bells to hand and the call system must be audible for all staff. All medication in the care home must be safely stored to protect residents. The records kept for medication administration must be clear when changes are made. The disposal of medication must meet current guidance and legislation. Hooklands Nursing Home DS0000024158.V291847.R01.S.doc Version 5.1 Page 7 A programme of activities should be available for residents in the home since those spoken with said there was nothing to do. Residents or their representatives should feel able to raise issues of concern and be assured they will be handled effectively. The care home must be kept clean, in a good state of repair and decoration throughout and equipment must be safely stored and in good working order. There must be adequate hot water and heating to meet the needs of the residents, at all times. Environmental hazards must be identified and minimised. The safety of the residents in case of fire must be protected. A thorough recruitment procedure, which protects vulnerable adults, must be in place in the care home. Staff must receive training for the work they are to perform and enable them to meet the needs of the residents. Training should be planned and recorded. A system for reviewing and improving the quality of care provided must be developed and implemented. Risks to resident’s health and safety must be identified and plans in place to minimise these risks. 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. Hooklands Nursing Home DS0000024158.V291847.R01.S.doc Version 5.1 Page 8 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 Hooklands Nursing Home DS0000024158.V291847.R01.S.doc Version 5.1 Page 9 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, 2 and 3 The statement of purpose and service user guide had not been reviewed. The manager confirmed all residents had a statement of terms and conditions. Pre admission assessments do not provide adequate information on a potential residents health, personal and social care needs. Standard 6 is not applicable to Hooklands care home. EVIDENCE: The manager confirmed there had been no changes to the statement of purpose and service user guide since 2002. A recommendation was made at the last inspection that these be updated to reflect changes in the past two years. This had not been done. At the previous inspection not all residents had terms and conditions of the services and facilities offered. The manager confirmed that these were now in Hooklands Nursing Home DS0000024158.V291847.R01.S.doc Version 5.1 Page 10 place for all residents in the home. Some were seen and these contained relevant information, including the fees to be paid. One pre admission assessment was seen. This was not signed or dated and provided very basic information as to the resident’s health and personal care needs. There was a further assessment available from the resident’s former care home, and this included information not recorded within the homes own assessment or care plan. An assessment of need had also been undertaken on admission and whilst this provided some further information, care plans were not in place for all identified needs. For another resident no pre-admission assessment had been completed prior to a resident being admitted in an emergency. The manager said information had been gained from the family members. There was no evidence that any contact had been made with the hospital ward prior to this resident being admitted. There was no evidence that residents or their relatives had received confirmation, in writing, that the services and facilities offered could meet their needs. Hooklands Nursing Home DS0000024158.V291847.R01.S.doc Version 5.1 Page 11 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): 7,8,9 and 10 Care plans do not provide detailed information as to individual residents health, personal and social care needs and how these are to be met by the staff team. Records were not available to show all health care needs of the residents were assessed and met. Risks to residents health and welfare were not identified or minimised. Residents were treated with dignity and respect by the staff. Recording of medication administration did not protect the residents EVIDENCE: Five care plans were reviewed during the inspection. The manager confirmed all residents had a care plan in place. Those seen varied in the amount of information as to the needs of the residents and how these were to be met by staff. For one resident, where a major change had occurred two days earlier a Hooklands Nursing Home DS0000024158.V291847.R01.S.doc Version 5.1 Page 12 comprehensive care plan was in place. For another resident there were two plans which detailed medical conditions and needs and for another there was no plan in place. Some files contained a lot of information which was no longer up to date, but was stored in the same file as the present plan. This caused confusion to the reader as to the current action required. Where a change in condition or need was identified there was no record of action taken in response to this. Assessments for the risk of developing a pressure sore were present. These had been reviewed and contained information as to the preventative equipment to be used. For those residents assessed at high risk there was no care plan in place which detailed the actions to be taken, by staff, to prevent a pressure sore developing. No nutritional assessments were in place despite one of the residents having special dietary needs (as identified in the pre admission assessment.) Weight charts were present which stated weekly weights should be recorded. One resident had one weight entered on 31/3/06 another had two dated 16/4/05 and 6/8/05. For one of these residents the care plan for eating and drinking also said to weigh weekly. Weight loss or gain would not be detected with this lack of monitoring. For one resident a fluid intake and output chart was present in their bedroom. This was dated 21/3/06 and staff informed the inspectors this resident did not need their fluids recorded. The care plan for management of fluid retention stated a fluid chart was in place. This had not been reviewed and there was no evidence this resident was receiving adequate fluids. There were no specific wound charts and the care plan for the management of a wound had not been reviewed with a change of dressing. Professional medical advice had been sought regarding this wound. The lack of review of the care plan, including addition of this advice, could lead to a physician’s instructions not being followed by staff. Whilst residents had a risk assessment in place in relation to mobility, these did not supply any information as to how this risk should be minimised or managed by the staff team. Risk assessments had not been reviewed and information contained within them was contradictory. Assessments for the risk of falls were present. There were no specific risk assessments for the use of bed rails and some were in use without protectors being in place. A number of accidents were seen to be recorded which involved the use of bed rails with residents managing to open or lower these and falling out of bed or with limbs getting trapped. It was discussed with the manager that the use of bed rails should be reviewed and fully assessed. Records showed that some residents had the diagnosis of dementia documented. There was no evidence to demonstrate that staff have received training in this area. The inspectors raised concerns regarding the supervision of residents during the day. On arrival at the home and throughout the day residents were Hooklands Nursing Home DS0000024158.V291847.R01.S.doc Version 5.1 Page 13 shouting for staff to assist them. Some did use their buzzers, but staff said the sound of them had gone quieter and they could not hear them in certain parts of the home or if they were behind a closed bedroom door. Residents were seen to try to move themselves and getting distressed because of the time they needed to wait for help. Three visitors commented on residents having to call out for help and waiting too long for staff to come and assist them. During the morning all the staff had their break at the same time, in the dining room, at one end of the home. The manager said this was an opportunity for a discussion about the residents care. This left no-one to supervise residents in the lounges or their bedrooms on the three floors. Visitors commented that this is common practice and they felt it was difficult to disturb staff to ask for help at this time. The manger should review this practice in order to safeguard the residents. Observations made during the day included residents being taken to the dining room some time before meals were due. In addition one resident was observed to be left at the dining room table from breakfast to lunchtime with no communication from staff The medication in the home is administered by the qualified nurses, unless a resident is able and wishes to manage their own. At the time of this inspection one resident was self administering their own medication. No risk assessment was in place for this practice to ensure the safety of the resident. Several issues were raised with the nurse in charge regarding the storage of medication. The medication trolley was locked and secured, however the door to the room where all medication was stored was left open throughout the day. The manager stated it was closed if no member of staff was in that area. On arrival a carrier bag of medication was in this room, with the door unlocked and open. The fridge containing medication was not locked. These medications were not securely stored. Two examples of medication handwritten dosage changes which were unclear on the record sheets were seen. Handwritten medication administration records were not signed or witnessed. Variable doses were not recorded. There was no warning signs for the storage of oxygen. The manager stated there was no contract for the disposal of medication in line with current legislation. It was returned via the pharmacist. Some medication which should have been disposed of remained in the home. All medication storage, administration, recording and disposal must be in line with current legislation and safeguard the residents. Residents spoken with said the staff were “polite and kind” and treated them with respect. Bedroom and bathroom doors were closed when assistance was given and staff were heard to speak to residents calmly and in a dignified manner. Hooklands Nursing Home DS0000024158.V291847.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Residents are not given suitable opportunities for stimulation through leisure and recreational activities. Residents are able to maintain contact with family and friends Choices of the residents, who were able to tell staff, were understood and respected. A varied and balanced diet is available for residents however care plans should reflect particular dietary needs and preferences. EVIDENCE: There was no planned activity programme within the home. Residents spoken with were generally dissatisfied with activity provision within the home. Some residents advised that there was little or nothing to do with comments including, ‘it can be very boring,’ ‘it is very dull at times’. Staff also advised that there were few planned or arranged activities. Some staff said that the residents, at a recent meeting, had decided they no longer wanted the planned activities to take place. The minutes of the meeting did not record this and the manager was unclear what had taken place since she was not present. On the morning of the inspection there were sufficient staff to enable some to spend 1-1 time with residents, with some female residents enjoying a manicure. Hooklands Nursing Home DS0000024158.V291847.R01.S.doc Version 5.1 Page 15 Residents had personal leisure facilities in their rooms including radios, talking books, televisions and videos. Three residents were enjoying watching a video together, which they organised between themselves. Activities suitable to meet the residents needs and preferences must be available in the home. Residents spoken with advised that they can receive visitors at any time, and this was confirmed by relatives who were visiting during the inspection. One resident spoke of the manager’s kindness in assisting her to attend her chosen church on Sundays. Staff discussed how they assisted residents to the local shops and had monthly outings which were enjoyed. Those residents who were spoken with said that their choices were respected, with regard to the daily routine, as far as possible within the home. They could choose to sit in the lounges or in their bedrooms and eat in the dining room or their own rooms. A menu for the day was displayed on a notice board in the dining room. The choices available were chicken stew or mince and onion with mashed potato, roasted parsnips and cauliflower. The cook advised that he operates a four weekly menu. This was seen and it demonstrated that a wide range of meals were served within the home. Residents were asked for their preferred choice when they had morning coffee. This was recorded on a standard form which was then kept within a file in the kitchen. All residents spoken with advised that they enjoyed the food. Residents were observed to be able to choose where they wished to eat their meals. Fresh fruit was available within the dining room during the day. Lunch was observed to be relaxed and unhurried with staff available to provide assistance as necessary. Drinks were offered throughout the meal. It was noted within care plans that some residents were diabetic and the cook confirmed that their diet is taken into consideration when preparing meals and suitable foods are provided. In addition the chef confirmed that special diets can be catered for. A separate list of vegetarian options was seen during the inspection. However it was unclear in some care plans where special dietary needs had been identified, how this was managed and these care plans should be reviewed to ensure that a suitable care plan is in place which meets the needs of individual residents. Hooklands Nursing Home DS0000024158.V291847.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Not all representatives of residents felt assured their concerns would be listened to and acted upon. Residents were protected from abuse. EVIDENCE: The manager said they had never received anything in writing about a complaint. A book to note complaints was present and this was blank. She explained that she asked people if they wanted to make an official complaint and they said no. One relative had spoken to the inspector about issues they had brought to the attention of the manager. These were not recorded. Two visitors said it was pointless to bring things up as “nothing happened.” Residents spoken with said they would approach the manager with any issues. The complaints procedure was on display in the home. All complaints raised with staff and the action taken should be recorded. Both day and night staff spoken with demonstrated a good understanding and awareness of adult protection and the procedures to follow in the event of suspicion or evidence of abuse. The West Sussex Guidance for Adult Protection was available to staff. Hooklands Nursing Home DS0000024158.V291847.R01.S.doc Version 5.1 Page 17 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): 19,20,21,22,23,24,25 and 26. Parts of the care home presented a risk to resident’s health and safety due to lack of infection control, unidentified hazards, poor fire safety practices and faulty equipment. The home is in need of redecoration and repair so that residents live in a pleasant environment. Staff had made the home as domestic as they could. EVIDENCE: Following the last inspection six requirements with regard to the environment were made. At this inspection some improvements had been made, particularly in the kitchen, food storage and laundry area. The kitchen and laundry were clean. The laundry had lino flooring fitted. New cupboards and extractor fan had been put in the kitchen. The environmental health department were monitoring compliance with their legislation with regard to the kitchen. Several bedrooms and toilets had been redecorated. A full tour of the building took place. All bedrooms, communal areas and bathrooms were seen. The home was free from odour and generally clean on Hooklands Nursing Home DS0000024158.V291847.R01.S.doc Version 5.1 Page 18 the day of inspection. Some areas could not be adequately cleaned due to wear and tear, such as toilet seats, bathroom flooring and bedroom furniture. Some visitors did comment that cleanliness was not good on occasion, with dirty floors and carpets. Some carpets were badly stained. The cleaner was also responsible for being the handyman in the home. Many of the windows in the ground floor bedrooms had broken latches and arms which meant residents could not choose to have their windows open without wedging them with something. Some could not be secured. One had a crack in it and the resident said they were in a draught when in bed. All windows must be in good repair. One velux window on the third floor had been repaired, however the manager said this should be replaced. The blind on this window was broken off and the resident said the light came in at dawn, waking him. Records seen showed that there were problems with the boiler and that on occasion parts of the home have been without heating or hot water. On the day of inspection, which was a cold day, several parts of the home felt cold. Some residents had portable electric heaters in their bedrooms. The manager said no risk assessments had been done for the use of these. Following the inspection the manager stated this problem was being resolved. A number of fire doors were observed to be wedged open including the kitchen, top of stair cases and individual residents bedrooms. Staff were observed to wedge fire doors open during the inspection. One toilet door on the second floor was blocked by a wedged open fire door. The wedging open of fire doors endangers residents in case of a fire and does not accord with fire service requirements. Devices which have been approved by the fire service should be used for those residents who choose to have their doors open. Staff had received training in infection control and said they had access to adequate protective clothing. This was used during the inspection. Some areas and items which were worn could not be adequately cleaned to ensure the protection of residents from the spread of infection. This included toilet seats and bathroom floors. One bathroom on the ground floor was used for storage with nine pieces of equipment stored in it on the day of the inspection. The door was open to residents which could present a hazard. Valves to regulate the temperature of the corridor radiators and hot water outlets had been purchased. Many had not been fitted and the manager said she was trying to speed up this process with difficulty. During the inspection staff were seen lifting the trolley with hot drinks, cups, plates etc up a small step, onto a ramp in order to get it out of the kitchen. No Hooklands Nursing Home DS0000024158.V291847.R01.S.doc Version 5.1 Page 19 risk assessment for this process, in line with Health and Safety legislation, was in place. Staff spoken with said they were sometimes embarrassed by the poor state of some areas of the home, particularly when new residents or relatives came to look round. The manager said she had spoken to the owners of the home with regard to the environmental issues. Risk assessments were present for the laundry and kitchen. All areas, equipment and limitations of the environment which present a potential hazard to residents must be assessed and the risks minimised. Hooklands Nursing Home DS0000024158.V291847.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 The number of staff was adequate to meet the needs of the residents although working practices meant there were times of inadequate supervision. Residents are not protected by a thorough recruitment procedure. Whilst some training is available the Registered Provider must ensure that there is an appropriate staff training and development programme which ensures that staff are able to fulfil the aims of the home and meet the changing needs of the residents. EVIDENCE: The duty rota showed sufficient staff numbers and skill mix to meet the needs of the residents accommodated. As discussed, in standard eight, some practices left the residents without adequate and safe supervision at times. The recruitment records for five staff members were reviewed during the inspection. Of these only three had the required two references in place, one had one reference and one had none. There was no evidence that a CRB disclosure had been obtained for any of the five members of staff. The manager stated these were obtained and copies held by the owner elsewhere. Therefore staff were working in the home without the manager having evidence that the CRB and POVA checks were satisfactory. Records must be Hooklands Nursing Home DS0000024158.V291847.R01.S.doc Version 5.1 Page 21 kept, in the care home, to demonstrate that CRB and POVA checks are satisfactory. Staff spoken with advised that they have received some training in moving and handling, fire safety, food hygiene. Training records were seen for staff, however it was not clear from these how training was planned and managed. The manager stated there was no budget for the training of staff. Within records seen it was also noted that some residents were or had developed dementia however there was no evidence to demonstrate that staff have received training in this area. Both residents and visitors were generally complimentary about the staff team and felt well cared for. Comments included ‘they treat me well’, ‘we have no concerns’, ‘I am happy here’ Hooklands Nursing Home DS0000024158.V291847.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33 and 38 Residents benefit from the home being run by an experienced manager. There is no review of the quality of care and services provided. The recording of accidents, lack of assessment of risk and hazards of the environment did not protect the residents. EVIDENCE: The registered manager is an experienced qualified nurse who has been manager at the home for over five years. She said she keeps herself updated by attending study days, reading journals and attending courses. She passed a moving and handling assessors course last year and attends the local managers forum. She has completed her registered managers award. Hooklands Nursing Home DS0000024158.V291847.R01.S.doc Version 5.1 Page 23 There was no formal system for reviewing the quality of care in the home. Surveys were done last February and nothing since. Residents and staff meetings do take place. A requirement regarding this remains unmet. A policy and procedure was in place in relation to Health and Safety and the reporting of accidents. This should be applied when assessing risks in the environment. Accident records were reviewed. The manager stated she carried out an audit of accidents every four weeks. Those seen were poorly organised and there was no evidence that care plans had been reviewed and risk assessments undertaken, reviewed and updated. Not all accidents recorded in the daily records had been entered in the accident records. Risk assessments were present for the laundry and kitchen. All areas, equipment and limitations of the environment which present a potential hazard to residents must be assessed and the risks minimised. Some maintenance certificates were seen. The manager confirmed that all moving and handling equipment was serviced. Hooklands Nursing Home DS0000024158.V291847.R01.S.doc Version 5.1 Page 24 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 3 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 3 2 2 X 2 2 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X X X X 1 Hooklands Nursing Home DS0000024158.V291847.R01.S.doc Version 5.1 Page 25 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 2 Standard OP1 OP3 Regulation 6 14 Requirement The statement of purpose and service users guide should be reviewed and up to date. Residents must not be admitted to the home unless a full assessment of their needs has been carried out by a person competent to do so. Assessments must be reviewed. It should be confirmed in writing that the home can meet a prospective resident’s needs. All residents must have a plan of how their needs are to be met. This must be kept under review and drawn up in consultation with the resident or their representative. This should include dietary requirements. All health care needs must be assessed and reviewed, with management strategies in place. This must include pressure sore prevention, nutrition and fluid intake. All risks to residents health and welfare must be assessed and minimised with records kept. This must include use of bed DS0000024158.V291847.R01.S.doc Timescale for action 30/06/06 15/05/06 3 OP7 15 31/05/06 4 OP8 12(1)(a) 30/06/06 5 OP8 13(4)(c) 30/06/06 Hooklands Nursing Home Version 5.1 Page 26 6 OP8 12(1)(b) 7 OP9 13(2) 8 OP12 16(2)(n) 9 OP19 13(4) 10 11 OP19 OP19 23(2)(d) 23(2)(b) 12 13 OP19 OP19 23(2)(j) 23(2)(p) 14 15 OP22 OP26 13(4)(a) 13(3) rails and environmental risks such as portable heaters. All residents must be adequately supervised at all times. All residents must have access to a fully working call system. The recording, storage, administration and disposal of medication must safeguard the residents and be in line with current legislation and the Nursing and Midwifery Council code of practice. Resident should be consulted about a programme of activities, suitable to meet their needs. This should be implemented. All fire doors must be kept closed unless held open by a device which meets the approval of the fire service. This requirement remains unmet from the previous inspection. The timescale of 31/1/06 has expired. All parts of the care home must be kept clean. All windows in the care home must be free from cracks and in full working order. This requirement remains unmet from the previous inspection. All parts of the care home must have a hot water supply available at all times. All parts of the care home must have heating which is suitable and safe for the residents. The regulator valves should be fitted. Equipment must be safely stored so as not to present a hazard to the residents. All areas of the home and equipment must be fully cleanable to prevent the spread of infection. Bathroom flooring and toilet seats must be replaced or repaired. DS0000024158.V291847.R01.S.doc 15/05/06 15/05/06 30/06/06 30/11/06 30/06/06 30/11/06 31/05/06 31/05/06 31/05/06 30/06/06 Hooklands Nursing Home Version 5.1 Page 27 16 OP29 19 and Schedule 2 18(1)(c ) 17 OP30 18 OP33 24 19 20 OP38 OP38 Schedule 4 (12)(a) 13(5) 21 OP38 13(4) No staff must work in the care home without all information to ensure they are fit to work with vulnerable adults, having been obtained. All staff must receive training for the work they are to perform. The registered person should provide suitable assistance for this to take place. A training plan should be in place. A system for reviewing and improving the quality of care provided must be implemented. This requirement remains unmet from the previous inspection. A record of any accident in the home must be kept. A safe system of moving and handling must be in place. The lifting of the hot drinks trolley should be reviewed. Environmental risks to residents must be assessed and minimised. 31/05/06 31/05/06 30/06/06 31/05/06 31/05/06 30/06/06 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 OP16 Good Practice Recommendations Any concerns brought to the attention of the manager should be recorded and acted upon. Residents and relatives should be assured they are taken seriously. Hooklands Nursing Home DS0000024158.V291847.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY 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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