Inspection on 26/03/07 for Hooklands Nursing Home

This inspection was carried out on 26th March 2007.

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 20/04/06

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 Mrs Pat Hibberd Unannounced Inspection 26th March 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hooklands Nursing Home Address West Bracklesham Drive Bracklesham Bay Chichester West Sussex P020 8PF 01243 670621 F/P 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.V322472.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th October 2006. 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. The current fees range between £525.00 and £650.00 per week. Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this unannounced visit to the home. They arrived in the home at 9am and left the home at 2.30pm. The registered manager was present throughout the inspection. At the time of this inspection 20 residents were accommodated. Prior to the inspection a pre inspection questionnaire was received giving details of service provision including any changes made since the last inspection. Comment cards were also sent to all residents prior to the visit to the Home of which details as to feedback received will be included throughout the report. During the inspection a full tour of the premises took place that included all bathrooms and bedrooms. Four 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. Five members of staff and the manager were spoken with. Inspectors talked to the majority of residents during the inspection and had detailed conversations with nine of them regarding their experience of living in the home. Two visitors had discussions with one of the inspectors. What the service does well: From discussions held with residents and relatives and from comment cards received it was evident that residents received the information they required to make an informed choice as to whether the Home could meet their needs prior to moving in. Residents further indicated that they receive the care and support they need, staff listen and act on what they ask of them, are generally available to provide support when needed and that there are some activities arranged in which they can take part. Meals were seen to be nutritious with special diets catered for. The majority of residents knew whom they would talk to if they were unhappy with residents and relatives provided with a copy of the complaints procedure at the point of admission. Residents considered that the manager was helpful, supportive and listened to their needs. Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? Following three visits to the Home in April, August and October 2006 by the commission there have been a number of improvements to the Home and services provided. The pre admission process now ensures that admissions to the home have been planned and that the process includes visiting potential residents and identifying the help and support that they needed before they moved into the home. Resident’s health care needs are now being reviewed and care plans hold details as to when they had been reviewed and any action required. Staff indicated that they were aware of changes that are shared during handovers. Copies of residents’ care plans are held in their rooms. Risk assessments are now undertaken for residents considered to be assessed as high risk in terms of their mobility and/or mental health needs. Weight charts, falls risk assessments, wound charts and the management of wounds are now being reviewed. Staff breaks are now staggered to ensure residents are adequately supervised. The medication cupboard is kept locked ensuring medication is securely stored. Medication administration records are being appropriately completed and there is a risk assessment in place for one resident who is self medicating. It is acknowledged however, that this is a piece of work that is ongoing as residents’ needs change and new residents are admitted and will be followed up at all future visits to the service. There has been an informal daily activity programme devised and residents meetings have been reintroduced. Care plans now contain details of residents’ dietary needs and. how they should be managed. A record of complaints is now documented with any follow up action required. Staff have received training in Dementia Care and the Home have a staff training development plan in place for this year. Risks to residents ‘ health and welfare are being assessed with strategies in place and records kept as to action required to minimise risks identified. Fire doors are now being kept closed unless held open by a device that meets the approval of the fire service. The Home was considered to be generally cleaner and free from odours on the day of the visit. Bathroom flooring and toilet seats have been replaced. A quality assurance system has been put in place for reviewing and improving the quality of care and environment. Staff are no longer accommodated on the premises. Accident records are now completed and areas in the Home, equipment and limitations of the environment that present a potential hazard to residents have been assessed with a view to minimising the risks identified. Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 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.V322472.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6 were inspected on this occasion. Quality in this outcome area is adequate. There were procedures in place to ensure that the home identified the assistance and support that potential residents needed before they moved into the home although further information as to their social care needs is required. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During this inspection a sample of the records of 4 residents was examined . The records included support needs and staff support required to meet needs identified. There was evidence from these documents that the admissions to the home of the individuals concerned had all been planned with staff with the appropriate knowledge and skills and that the process included visiting potential residents and identifying the help and support that they needed before they moved into the home. Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 10 The home’s pre-admission assessments were complemented by more thorough and comprehensive assessments of a resident’s needs when they actually moved into the home. Residents and relatives spoken to commented about the process referred to above and comments included: • “I came and looked around before I moved, in Matron talked to me about what help I needed” There was documentary evidence that assessments of residents needs were reviewed regularly and revised as necessary when an individual’s circumstances had changed. However, resident’s social history was not always obtained at the point of admission and was not therefore documented in all files viewed. This was discussed with the manager who agreed that this information would be included in the future. Requirements from previous inspections have therefore been met. However, the manager acknowledges that this is an ongoing piece of work as resident’s needs changed and new residents are admitted. Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10 were inspected on this occasion. Quality in this outcome area is good. The home had systems in place to ensure; the personal and healthcare needs of residents were met. Medication was managed safely and effectively. Among other things staff working practice helped to ensure that residents’ privacy and dignity was promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During this inspection 4 residents’’ care plans were inspected including an individual who was receiving treatment for a pressure area. The documents examined contained sufficient detail and the plans were based on the assessments the home carried out in order to identify what help individuals needed. Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 12 Assessments included a range of potential risks to residents e.g. pressure sores; falls; moving and handling; malnutrition; wound care plans. Where a pressure area assessment indicated that an individual was at risk it was noted that the corresponding plan of care for the person concerned referred to the use a pressure relieving aid. The plans examined also set out clearly the actions staff had to take and what specialist equipment was needed to provide the support and assistance each person required. Where care plans referred to the use of equipment or how a specific need was to be met this was observed to be available, provided or in place e.g. pressure relieving aid; bed rails; Zimmer frame; or hoist. Records indicated that care plans were reviewed at least monthly and daily notes referred to the actions taken by staff to provide the needs set out in those plans. Staff spoken to were aware of the needs of the individuals whose records were sampled and they were able to describe the contents of the care plans. One staff member explained that they kept a note book with them to “ jot down any care needs that might need changing or discussing with staff during hand over so I can insure staff coming on shift know what needs to be done, I also talk to matron about any changes“. However, this practice could mean that records are not only duplicated but, could become a legal record. This practice should not, therefore, continue. Staff have also received training in Dementia care and indicated that this had been beneficial to their practice in supporting the needs of residents. Comments received in comment cards and discussions held with residents during the visit as to the abilities of staff the care and support that they provided included: • “The staff are good, they are friendly, nothing is too much trouble …if I press the call bell staff generally come when I need them and know what was wrong and what to do”. • “The staff are helpful. They help me with a bath … I feel comfortable when the staff help me”. The records examined indicated that a range of healthcare professionals visited the home and that arrangements were made for treatment for service users when it was necessary. Residents said that they saw and received treatment from among others, doctors, podiatrists and opticians and when required arrangements to attend outpatient clinics were made by the home. There was documentary evidence that when an individual had a wound/pressure sore that specific plans were implemented to manage the wound and monitor progress with healing. There were also very specific plans in place where weight loss or eating difficulties had been identified as a problem for an individual. The plans specified how this would be managed. Individuals’ health was monitored routinely and regularly e.g. weight, blood pressure and temperature. Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 13 The practice of staff taking coffee breaks at the same time leaving residents without any supervision is no longer taking place with staff observed during this inspection taking “staggered” breaks. Residents spoken to indicated that this now ensures there are always staff available. The home had written policies and procedures concerned with the management and administration of medication. The qualified nurses administer the medication in the home, unless a resident is able and wishes to manage their own. Currently one resident is self-medicating. A risk assessment is in place that was seen to have been regularly monitored and reviewed. The home uses a monitored dosage system, which is supported by the use of the MAR sheet [medication administration record sheet]. These were satisfactorily completed, with no omissions. The deputy manager reported that the home is looking to doing repeat prescriptions and prescriptions ‘on line’. The GP signs the MAR sheet if medication is changed. The drugs’ cupboard was clean and tidy. The home has individual trays for non-blister pack medication. A locked refrigerator is used for medication that needs to be kept cool. Records were kept of the ordering, receipt, administration and the disposal of medicines and these were accurate and up to date. All bedrooms are single and, as a consequence the privacy of residents was promoted by the fact that they were accommodated in singe rooms. Residents spoken to said that staff always knocked before entering their rooms. This latter practice was observed during the fieldwork visit. Residents and relatives spoken to described the staff as respectful and polite. Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All of the above standards were inspected on this occasion. Quality in this outcome area is adequate. The home organise social activities that provided stimulation although some improvement is required. Resident’s self-determination is promoted, enabling residents to exercise choice about all aspects of their daily life. Residents were able to maintain links with relatives and representatives. The dietary needs of residents were well catered for with a balanced and varied selection of food available that met their tastes and choices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During this inspection the manager showed the inspectors an informal activities folder that detailed the daily responsibilities of one staff member to encourage those residents who so wished to partake in an activity. The manager explained that whatever was planned would be discussed with residents and if they so chose they would be supported to join in. The activities ranged from bingo, games and discussion. Residents meetings are now been held again and minutes seen indicated that requests and agreements reached were being actioned. Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 15 It was acknowledged by the manager however, that for some residents that didn’t wish to or, could not participate in a meeting that alternative methods of identifying social stimulation needed to be identified. The manager agreed that this piece of work could be undertaken as part of the collation of resident’s social history and social interests as agreed in the previous section of this report. Residents were seen to have personal leisure facilities in their rooms including radios, televisions, talking books and videos. Residents can attend church and a minister visits monthly. Most residents spoken to indicated that their life style preferences were respected and that routines in the home were flexible and relationships were informal. Comments from residents about the activities that were organised, their ability to exercise choice and day-to-day routines in the home included: • “I join in the activities if it is something that interests me.” • “There are sometimes things to do I enjoy but not always”. Residents and relatives spoken to confirmed that there were no restrictions concerned with visiting the home and relatives said that they were always made welcome. There was information in the entrance of the home with details about an organisation that could provide impartial advice, information and guidance to residents and/or their families. At the time of the fieldwork/site visit no resident was managing his or her own financial affairs. The responsibility had been delegated to either relatives or representatives. Residents were able to bring personal items into the home including furniture and it was apparent from discussion with residents and observation during a tour of the building that many individuals had taken trouble to personalise their bedroom accommodation. Sensitive information that the home held about residents was kept secure and the home had written policies and procedures about maintaining confidentiality and residents rights to access their personal files and case notes. Residents were generally complimentary about the food provided and confirmed that they had 3 meals a day and could have snacks and drinks at other times. The menus and records of food provided indicated that the food was nutritious and there was a wide range of meals provided with a selection of choices every day. Care plans now hold details as special dietary needs and how this was to be managed with special diets and individual preferences and needs catered for e.g. soft and pureed meals, diabetics and vegetarian. Documents and the information were also readily available to catering staff in the kitchen area. Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 16 Fresh ingredients were used in the preparation of meals and the ready availability of fluids was noted. If required the ingredients for some pureed meals were prepared separately. Residents could choose where to eat and some preferred to eat in their rooms. The list of menu choices for the week was on display in the home. A member of staff asked individuals what choices they wanted during the morning of the meal in question. The main meal of the day was observed and it was unhurried and staff were sensitive when providing assistance. It was apparent from conversation around the dining room tables in the dining room that the meal was enjoyable. Comments from residents about the food provided included the following: • “The food is very good, we have 2 choices every day and they cater for my needs”. “ I get plenty of vegetables and the food is good “ and “we get a choice “. On the day of the visit, the cook was on a day’s leave and the home had employed an agency cook, who had been to Hooklands before. In discussions held with the cook he appeared to have been informed as to what he was required to do and, was seen to be supported by the permanent kitchen assistant employed by the Home. Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were inspected on this occasion. Quality in this outcome area is adequate. The home had a clear and satisfactory complaints procedure to address the concerns of residents and relatives/representatives. Robust procedures were in place to protect service users from the risk of abuse although these are not followed at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During this inspection the manager confirmed that the home had a written policy and procedure about how complaints could be made about the service that it provided. A copy was clearly displayed in the home’s entrance hall. All residents and relatives spoken to were confident about raising any concerns with the home’s manager or any of the senior staff working in the home. The home kept records of complaints that detailed the issue, and set out any agreed action to remedy the matter and its outcome. There had been five complaints made to the home since the last inspection in October 2006 one of which was still in the process of being resolved. The Commission for Social Care Inspection (CSCI) have received no complaints about the home during the same period. Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 18 The home had written procedures available with adult protection. These were intended to provide guidance and ensure as far as reasonably possible that the risk of residents suffering harm was prevented. Staff spoken to said that they received in house training about protecting vulnerable adults and an examination of staff training records confirmed this. Staff spoken to were also able to demonstrate an awareness of the different types of abuse and the action they would take if they suspected or knew that it had occurred. However, when reading the details of one of the complaints it was evident that the matter should have been reported under the West Sussex Guidance for Adult Protection. The manager had reported the matter to the Police but as there had been no conclusion to their investigation the matter had been closed without being brought to the attention of Adult Services. The manager was required to contact Adult Services to report the matter and discuss further. The manager was further reminded that this should have also been reported to the commission under Regulation 37. Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,20,23,24,25 and 26 were inspected on this occasion. Quality in this outcome area is poor. Most areas of the home are clean and safe, but all areas need to be of the same standard for service users enjoyment and safety. The home is in need of redecoration and repair so that residents can live in a pleasant environment. All parts of the care home do not have heating which is suitable and safe for the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Following a key inspection of the Home in April 2006 and a random inspection on 9 August 2006, the home was required to take six actions in respect of the physical environment. A follow up inspection on 6 October 2006 found that four of these were still outstanding and so the inspector spent time touring the Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 20 building and the physical environment standards were again inspected in some depth. The Commission received an action plan from the registered provider on 20 November 2006, in which the registered provider stated that a magnetic device for keeping a door open were being fitted to fire doors, cleaning was regularly undertaken, radiator covers had been fitted and suitable heating provided in all bedrooms, the heating system had been descaled to improve efficiency, the downstairs bathroom had a new floor and toilet seats have been replaced and staff are no longer accommodated on site. During this inspection it was noted that in some of the communal areas radiator covers had not yet been fitted. These radiators had been turned off to ensure that they were not a safety hazard. The inspectors were shown a record of the daily temperature taken in the home, ranging from 21 to 26 degrees Celsius. The inspectors were also shown an order, dated 20 March 2007, for seventeen radiator covers although a date for fitting had not been confirmed. On the day of the inspection a plumber was in attendance as there had been a problem with the boiler, resulting in no hot water to the upper floors. The plumber told the manager that a new radiator would be fitted in rooms 5 and 8 on 29 March 2007 and was attending the Home daily to try to rectify the problems with the heating. The registered provider was contacted by telephone during the inspection .He confirmed the 17 radiator covers had been ordered. However, he could not confirm the date on which they would commence the fitting and was required to write to the commission within 48 hours of the visit to confirm when the 17 radiators were to have covers fitted. The manager was further required to write to the commission confirming that the heating was in full working order. Requirements regarding the heating and radiator covers have been made during the last three inspections. Hooklands is situated on the seafront at Bracklesham Bay, and is a threestorey building. The rear garden has a patio area, is laid mainly with shingle and shrubs and backs onto the beach. The home has twenty-six single bedrooms, of which four are provided with en suite toilet facilities. Following a tour of the building the following was noted. Since the last inspection in October 2006 double glazed windows have been installed on the ground floor, although they have not been fitted with staves, the window will stay in an opened position, providing it is not windy. One visitor said, “It’s always windy here and I have to tie the window up”. It was noted in other parts of the home, in bedrooms 4, 5, 6, 10 and 11 that, the Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 21 seal between the two panes of glass in the doubled glazed windows had blown, leaving condensation and a misting in the window. This in particular spoilt the view of the sea from some of these bedrooms. The manager reported that the glazing firm had been to measure up these windows, with a view to them being replaced. This will be followed up at the next site visit. Various issues were found in bedrooms viewed : • One bedroom although empty, had a worn carpet. • Another had a hole in the wardrobe door, the carpet was worn and the outside window needed cleaning, as there were bird droppings and dirt on the window. • The veneer edging had come away on a chest of drawers in another room. • Redecorating was required in one bedroom as the walls and ceiling were discoloured. The radiator was not working. • The carpet was worn in another bedroom. • A further empty bedroom although empty, one wall had holes filled but needs redecorating. The white vinyl furniture was chipped. The manager reported that this was due to be done. There were two cracks in the front door and an amount of bird droppings on the outside steps leading up to the front door. It was noted that in some of the communal areas radiator covers had not yet been fitted. These radiators had been turned off to ensure that they were not a safety hazard. The inspectors were shown a record of the daily temperature taken in the home, ranging from 21 to 26 degrees Celsius. The inspectors were also shown an order, dated 20 March 2007, for seventeen radiator covers although a date for fitting had not been confirmed. On the day of the inspection a plumber was in attendance as there had been a problem with the boiler, resulting in no hot water to the upper floors. The plumber told the manager that a new radiator would be fitted in rooms 5 and 8 on 29 March 2007. Hooklands has a large lounge/dining room, with a patio door leading into the garden and access to views of the beach. It was noted that the coving was coming away at one end of the room. The seal between the two panes of glass in the doubled glazed patio door had blown, leaving condensation inside. This door was also locked. The manager was requested to contact West Sussex Fire & Rescue Service to determine whether this was a fire door and to consider having an alternative method of open access without the need to use a key. There are two smaller lounges, which also overlook the sea one of which is a quiet lounge and can be used by residents to meet with their visitors. Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 22 The shower tray mastic edging on the first floor bathroom had mould and also had gaps. The manager reported that residents do not use this shower. The corridor carpet by the lift on the second had frayed and come away from the metal carpet joiner. The manager reported that this is down to be done by the maintenance man. The home has a fire emergency evacuation plan. Each individual resident has an fire evacuation notice displayed on the back of their bedroom door, giving relevant information on means escape, depending on where they are situated within the building. All the toilets were provided with paper towels and soap dispensers and were clean on the day of the visit. The laundry room, which is situated away from food preparation, has a commercial washing machine and dryer. Each resident has an individual laundry basket. The area was clean. There were no unpleasant smells detected within the home. An anonymous comment card received from one resident indicated that washing is sometimes returned to them inside out and discoloured. No other concerns were raised. The laundry was discussed with the manager who assured the inspectors that she would look into the issues raised later that day. This will be monitored at the next inspection. Residents, spoken to, expressed a general satisfaction with their rooms and facilities. However, as noted above some of the rooms are in need of decorating, some windows were dirty, carpets dirty and an upgrade of furniture. Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All of the above standards were inspected on this occasion. Quality in this outcome area is adequate. There was an appropriate and satisfactory level and mix of staff that ensured the needs of residents were met. There were procedures in place for the training of new and existing staff to ensure that they had the skills to meet residents’ needs. The home’s recruitment procedures were not sufficiently robust and must be improved to ensure that people unsuitable to work with vulnerable adults are not employed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During this inspection information received in a pre inspection questionnaire indicated that the Home employ 29 staff including the manager, a deputy manager, 13 care workers, 8 ancillary staff and 8 first level registered nurses. This includes 2 cooks, 4 juniors, I kitchen assistant, 1 cleaner and handy man. Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 24 Of the 8 care staff 2 have National Vocational Qualifications. The manager said that there had been three more staff who had achieved the qualification but had subsequently left. At the time of the fieldwork visit the care staff rota setting out the minimum number and skill mix deployed in the home was as follows: 08:00 – 14:00 1 4 5 14:00 – 20:00 1 3 4 20:00 – 08:00 1 2 3 Registered nurses Health care assistants Total All residents and relatives spoken to were generally complimentary about the staff and their abilities. Residents, staff and relatives spoken to as to whether they considered the staffing levels to be adequate indicated that generally the number of staff deployed in the home was sufficient and comments included the following: • • • • “Sometime I think that they are a bit pushed, but it is swings and roundabouts”. “I think it varies a bit, staff numbers, sometimes they seem short but I am not too sure. They always answer the bell promptly”. “I find that staffing levels are what we need, any less and we would be much busier and any more and things would not get done “. “Very good Matron “. Five staff files were viewed including those relating to agency staff and, staff recently employed. It was apparent that in all cases the enhanced certificate from the Criminal Records Bureau (CRB) had been obtained and references were in place. However, in three files there was no evidence of the staff member’s current address and, in two no written confirmation that the staff member was eligible to work in the UK. The manager contacted the agency that had supplied the staff to the Home requesting the information relating to their right to work in the UK be faxed to the Home as soon as possible. This information was required to be forward to the commission within 48 hours of the visit. The manager further explained that the practice of staff residing on the premises no longer took place and, that the lack of current addresses in the three files related to the three staff who used to live in the Home. The inspector explained that the new address must be documented in the individual Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 25 staff file which the manager confirmed she would do. This will be followed up at the next site visit to the Home. Training records inspected confirmed that there is now a training programme in place to demonstrate that staff have received all statutory training including moving and handling, food hygiene, dementia awareness, fire safety, first aid (4 staff) Adult Protection (2 staff have undertaken the training which is cascaded to all staff) catheter care, risk assessment (2 staff who are responsible for risk assessing) pandemic flu preparation (2 staff). There is further training planned for the coming year including continuing care and care of the terminally ill. This will be monitored at future inspection visits to the service. Staff training needs were identified through appraisals and individual supervision sessions. It was apparent from discussion with the home’s registered manager that she was committed to staff development and training and provided and led a lot of training in the home herself. The manager said it was frustrating however, when staff were trained only to resign. Conversation with staff indicated that in addition to their induction training they attended training in subjects that ensured that they kept their clinical and other skills up to date. Staff comments about their induction and further training opportunities included: • “We have done mandatory training, health and safety at work, moving and handling and fire. We have done abuse training”. • “I have done fire safety, abuse, moving and handling, health and safety and basic food hygiene”. • “The matron is a good teacher”. There were no poor moving and handling practices observed during the visit. Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35 and 38 were inspected on this occasion. Quality in this outcome area is adequate. The home’s manager generally provides effective leadership although systems and procedures in place for monitoring and maintaining the quality of the service provided and promoting the safety and welfare of everyone living and working in the home needs to improve. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During this visit and, in discussion with the manager it was evident that 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 Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 27 moving and handling assessors course last year and attends the local managers forum. She has completed her registered managers award. Comments from staff, residents, and relatives about the registered manager were all very positive and included the following: • “ A good matron.” • “ Matron is very nice and we can talk to her if we have a problem.” A system is now in place for monitoring the quality of the service that the Home provides including the use of questionnaires to obtain the views of residents and relatives. The home’s registered manager also said that residents meetings had now been reintroduced as part of the Home’s quality assurance programme, and minutes viewed confirmed that any action agreed was being implemented. Some recently returned questionnaires were seen and the registered manager said that the results were due to be collated and then if necessary an action plan would be set out. The home had a range of policies and procedures that staff spoken to said were useful for reference and advice. Copies were available in the office. The manager indicated that they are reviewed and up-dated as necessary. Records examined indicated that the home’s equipment, plant and systems were checked and serviced or implemented at appropriate intervals i.e. passenger lift and hoists; fire safety equipment portable electrical equipment; hot water system; etc. There were contracts in place for the disposal of clinical and household waste. The policy and procedure in place in relation to Health and Safety and the reporting of accidents is now being applied when assessing risks in the environment. For example where a risk had been identified a risk assessment was clearly displayed for staff where vigilance is required. One practice included how staff should lift the tea trolley up a step from the kitchen. Accident records were better organised and there was evidence that care plans had been reviewed and risk assessments undertaken, reviewed and updated. Staff said that they attended regular and compulsory fire and other health and safety training. However, whilst the manager explained that she undertook regular risk assessments of the premises and working practices undertaken there was no formal documented system to indicate how often this took place. It was agreed that a system must be implemented and available for inspection. A further discussion was held with the manager in relation to the practice of locking the double dining room doors that are the only exit from this room into the garden (with the exception of a single door leading to a hallway and kitchen area) in the event of a fire. The manager explained that the single door was a fire exit at one time and the double doors to the garden were always open. However, following advice from the Statutory Fire Authority the fire exit signs were removed and the doors to the garden are now locked the majority of time. The manager could not find any written confirmation from the Fire Authority that the signs should be removed and, that it was safe to lock the Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 28 dining room doors. The manager telephoned the Fire Authority during the inspection and left a message for a fire officer to call to discuss fire evacuation procedures in the dining room. Any changes made must be shared with staff, monitored and regularly reviewed. Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 2 X X 2 2 1 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement Resident’s social history must be obtained at the point of admission and included as part of their overall care plan. Timescale for action 26/03/07 2. OP18 13(6) 3. OP38 37 4. OP38 23(2)(b) (c) The Home’s policy and 26/03/07 procedures in relation to the reporting of any allegation of abuse must be followed at all times. Incidents must be reported to 26/03/07 the commission as appropriate under Regulation 37 of the Care Homes Regulations 2001. A formal documented system to 03/04/07 indicate how often risk assessments of the premises and working practices are undertaken must be implemented and available for inspection. 5. OP29 19 and Schedule 2 No staff must work in the care home without all information to ensure they are fit to work with vulnerable adults, having been obtained. The timescale of 30/6/06 DS0000024158.V322472.R01.S.doc 26/03/07 Hooklands Nursing Home Version 5.2 Page 31 and 31/10/06 has expired. 6. OP19 23(2)(p) All parts of the care home must have heating which is suitable and safe for the residents. The timescale of 31/05/06 and 31/10/06 has expired. 7. OP19 23(2) (b)(d) The Home must have a programme of redecoration and repair to ensure all residents can live in a pleasant environment. The registered provider must consult with the Statutory Fire Authority with regards to the fire evacuation procedures in the dining room. Any changes made must be shared with staff, monitored and regularly reviewed. 09/04/07 20/03/07 8. OP38OP38 23(4) 26/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hooklands Nursing Home DS0000024158.V322472.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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