CARE HOMES FOR OLDER PEOPLE
Hooklands Nursing Home West Bracklesham Drive Bracklesham Bay Chichester West Sussex, PO20 8PF Lead Inspector
Mrs L Riddle Announced Wednesday 5 October 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hooklands Nursing Home H60-H11 S24158 Hooklands V244764 041005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Hooklands Nursing Home Address West Bracklesham Drive, Bracklesham Bay, Chichester, West Sussex, PO20 8PF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01243 670621 Mr Mohammed Saleem Chaudhry Mrs Jeanette Louise McDowell Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (OP) - 27 both of places Hooklands Nursing Home H60-H11 S24158 Hooklands V244764 041005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 3 May 2005 Brief Description of the Service: Hooklands is a care home registered to provide personal and nursing care for up to twenty seven elderly (over the age of 65 years) persons. The registered provider is Mr Mohammed Saleem Chaudry and the registered manager in charge of the day to day running of the home is Mrs Jeanette Louise McDowell. The home is situated on the seafront at Bracklesham Bay within easy walking distance of local shops. A restricted bus service is available. The original part of the premises is three-storey with accommodation arranged on all three floors accessed by a passenger lift. There is also a ground-floor extension which includes further bedrooms and two lounges. A dining room is in the original part of the building. The large rear garden provides direct access to the beach and there are a small number of parking spaces to the front of the home. A ramp provides easy access to the home for those in wheelchairs. Hooklands Nursing Home H60-H11 S24158 Hooklands V244764 041005 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This annual announced inspection was carried out over a period of eight hours by one inspector. Prior to the inspection the previous two reports were read along with other documents and correspondence relating to the home. A pre-inspection questionnaire was completed by the registered manager and returned to the Commission for Social Care Inspection and some of the information included in this contributed to the inspection process. Two comment cards were received from relatives/visitors which were mainly complimentary in relation to the care and services provided. Seven residents and four members of staff were spoken with during this inspection, one visiting relative was also spoken with. Discussion took place with the registered manager and a tour of the building was undertaken. Records and other documents were also examined as part of the inspection process. What the service does well:
The home has friendly and competent staff who care for each resident according to his or her individual needs and wishes. This is supported by resident’s comments which included “I wouldn’t want to be anywhere else, this is home to me. They know my needs and take care of them” “the staff are very good, they never mind what they do” “staff know what I need and attend to me very well”. Resident’s legal rights are respected. Residents made such comments as “yes I have postal votes” and “I went in my buggy to vote”. Residents and relatives are confident that any complaints they may have are or will be listened to and acted upon. Responses from those asked included “on occasions when I’ve had to raise concerns they have always been dealt with promptly and satisfactorily” and “if I had a complaint I’d tell the manager, she would do something about it I know she would”. Hooklands Nursing Home H60-H11 S24158 Hooklands V244764 041005 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better:
The velux window in room 3 remains in poor condition. Many areas of the home including resident’s bedrooms remain in need of redecoration and some carpets and furnishings are not in good condition. Some parts of the home are in poor repair. A more active response to improve the environment would benefit those living in the home. Not all hot water outlets are fitted with regulating valves to control safe temperatures. The registered manager is still without a training budget and therefore restricted to seeking only training which is free of cost. The registered provider has a responsibility to ensure that those working in the home receive training appropriate to the work they carry out. Monthly reports of unannounced visits to the home by the provider in accordance with legal requirements are not being properly managed.
Hooklands Nursing Home H60-H11 S24158 Hooklands V244764 041005 Stage 4.doc Version 1.40 Page 7 A system to monitor the quality of care provided in the home has not yet been fully developed. Not all residents have an up to date statement/contract of their terms and conditions of residence. More thought should be given to keeping residents safe, especially in relation to the risk of fire. 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 H60-H11 S24158 Hooklands V244764 041005 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Hooklands Nursing Home H60-H11 S24158 Hooklands V244764 041005 Stage 4.doc Version 1.40 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 standard(s) 2 Not all residents have up to date statements/contracts of terms and conditions with the home which could disadvantage them. EVIDENCE: Files looked in did contain contracts of terms and conditions but the registered manager said that not all residents have them and they are not all up to date. Some residents asked were aware of the contracts and thought that the copies were held by their relatives, others could not remember. Hooklands Nursing Home H60-H11 S24158 Hooklands V244764 041005 Stage 4.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 8 The health care needs of residents are fully met with residents having access to appropriate health care practitioners. EVIDENCE: Four care plans examined contained information to show that residents receive care appropriate to their assessed needs. Daily records include information about visits by GPs, chiropodists, opticians and other practitioners. A GP from the local surgery visits weekly. Some residents said that they had been able to keep their own GPs when they entered the home as they had lived locally. They confirmed that they are encouraged to take exercise walking about the home or in the gardens. The dietary needs of residents were seen to form part of their assessments and are catered for appropriately. Two residents were receiving treatments for pressure sores and were seen to have appropriate equipment such as special mattresses and care which included very regular turning as part of their treatments . Risk assessments had been undertaken for residents in relation to their vulnerability in this respect. Hooklands Nursing Home H60-H11 S24158 Hooklands V244764 041005 Stage 4.doc Version 1.40 Page 11 Other risk assessments such as those relating to falls, use of cot sides, and smoking were contained in the care plans. Hooklands Nursing Home H60-H11 S24158 Hooklands V244764 041005 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14 Social activities are suitably managed to provide sufficient variation and interest for those living in the home. EVIDENCE: Information provided in the pre-inspection questionnaire listed a number of recreational and social activities which take place in the home throughout the year. These included ship-spotting, beach watching, bread-making, quizzes and trips out to venues such as a canal trip, garden centres, gardens, cinema and others. Residents asked were able to confirm that they had had opportunities to partake of these. Some had participated and some had chosen not to or been unable to. A hairdresser visits three-weekly for those who want her services. One resident said that her friend takes her to the hairdressers in the village. There are religious services in the home for both Church of England and Catholic faiths. Two residents said they attend church every Sunday. Residents spoken with felt that they had control over their lives and are able to make choices and decisions. One resident said “I go where I want when I want” and another said “ I get up and go to bed at times which suit me and I choose what I want to wear”.
Hooklands Nursing Home H60-H11 S24158 Hooklands V244764 041005 Stage 4.doc Version 1.40 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 Complaints are handled objectively and residents are confident that their concerns will be listened to. EVIDENCE: The home has a detailed complaints procedure which residents and relatives are aware of. The two comment cards received back from relatives indicated that they were aware of the complaints procedure. Residents and a relative spoken with knew who to complain to should it be necessary and were sure that they would be taken seriously and their complaints acted upon. One complaint about the home made initially to the Commission for Social Care inspection and concerning an adult protection issue, was still awaiting an outcome. Not all concerns or minor complaints are currently recorded although there was documentary evidence and correspondence to show that complaints are followed up and investigated. The manager said that the more minor concerns are dealt with straight away and she had not thought it necessary to record them. She said that she will do so in future. Residents spoken with were able to confirm that they are given the opportunity to vote, either by attending the polling station or by postal ballot. Hooklands Nursing Home H60-H11 S24158 Hooklands V244764 041005 Stage 4.doc Version 1.40 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22, 24, 25, 26 Limited improvements to the décor have been made. A more active approach to upgrading the property would provide the persons living in the home with brighter and more comfortable surroundings. EVIDENCE: Since the last inspection the home has continued with a programme of redecoration and one or two bedrooms have been redecorated. However a number are still in need of redecoration where walls have become marked and paintwork chipped. The decor in some areas of corridor and landing are also in need of attention for the same reason. The carpeting in some corridors and on stairs is very worn. This could be hazardous to residents and cause them to trip. This matter was identified in the previous report. The carpet in bedroom 9 is very stained and unsightly. The white furniture in some bedrooms has become very shabby and needs replacement. A chest of drawers in bedroom 14 is missing a bottom drawer. The bed in room 1 was broken underneath. Resident’s rooms do not provide
Hooklands Nursing Home H60-H11 S24158 Hooklands V244764 041005 Stage 4.doc Version 1.40 Page 15 lockable storage space for money and other valuables. Residents said that their rooms and other areas are cleaned regularly. Comments about rooms included “I’m very comfortable” and “I like my room, I’ve got lots of my own things around me”. It was observed that all rooms contained some or many of the occupant’s own possessions. A small staff room has been provided in the garage area but there is no heating in this as yet. The area of the garage used for storage of food and other items is in very poor repair with unfinished walls and poor flooring. The laundry flooring is in very poor repair including the boiler room where one of the washing machines is sited. Tiles are missing from the wall in the laundry room and this means that the walls are not easily cleanable. These matters could impact on the control of infection. Regulating valves have been fitted to most hot water outlets in bedrooms to control temperatures of hot water. However, seven rooms are still needing these. Hooklands Nursing Home H60-H11 S24158 Hooklands V244764 041005 Stage 4.doc Version 1.40 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28, 29, 30 The procedures for the recruitment of staff are robust and provide safeguards which offer protection to people living in the home. EVIDENCE: Five care staff have achieved National Vocational Qualifications at level 2 or above. This is less than the required 50 to fully meet this National Minimum Standard. The registered manager has so far done well to find and obtain free training for staff but this may not always be available. The registered provider should ensure that she is able to access a proper annual training budget. Five staff files examined showed that all necessary recruitment checks and procedures had been followed. They contained application forms, at least two references, and confirmation of identification. The registered manager was able to produce evidence of all staff having Criminal Records Bureau clearance with the exception of one still awaited. Appropriate documentation was available for those staff from overseas to show that they are legally able to work in the home. Hooklands Nursing Home H60-H11 S24158 Hooklands V244764 041005 Stage 4.doc Version 1.40 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35, 38 More continuous monitoring of the home’s performance would help to ensure that it’s aims and objectives are met and resident’s best interests safeguarded. EVIDENCE: The registered provider’s monthly unannounced visits to the home are not being properly managed. The person making the visits has been leaving the manager to write the reports of those visits which is not acceptable and does not meet the legal requirements. Copies of the reports have not been sent in regularly each month to the Commission. Before the inspection four were sent in with the pre-inspection questionnaire. Surveys are sent out to residents and relatives but there is no system to quantify the outcomes of these. The home does not have an annual development plan. To date the provider has been less than diligent in progressing action within given timescales to implement all requirements identified in CSCI reports.
Hooklands Nursing Home H60-H11 S24158 Hooklands V244764 041005 Stage 4.doc Version 1.40 Page 18 The arrangements for handling money for a small number of residents were seen to be satisfactory. Records were examined and facilities for the safekeeping of valuables observed. Most residents have relatives or other representatives who handle their finances. Comments received included “My son looks after my money. He brings me whatever spending money I need and Jeanette puts it in the safe if need be” and “I manage my own finances through my bank, when I need money I go to the local branch in my buggy and cash a cheque”. Records examined showed that most staff had received training in topics relating to health and safety such as first aid, infection control and food hygiene. The registered manager has just completed a trainers course in moving and handling and will be training the staff. Arrangements are in place for the servicing and repairs of equipment in the home. A risk assessment of the premises and gardens has not been undertaken. Not all fire doors were closed. Some were seen to be wedged open. The registered manager said that one resident insists on her door being kept open at night as well as in the day. Wedging fire doors open at any time puts residents and others at risk especially as the home accommodates two people who are heavy smokers. If specific fire doors need to be held open they should be fitted with an approved device after consultation with the fire officer. Hooklands Nursing Home H60-H11 S24158 Hooklands V244764 041005 Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 2 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 x
COMPLAINTS AND PROTECTION 1 x x 3 x 2 2 1 STAFFING Standard No Score 27 x 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x x x 1 x 3 x x 1 Hooklands Nursing Home H60-H11 S24158 Hooklands V244764 041005 Stage 4.doc Version 1.40 Page 20 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 19 Regulation 23 (2)(b) Requirement The registered person shall ensure that the premises are kept in a good state of repair. The velux window in room 3 needs repair or replacement.(privious timescale of 30/08/05 not met) The registered person shall ensure that all parts of the care home are kept reasonably decorated. The registered person shall provide adequate furnishings and floor coverings suitable to the needs of residents. The registered person shall ensure that unnecessary risks to the health and safety of residents are identified and so far as possible eliminated. (Fit regulators to all hot water outlets in areas used by residents) The registered person shall establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home. The registered person shall take adequate precautions against the Timescale for action 30 November 2005 2. 19 23(2)(d) 31 January 2006 31 January 2005 31 December 2005 3. 19 and 24 16(2)( c) 4. 25 13(4)( c) 5. 33 24(1)(2)( 3) 31 January 2005 6. 38 23(4)(a) Immediate 05 October
Page 21 Hooklands Nursing Home H60-H11 S24158 Hooklands V244764 041005 Stage 4.doc Version 1.40 7. 26 23(2)(b) risk of fire(keep all fire doors closed unless fitted with an approved device) The registered person shall ensure that the premises are kept in a good state of repair internally. (The laundry floors and walls to be attended to and the storage areas to be improved) 2005 31 January 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 24 28 and 30 38 2 Good Practice Recommendations Lockable storage space should be provided in residents rooms. The registered manager should have access to a training budget for her staff A risk assessment of the premises and grounds should be undertaken. All residents should have an up to date contract of terms and conditions. Hooklands Nursing Home H60-H11 S24158 Hooklands V244764 041005 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 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
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