Inspection on 01/03/06 for Hookstead Resource Centre

This inspection was carried out on 1st March 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

Hookstead Resource Centre 02/02/07

Hookstead Resource Centre 23/09/05

Hookstead Resource Centre 14/12/04

Hookstead Resource Centre 22/06/04

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

CARE HOMES FOR OLDER PEOPLE Hookstead Resource Centre Goldsmith Avenue Crowborough East Sussex TN6 1RH Lead Inspector Judy Gossedge Unannounced Inspection 1st March 2006 10:30 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 Hookstead Resource Centre DS0000041399.V270032.R01.S.doc Version 5.0 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. Hookstead Resource Centre DS0000041399.V270032.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hookstead Resource Centre Address Goldsmith Avenue Crowborough East Sussex TN6 1RH 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) 01892 667855 01892 655862 East Sussex County Council Ms Carol Howie Care Home 22 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (4) of places Hookstead Resource Centre DS0000041399.V270032.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users to be accommodated is twenty two (22). That service users must be aged sixty five (65) years and over on admission. That a maximum of eighteen (18) service users with a dementia type illness to be accommodated. That accommodation is provided as follows: Willow Suite, seven (7) service users with dementia, receiving respite care for periods up to six weeks, or periods of short term care up to six months, with one place for a service user between the age of fifty five (55) and sixty four (64). Maple Suite, four (4) service users who are older people not falling within any other category, receiving assessment for a period of up to two weeks and rehabilitation on the Living at Home Programme, with one place for a service user between the age of fifty five (55) and sixty four (64). Cypress Suite, four (4) service users with dementia, receiving respite care for periods up to six weeks, or periods of short term care up to six months, with one place for a service user between the age of fifty five (55) and sixty four (64). Cedar Suite, seven (7) service users with dementia, receiving respite care for periods up to six weeks, or periods of short term care up to six months, with one place for a service user between the age of fifty five (55) and sixty four (64). That one named service user who is under the age of fifty five (55) can be accommodated on the Cedar Suite, Willows Suite or Cypress Suite for periods of respite care. 5. Hookstead Resource Centre DS0000041399.V270032.R01.S.doc Version 5.0 Page 5 Date of last inspection 23rd September 2005 Brief Description of the Service: Hookstead is run by East Sussex County Council (ESCC), and is a purpose built property on three floors, set in its own grounds located a short distance from the centre of Crowborough. Service user accommodation comprises of twenty-two single bedrooms situated on the first and second floor in four self-contained units (suites), each with a lounge and dining area. Three suites provide respite care or short term care of up to six months for service users with a dementia type illness. One suite is part of the Living at Home Programme a rehabilitation scheme, where older people who may have suffered a period of illness or hospitalisation can have up to a two week period of assessment, or are rehabilitated for a period of up to six weeks in preparation for their return home. There is a five-day, day care service on site, which service users can access when there is a vacancy. Level access is facilitated in the home by the provision of a passenger lift. There is a very attractive garden at the rear of the home. Hookstead Resource Centre DS0000041399.V270032.R01.S.doc Version 5.0 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over six and a half hours on 1 March 2006. This is the second statutory inspection for the year and should be read in conjunction with the first inspection carried out on 3 September 2005 to give an overview of all the standards to be assessed within this period. A tour of the home took place including communal areas and service users bedrooms. Rotas and care records were also inspected. Sixteen service users were resident, but on the day the home was very busy with three discharges, one an admission into hospital and two admissions in to the home. One service user was spoken with individually, and the Inspector sat and spoke to six service users from two suites in one of the lounges during a joint activity. Seven users in another lounge were spoken with generally during the afternoon. Due to communication difficulties it was not possible to speak to all service users individually and so the opportunity was also taken to observe the interaction between staff and service users in the communal areas. The Manager was not present during the inspection but two senior care officers, six care workers including agency and relief staff, an agency member of the housekeeping team, the cook and kitchen assistant and the administrative assistant were spoken with. An occupational therapist was also spoken with prior to the inspection. Comment cards were left for service users and their relatives/representatives to complete after the last inspection if they wished but none were received during the interim period. The CSCI have also met with representatives of the organisation to discuss the outstanding issue of the collation of quality assurance information and proposals have been put forward to address these issues. What the service does well: A Statement of Purpose is in place and a Service Users Guide is available to view. The home provides a comfortable and homely environment. Service users are treated with dignity and respect. Feedback from service users was that they were pleased with the overall care provided in the home. There is a detailed complaints procedure in place. Over 50 of the homes care staff have completed NVQ Level 2 in care. Hookstead Resource Centre DS0000041399.V270032.R01.S.doc Version 5.0 Page 7 The meals in the home offer both choice and variety and special dietary needs can be catered for. The home holds the ‘Only the Best’ Catering Award from Wealden District Council. What has improved since the last inspection? 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. Hookstead Resource Centre DS0000041399.V270032.R01.S.doc Version 5.0 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 Hookstead Resource Centre DS0000041399.V270032.R01.S.doc Version 5.0 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, 3 and 6. Although detailed information about Hookstead is available to be viewed prior to any admission to the home, because of the type of service provided service users have limited choice of placement. There are pre-admission procedures in place which need to be followed to ensure that service users care needs can be met at Hookstead. EVIDENCE: A Statement of Purpose is in place and a copy of the Service Users Guide is kept for reference in each service users bedroom. It should be ensured that service users, carers/representatives are aware of how to access the latest inspection report. All service users are assessed by staff from one of ESCC’s Adult Social Care Department’s assessment teams and have an assessment completed. Staff spoken with confirmed a copy of this or of the latest review of this assessment is sent to the home for reference. Sample documentation viewed for four service users evidenced this had been received. Hookstead Resource Centre DS0000041399.V270032.R01.S.doc Version 5.0 Page 10 One service user resident did not meet the registration category for the home. The CSCI had not been made aware of this placement or a variation to registration applied for. The Manager has subsequently stated that admission procedures have been reviewed to ensure if required a variation is applied for. One suite is for the use of service users on the Living at Home Programme and on the day there were three service users resident. One service user had completed their six weeks and was waiting whilst their family finalised a care package to return home, and two who were not on the programme but receiving respite care. The Manager subsequently stated that proposals are currently being considered for a change of use for this suite. Occupational therapists and physiotherapists working on the suite were not in the home on the day, usually working at Hookstead on a Tuesday and Thursday. Feedback received indicated that it can be difficult to maintain continuity of the rehabilitation programme provided when staff working on the Living at Home Programme are not on site. The one service user who had completed the programme spoke of the support given, of the exercises they were working on, of reviews of the care being provided and progress made and home visits prior to going home. Hookstead Resource Centre DS0000041399.V270032.R01.S.doc Version 5.0 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 and 9. Care plans were in place and detailed to ensure that service users’ health, personal and social care needs are met whilst resident in the home. There are detailed policies and procedures in place to manage medicine to ensure the protection of service users. EVIDENCE: A sample of the service users individual care plans viewed were detailed, described the service users’ health, personal and social care needs and how service users goals are to be achieved. It was evident that work to improve the detail on the care plans has been carried out since the last inspection. All had a copy of a falls risk assessment and a number of supporting risk assessments were also seen to be in place. Where service users have been resident for short or long-term care the reviews of the care plans need to be evidenced. Medication policies and procedures are in place and being reviewed. Staff spoken with confirmed they are in the process of receiving further medication training arranged by the organisation to meet the requirements of the standard. The storage and a sample of the recording of the administration of Hookstead Resource Centre DS0000041399.V270032.R01.S.doc Version 5.0 Page 12 medication were also viewed on two of the suites. Staff and records confirmed that a pharmacist visits but had not been for a significant period. None of the service users were self-medicating at the time of the inspection. Hookstead Resource Centre DS0000041399.V270032.R01.S.doc Version 5.0 Page 13 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 and 15. There are opportunities for service users on three of the suites to participate in social activities during their stay, so that service users social care needs are fulfilled. But this needs to be further developed on the fourth suite. The meals in the home offer both choice and variety and special dietary needs can be catered for. EVIDENCE: There are opportunities for service users on Willow, Cyprus and Cedar suites to participate in social activities in the home. Service users and staff spoke of and records detailed activities that had been organised. During the morning there was a general discussion/reminiscence group, a quiz and poetry reading. Service users social care needs are now included on service users individual care plans. There are less opportunities for service users on the Maple suite and these need to be developed. One service user spoken with on the suite stated they had joined in an activity in day care that morning but that it was the first social activity they had participated in during their six-week stay. The food provided in the home is freshly cooked and a seasonally varied. A rotating menu is in place, and service users are also asked for suggestions as to what they would like to be added to the menu. There are choices at all Hookstead Resource Centre DS0000041399.V270032.R01.S.doc Version 5.0 Page 14 meals and service users are asked to select their choice for each meal. Special diets are catered for. In addition there is a kitchen on the suites where breakfast, supper, drinks and snacks can be prepared. Breakfast is mainly cereals and toast, but the Manager stated that a cooked breakfast where requested can also be provided. The lunch on the day was Irish stew, fish fingers, or a salad and apple and ginger pudding and custard. Fresh fruit was seen on the suites. One service user commented that they were aware that fresh fruit was available on their suite, but that they felt uncomfortable asking for this and would welcome staff proactively offering the fruit. All service users spoke very well of the food provided. The home has been awarded the ‘Only the Best’ Catering Award from Wealden District Council. Hookstead Resource Centre DS0000041399.V270032.R01.S.doc Version 5.0 Page 15 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. There is a clear and effective complaints procedure in place, which enables service users and their representatives to raise any concerns that they might have. There are detailed policies and procedures in place to protect service users from abuse. EVIDENCE: ESCC has a detailed compliments and complaints policy and procedure in place. Any complaints received are monitored through the line management arrangements in place within the organisation. One complaint had been received since the last inspection, which had been dealt with appropriately. The CSCI have not received any complaints in relation to the service provided at Hookstead. Where asked service users confirmed that they would feel comfortable raising any concerns with the staff or the Manager. There are detailed policies and procedures in place in relation to vulnerable adults. Four care staff spoken with demonstrated an awareness of the policies and procedures. Hookstead Resource Centre DS0000041399.V270032.R01.S.doc Version 5.0 Page 16 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 and 26. The home provides a safe, comfortable and homely environment. EVIDENCE: The entrance to the home and communal areas on the suites were decorated last year. But some of the bedrooms are starting to show evidence of wear and tear and some of the décor is damaged. It was not demonstrated that a maintenance plan to address this was in place. But it is proposed to refurbish two of the suites kitchens. There is a passenger lift between the ground, and first floor within the home. There are twenty-two single bedrooms which all meet the minimum space requirements. Service users are able to control the temperature in their own bedrooms. All bedrooms have an emergency call bell system. Some of the bedrooms seen reflected a range of individual styles and interests. Hookstead Resource Centre DS0000041399.V270032.R01.S.doc Version 5.0 Page 17 All of the bedrooms have en-suite facilities and there are assisted shower and bathing facilities, which have been made homely on each of the units in the home. Hot water in twelve of the wash hand basins and baths used by service users were tested, and were all close to the recommended safe temperature of 43° C. The homes own records of checks of the hot water temperatures were also seen. There are separate lounge and dining rooms on each of the suites. The home was clean and free from offensive odours. One agency member of the housekeeping team was spoken with and demonstrated knowledge of infection control procedures in place. The recording of routine fire checks were seen and were adequate. Hookstead Resource Centre DS0000041399.V270032.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 and 30. Adequate staffing levels are maintained to ensure that all the care needs, the health safety and welfare of the service users resident are met. ESCC have detailed recruitment policies and procedures in place in order to protect service users. EVIDENCE: The staff rota was viewed and staffing was adequate on the day to meet the care needs of the service users resident. The homes relief staff and agency staff were working in the home during the day and there is still a high reliance on these staff to maintain staffing levels. On the day there were two agency staff and two relief staff on duty out of the six care staff during the morning. Those spoken with confirmed that they regularly work in the home. Agency staff are also being used to cover catering and ancillary tasks in the home. All staff spoken with spoke well of working in the home. Staff confirmed that over 50 of the staff hold NVQ Level 2 in care. This does not include agency and relief staff working in the home. Four further care staff are also working towards the qualification. All recruitment of ESCC staff is co-ordinated by the Personnel Section at organisations head office. Staff information/recruitment documentation for staff employed is now held at the home and a sample was viewed and in place. Hookstead Resource Centre DS0000041399.V270032.R01.S.doc Version 5.0 Page 19 The Manager has subsequently confirmed that all staff have a satisfactory Criminal Records Bureau (CRB) check in place. The Senior Care Officer who co-ordinates the induction for new staff recruited confirmed the induction training provided for new staff. ESCC have detailed induction and foundation training in place which new staff are expected to complete. Hookstead Resource Centre DS0000041399.V270032.R01.S.doc Version 5.0 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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, 35 and 38. There is a detailed quality assurance policy in place to enable service users and their carers/representatives to give their views on the home and the care provided. But this needs to be maintained. Satisfactory arrangements need to be put in place to evidence staff have undertaken the required health and safety training. EVIDENCE: The Manager has worked for East Sussex County Council for many years, as a Senior Manager. There have been opportunities within the organisation to undertake periodic training, and the Manager holds a Certificate in Social Services qualification and is still working towards NVQ Level 4 in Management. ESCC has a quality assurance system in place, which has been implemented in the home but not maintained. There are opportunities for service users and carers to put forward their views about the home and the care that they Hookstead Resource Centre DS0000041399.V270032.R01.S.doc Version 5.0 Page 21 receive through forums and questionnaires completed at the end of a each stay on the unit which informs ESCC and staff of the quality of the service being provided. Regular service users meetings have not been maintained. Representatives from ESCC have confirmed that feedback from the quality assurance process is currently being collated to be available in April 2006. A formal process to gain feedback from other stakeholders has been developed and is due to be implemented. Regular quality assurance visits by a representative of ESCC are completed and recorded to meet the requirement under Regulation 26. Where a small ‘float’ of money is held for some service users the financial records to support this activity were adequate. The organisation has now implemented a system to evidence that the maintenance of equipment and services has been carried out. The Manager is in the process of collating staff training completed. All staff spoke of recent training in moving and handling, first aid and fire training. But it was not possible to evidence from staff training records available that all staff had received the required health and safety training. Hookstead Resource Centre DS0000041399.V270032.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Hookstead Resource Centre DS0000041399.V270032.R01.S.doc Version 5.0 Page 23 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 OP7 Regulation 4 (2) 13 (4) Requirement That a copy of the last inspection report is available to view in the home That individual plans of care are subject to regular review. This issue is outstanding since 30.11.05. That leisure and social activities are developed for service users on Maple Suite. That a maintenance and redecoration plan for the home is in place. That the quality assurance systems in place are maintained. That is evidenced that all staff have received training in fire prevention, basic food hygiene, moving and handling, medication and first aid. Timescale for action 31/03/06 30/04/06 3. 4. 5. 6. OP12 OP19 OP33 OP38 16 (1) (m) 23 (2) (d) 24 (1) (2) (3) 23 (4) (d) 30/04/06 30/04/06 30/04/06 30/04/06 Hookstead Resource Centre DS0000041399.V270032.R01.S.doc Version 5.0 Page 24 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 Hookstead Resource Centre DS0000041399.V270032.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hookstead Resource Centre DS0000041399.V270032.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!