CARE HOMES FOR OLDER PEOPLE
Hopes Green Care Centre 16 Brook Road Benfleet Essex SS7 5JA Lead Inspector
Carolyn Delaney Un-announced 23rd June 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. Hopes Green Care Centre I06-I56 S18097 Hopes Green V228884 230605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Hopes Green Care Centre Address 16 Brook Road Benfleet Essex SS7 5JA 01268 752327 01268 755518 hopesgreen@ashbourne-home.co.uk Exceler Healthcare Services Limited 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) Vacant CRH 50 Category(ies) of Older People (OP) 50 registration, with number of places Hopes Green Care Centre I06-I56 S18097 Hopes Green V228884 230605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Old age, not falling within any other category (50) Date of last inspection 19/02/05 Brief Description of the Service: Hopes Green Care Centre is a large home providing accommodation and personal care for up to fifty older people aged over 65 years of age who need assistance with personal care. The homes facilities include several communal lounge/dining areas and fifty single bedrooms all with ensuite facilities. The home is situated within easy walking distance of local shops and amenities, with Southend and Canvey Island main shopping centres a short car or train journey away. There are good bus and train links to the area.The garden enables service users to access a patio area and garden safely. There is ample car parking for visitors and the home has adequate wheelchair accessibility throughout. Hopes Green Care Centre I06-I56 S18097 Hopes Green V228884 230605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection carried out between 08.45 and 16.00 on 23rd June 2005 by the homes lead inspector, Carolyn Delaney and second inspector Michelle Love. During the inspection residents care notes such as assessments of their needs, care plans and assessments in respect of risks of potential injury were examined. Eight residents, four relatives and four members of staff were spoken with during this inspection and their views and comments have been reflected within this report. Records in respect of the recruitment and training of staff were also examined. What the service does well:
Hopes Green provides a homely and well-maintained environment for older people who require assistance with daily activities. One resident commented that it was like ‘home from home’ and relatives were overheard to say that this was ‘the best home in the area’ and that they could not speak highly enough of the manager. Staff record detailed information about residents in their care plans so as to ensure that all staff working at the home are aware of residents needs and any changes in these needs. Staff working at the home are well trained so that they can meet the needs of residents. Staff spend time with residents and interact with them at meal times and when helping them with care. The acting manager ensures that people recruited to work at the home have all of the necessary checks such as references from previous employers and Criminal Records Bureau (CRB) / POVA First checks in place before staff commence work so as to ensure that residents are kept safe and free from harm. Hopes Green Care Centre I06-I56 S18097 Hopes Green V228884 230605 Stage 4.doc Version 1.30 Page 6 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.
Hopes Green Care Centre I06-I56 S18097 Hopes Green V228884 230605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Hopes Green Care Centre I06-I56 S18097 Hopes Green V228884 230605 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Assessments of residents needs are carried out in a consistent manner prior to them being offered a place at the home, and assessments are reviewed upon each admission so as to determine that the home can meet individual’s needs. EVIDENCE: A qualified member of staff carries out an assessment of peoples needs before they are offered a place at Hopes Green. A further assessment / care plan is carried out upon each individuals admission to the home. Assessments, which were examined were generally well written and included specific details about the residents needs in respect of carrying out daily activities of living. For example one resident it was clearly recorded what his likes and preferences for his daily routines were and there was evidence that staff assisted him in carrying out his wishes. Some assessments did not include how specific needs, in particular mental health needs affected individuals abilities with regards to carrying out daily activities of living.
Hopes Green Care Centre I06-I56 S18097 Hopes Green V228884 230605 Stage 4.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,&9 Care plans, daily care notes and assessments in respect of risks to residents were not always detailed, reviewed and updated with information about residents so as to ensure that all staff were aware of residents needs and any changes in these needs. Residents receive medication, which is prescribed for them, at appropriate times and those residents who can and chose to retain and administer their medicines are supported in doing so. EVIDENCE: In general there have been improvements made since the last inspection in respect of the recording of information about residents living at the home. Some care plans were well written and detailed with information about the needs of residents living at the home. However all care plans were not written in a consistent manner and many did not include details specific to each individual resident in respect of how their needs impacted upon their ability to carry out activities of daily living. Care plans were not always specific in respect of what care and assistance staff were to provide to each individual so as to meet their needs. For example it was not clear for one resident, for whom it was recorded ‘could be uncooperative and very confused at times’,
Hopes Green Care Centre I06-I56 S18097 Hopes Green V228884 230605 Stage 4.doc Version 1.30 Page 10 how this affected their daily lives or what actions that staff were to take in respect of this need. Care notes were not detailed for all residents. For example where it was recorded, for example that residents had refused food it was not clear what actions staff had taken such as offering alternatives or offering food later in the day etc. Assessments in respect of risks to residents of injuries from falls etc were not always reviewed following such incidents. The home does not have an assessment too for determining the risks to residents of developing pressure sores. One resident who had developed a pressure sore during her stay at the home due in part to her refusal to use a specialist pressure-relieving mattress. This was not clearly recorded, nor was it clear what other measures staff took to minimise the risks to this resident. Staff working at the home receive training in respect of the safe administration of medication. Residents receive their medication according to the times for which it is prescribed. Assessments in respect of risks associated with selfadministration of medication were examined for two residents who had chosen to retain and administer their medication. These were up to date and reviewed on a regular basis Hopes Green Care Centre I06-I56 S18097 Hopes Green V228884 230605 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 & 15 The provision of meaningful social, leisure and occupational activities do not always meet the needs or expectations of residents living at the home. Residents living at the home are not always provided with meals, which they feel meet their needs. EVIDENCE: Hopes Green employs an activities coordinator for thirty hours per week between Monday and Friday. The activities coordinator was on holiday at the time of this inspection. A number of residents said that they had little to do during the day. On the day of the inspection there was a service with hymns in the lounge in the morning, however there was little observed in the way of activities provision for residents throughout the day. A number of resident’s relatives visited the home on the day of the inspection and said that they always felt welcome. One residents’ relatives said that they would like to be provided with more general information about the care of their relative and daily routines / activities within the home.
Hopes Green Care Centre I06-I56 S18097 Hopes Green V228884 230605 Stage 4.doc Version 1.30 Page 12 Meals were served in an unhurried manner by staff and residents were assisted as necessary. It was positive to see staff offering residents a choice of vegetables with their meal. While there were some positive comments made about the food provided by the home, a number of people said that the food ‘could be better’. Menus were not readily available and residents when asked were not aware of the choice of foods for the lunchtime meal. Condiments such as sauces were not readily available. Residents were not offered a choice of cold drinks such as water or juices with their meal, only orange cordial. Hopes Green Care Centre I06-I56 S18097 Hopes Green V228884 230605 Stage 4.doc Version 1.30 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 Complaints made by residents of the home and / or their relatives are dealt with and responded to appropriately. Staff act so as to protect residents living at the home. EVIDENCE: Records in respect of complaints made about the home were well maintained and all complaints were dealt with and responded to in an appropriate manner. It was positive to note that the number of complaints made had fallen since the previous inspection and residents said that they felt that any concerns and / or complaints would be addressed quickly and effectively. Staff working at the home receive regular training and could demonstrate that they were aware of what action to take so as to protect people living at the home. Hopes Green Care Centre I06-I56 S18097 Hopes Green V228884 230605 Stage 4.doc Version 1.30 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 0 The environment was not fully assessed during this inspection, however no issues of concern were noted throughout the day. Standards nineteen to twenty six will be assessed at the next inspection. EVIDENCE: Hopes Green Care Centre I06-I56 S18097 Hopes Green V228884 230605 Stage 4.doc Version 1.30 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 & 30 Staff are recruited, trained and supervised appropriately so as to ensure the welfare and safety of residents living at the home. EVIDENCE: Staffing levels are reviewed on a regular basis and agency support staff are employed as required so as to ensure continuity in the care of residents living at the home. Staff were noted to assist residents in an appropriate manner. Staff recruitment files were well maintained and there was evidence that references, Criminal Record Bureau (CRB) disclosures / POVA First checks were carried out prior to employing staff at the home. Some staff files did not include proof of staff identity and where agency staff were employed there were no records in respect of their training and appropriate checks. This was discussed with the acting manager. Staff receive regular training and supervision so as to assist them in meeting the needs of residents living at the home. It was positive to note that some staff had received training in respect of blood glucose monitoring and catheter care. Hopes Green Care Centre I06-I56 S18097 Hopes Green V228884 230605 Stage 4.doc Version 1.30 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35 & 36 Residents living at the home are provided with care from a team of wellsupported and managed staff. EVIDENCE: The temporary acting manager, one of Ashbourne’s senior managers, has for the past three months managed Hopes Green in the absence of the acting manager due to ill health. The care manager who has also been at the home for a period of three months supports Judith in the management of the home. Staff said that Judith has improved things at the home and that it is more organised. Staff receive regular supervision and are well supported. The numbers of complaints made in respect of the services provided have decreased and residents and relatives made more positive comments about the care provided by the home. Hopes Green Care Centre I06-I56 S18097 Hopes Green V228884 230605 Stage 4.doc Version 1.30 Page 17 Where monies are held by the home on behalf, this is held securely and up to date records in respect of any financial transactions are maintained. Standard thirty-eight was not fully assessed, however there were no health and safety issues in respect of the premises noted during this inspection. Hopes Green Care Centre I06-I56 S18097 Hopes Green V228884 230605 Stage 4.doc Version 1.30 Page 18 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 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 x 15 1
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x 3 3 x x Hopes Green Care Centre I06-I56 S18097 Hopes Green V228884 230605 Stage 4.doc Version 1.30 Page 19 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 OP7 Regulation 15 Requirement The registered person must ensure that each service user has a detailed plan of care, which identifies their care and welfare needs, is kept under regular review and includes the actions that staff are to take to meet these needs. This with particular reference to ensuring that each service users needs and how these needs affect their ability to carry out activities of daily living safely are clearly identified and reviewed according to their changing conditions. Elements of this requirement are repeated from the previous two inspections. The registered person must ensure that the home is conducted so as to ensure that service users health and welfare is promoted and that they are safeguarded from harm. This with particular reference to assessing the risks of injury from falls, developing pressure sores etc, planning care so as to
Hopes Green Care Centre I06-I56 S18097 Hopes Green V228884 230605 Stage 4.doc Version 1.30 Page 20 Timescale for action 30/07/05 2. OP8 15 30/07/05 minimise these risks and ensuring that these assessments are reviewed according to each individuals changing condition. Elements of this requirement are repeated from the previous two inspections. The registered persons must ensure that appropriate meaningful social, leisure and occupational activities are provided which meet the needs of residents living at the home. The registered persons must ensure that suitable, appetising meals which sos far as it is posssible meet the wishes of residents living at the home. The registered persons must ensure that all documents as required in respect of staff working at the home, including any agency staff employed are maintained on file and are available for inspection upon request. 3. OP12 16(2)(n) 30/08/05 4. OP15 16(2)(i) 30/07/05 5. OP29 19 30/07/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP3 OP7 OP8 Good Practice Recommendations Assessment documents would benefit from more detail in respect of residents needs. Care plans would benefit from more detail in respect of residents care needs and the actions which staff are to take to meet these needs. It is recommended that a formal assessment tool is employed so as to consistently determine risks to residents of developping pressure sores. Hopes Green Care Centre I06-I56 S18097 Hopes Green V228884 230605 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on sea, Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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