Inspection on 28/06/05 for Hornegarth House Nursing Home

This inspection was carried out on 28th June 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hornegarth House Nursing Home 28/11/07

Hornegarth House Nursing Home 13/07/06

Hornegarth House Nursing Home 28/11/05

Hornegarth House Nursing Home 21/02/05

Hornegarth House Nursing Home 21/09/04

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

CARE HOMES FOR OLDER PEOPLE Hornegarth House Nursing Home 204 Walsall Road Great Wyrley Walsall West Midlands - WS6 6NQ Lead Inspector Joanna Wooller UnAnnounced Tuesday 28 June 2005- 09:30am 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. Hornegarth House Nursing Home E51-E09 S22342 Hornegarth hs V235685 28.06.05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Hornegarth House Nursing Home Address 204 Walsall Road Great Wyrley Walsall West Midlands WS6 6NQ 01922 701702 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) Highfield Care Homes Ltd Ms Sandra Grierson CRH 45 Category(ies) of DE- 45 registration, with number DE(E) - over 65 - 10 of places MD - 45 Hornegarth House Nursing Home E51-E09 S22342 Hornegarth hs V235685 28.06.05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 45 Dementia (DE) min age 60yrs on admission 30/07/02 Date of last inspection 21/02/2005 Brief Description of the Service: Hornegarth House offers nursing care to 42 service users with mental health problems and long-term mental illness. The home has 38 bedrooms with ensuite facilities. There are 34 single bedrooms and 4 double bedrooms. The home promotes and encourages community involvement. The home is situated within a thriving village on a bus route between Walsall and Cannock. It is within easy walking distance of the main Stafford to Birmingham railway line. This purpose built home has wide corridors and ramps for easy access by wheelchair users. The home is on two levels and has access via the stairs or a passenger lift. There are two lounges, a large dining room and a conservatory. A secure garden is plannted out with bushes and plants. Many recreational and diversional activities are carried out daily. Hornegarth House Nursing Home E51-E09 S22342 Hornegarth hs V235685 28.06.05 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors undertook this unannounced visit on Tuesday 28th June 2005. The inspection was completed using the National Minimum Standards for Older People as a reference. The total time spent for the inspection, including pre and fieldwork, amounted to 8hrs. The deputy manager was in charge of the home accompanied by one registered nurse and six care assistants. The ancillary staff on duty included; the cook, a catering assistant, three housekeepers, one laundry person, and the administrator. These staffing levels were adequate to meet the needs of the current 41 service users in the home. One-service user was out of the home as it was his birthday and his family had taken him home for the day. The inspection included the following elements; a tour of the building, observation and inspection of records relating to provision of care, discussions with several residents, discussions with all the staff members on duty, observation and sampling of other services provided such as catering and laundry, and an inspection of the managerial aspects such as staffing issues, quality assurance and health & safety. It was evident that aspects of care were being addressed, with service users and their relatives able to choose the home following an assessment and invitation to visit the home. Service user plans had been well written and included health; personal and social care needs, which were generally well documented. Privacy, dignity and choice aspects for residents were being upheld. The home was fit for purpose and provided a safe environment for the residents and staff. A very homely atmosphere had been created, and the premised were clean, warm and tidy. Adequate areas for residents were provided including; communal space, dining/activity space, bathing/toilet facilities, and bedrooms. Services and facilities, including catering and laundry, were adequately provided. Health and safety aspects had been given a high priority and no shortfalls were noted. Staffing levels and skill mix had been adequate to meet the assessed needs of the existing residents. Recruitment and retention of staff aspects were good with little staff turnover. Staff training had been given a high priority, with induction training being followed by NVQ training, and staff had received regular supervision. The home appeared to be managed well by a qualified and competent care manager. General management aspects were good with quality assurance taking place. Records had been correctly filed and stored. Assurances were Hornegarth House Nursing Home E51-E09 S22342 Hornegarth hs V235685 28.06.05 Stage 4.doc Version 1.40 Page 6 given regarding the positive financial viability of the home, and that suitable accounting/business procedures are adopted. What the service does well: What has improved since the last inspection? What they could do better: The general standard of fixtures and fittings are now poor in bedrooms, the paintwork is chipped and looking tired and the general tidiness of the home need addressing. Wardrobes are required to be attached to the bedroom walls. The lack of storage within the home causes storage of certain equipment to be very difficult and this can lead to the home looking untidy. Plans to build a secure storage shed are underway. Southern Cross Healthcare has recently taken over the home and there policies and procedures `and other documentation are not at the home as yet. The lead inspector spoke to the operations manger and reported this to her. Please contact the provider for advice of actions taken in response to this Hornegarth House Nursing Home E51-E09 S22342 Hornegarth hs V235685 28.06.05 Stage 4.doc Version 1.40 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hornegarth House Nursing Home E51-E09 S22342 Hornegarth hs V235685 28.06.05 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 Hornegarth House Nursing Home E51-E09 S22342 Hornegarth hs V235685 28.06.05 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) 3 All service users have pre admission assessments completed by the manager or a senior nurse this ensures that there individual need will be met. EVIDENCE: Each service user had been assessed prior to admission. Multidisciplinary involvement was evident in most care records. Any special needs of the individual including cultural, social and personal needs are fully discussed and documented. This assessment initiates the process of care, each individual having a plan of care, which includes a daily living plan and longer-term goals and outcomes. In line with Regulation 14 (1d) the manager is required to confirm in writing to the service user or their next of kin, that the home will be able to meet the individuals assessed needs. Hornegarth House Nursing Home E51-E09 S22342 Hornegarth hs V235685 28.06.05 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) 7 to 10 The individually assessed health and personal care needs of service user had been well documented as being met, with good standards of care being delivered. There was a safe system for the receipt, storage, administration and disposal of medicines. There was evidence that service users were treated with respect, privacy and dignity, during the caring process. EVIDENCE: Several relatives spoken to commented positively about the care being provided. The service user plans and documentation was well written, meaningful and reflected the current condition of residents. The documentation seen evidenced that health and personal care needs were being well met. NHS facilities and professionals including community nurses, medical consultants and clinical nurse specialists had all been accessed when required, and these events were seen recorded. A local GP practice and a local pharmacist (8pm Chemist) service the home, and there is a good working relationship with them. Hornegarth House Nursing Home E51-E09 S22342 Hornegarth hs V235685 28.06.05 Stage 4.doc Version 1.40 Page 11 Records of their visits and outcomes were seen documented. The medicines within the home, medication administration records, controlled drugs book and drugs returned book, were all checked and no errors were noted. It was observed that a safe system was in place, and that the comprehensive medicines policy documentation seen was being complied with. The documentation seen evidenced that only senior care staff administered medicines. During the inspection it was observed that privacy and dignity were being afforded to residents, and there was very good interaction with staff. Care staff knocked on doors before entering. Issues raised relating to care plans were as follows: • • • • Some photographs were missing from the front of the care records. There was no evidence of service users or relatives involvement in care records in the form of signatures. Some service users weights were not recorded. The need to purchase hoist-weighing attachment was identified. One service user was without a social profile care record. Hornegarth House Nursing Home E51-E09 S22342 Hornegarth hs V235685 28.06.05 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 to 15 The lifestyle provided by the home [environment excluded] appeared to be meeting the needs of the residents, and links with family were being observed. The diet of residents was being provided in line with their choices and/or assessed needs. EVIDENCE: The inspectors were able to discuss activities with the co-ordinator who reflected the need to balance group activities with more single person centred input to reflect the capacity of the more confused residents. All staff were observed directing and re-assuring residents. The inspector was disappointed to find that whilst the home had a Snoezelen room, this facility which can be so essential in defusing aggression, frustration, and agitation in confused residents, was cluttered with discarded bedroom furnishing items that had recently been discarded in line with new best practise guidelines. On the day of the inspection one resident was on leave from the home to be with his family who were helping him to celebrate his birthday. A steady stream of visitors was seen entering the home both morning and afternoon, and care plans contained notes of letters and visits received by residents. Hornegarth House Nursing Home E51-E09 S22342 Hornegarth hs V235685 28.06.05 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 to 18 The complaints procedure was in place but is required to be changed to the current owners EVIDENCE: Southern Cross healthcare policies, procedures and relevant documentation are required to be in place at the home. The complaints record must also be available at all times. The commission had been informed of one complaint only. Hornegarth House Nursing Home E51-E09 S22342 Hornegarth hs V235685 28.06.05 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 & 26 The inspectors were disappointed that the refurbishment recommended in the last report had not progressed sufficiently to present the home as being universally comfortable, safe, and environmentally acceptable EVIDENCE: Externally the home presented as being well maintained. Internally, many of the bedrooms visited had damage to the decoration that was not recent. Often, one wall was in a worse condition than all the rest, suggesting that major pieces of furniture had been re-rearranged. This view was supported in rooms said to formerly have been for shared occupation where wardrobes were no longer secured to the walls, and the inspector was told they were no longer in their original position. • Wardrobes were also noticed to have items stored on top of them, constituting a source of potential danger to residents and staff alike. Hornegarth House Nursing Home E51-E09 S22342 Hornegarth hs V235685 28.06.05 Stage 4.doc Version 1.40 Page 15 In a shared room there was only one lockable facility for the two residents, and in other rooms the temperature of the hot water was not satisfactory. • In room 28 no hot water was obtainable at all, and as the inspectors were told that this was a known “problem” room, the problem must be sorted out without delay. The state of some bathrooms was particularly disappointing as these were cluttered with items such as wheelchairs and trolleys [Standard 22.7 clearly states that “Storage areas are provided for aids and equipment including wheelchairs”. • Similarly the Snoezelen room was unusable as it was [temporarily?] full of discarded bed aids, and the hairdressing salon was not acceptable. This [ex bathroom?] had items piled up behind a half closed shower curtain, and worse, some of the equipment said to be used by the hairdresser had no current Portable Appliance Testing labels. The deputy manager was reminded that the users of this facility were in the care of the home, and should they come to harm, it would be no defence to claim that the equipment belonged to a contractor, as it was the responsibility of the home to ensure their health and safety. The inspectors were told that there was a shed in course of construction in the car park, but when they viewed this after leaving the home, it was their opinion that this would be in no way adequate to meet the shortfall in storage capacity observed in the home during this inspection. One inspector visited the laundry, and was impressed with what the staff were achieving in such an unsuitable provision. The deputy manager later informed him that this facility had already been extended to accommodate the throughput of bed linen and residents clothing generated by a home of this size, but in his opinion, the lack of proper surfaces for folding on, or of free floor area to set up and service, the use of the ironing board, seriously hampered the efficiency of this operation. On the credit side, given the tiredness of some of the décor, the inspectors were impressed with the work being done by the domestic staff to keep the environment so clean and hygienic. In one room a carpet did smell of urine, but the deputy manager assured the inspectors that this had been subject to a heavy program of deep cleaning without the desired results, and she was advised to ensure that it was replaced with a suitable alternative means of flooring. Hornegarth House Nursing Home E51-E09 S22342 Hornegarth hs V235685 28.06.05 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) 27, 29 and 30 The assessed needs of service users had been met by an adequate number of suitably trained staff. Recruitment procedures had been correctly addressed since the last inspection which had contributed to the protection of service users. Staff training had been given high priority. EVIDENCE: Hornegarth House Nursing Home E51-E09 S22342 Hornegarth hs V235685 28.06.05 Stage 4.doc Version 1.40 Page 17 The duty rosters seen, and a discussion with the deputy manager and the staff, evidenced that adequate numbers of staff had been on duty to meet the needs of the existing service users. Staffing levels were being maintained as at 1st April 2002 and following a discussion with the staff it was agreed that the shift cover was adequate. There are two registered nurses on duty 8am to 8pm in addition to the minimum of six care staff on each morning shift and five care assistants on each evening shift. Three carers on duty during 8pm to 8am support one registered nurse. Adequate ancillary staff had been provided each week. The homes recruitment policy, procedures and documentation were examined and recruitment issues had been handled correctly. Staff had been subject to POVA/CRB comprehensive checks, and these were seen recorded. Training had been given a priority and the training records of individuals were seen. The records evidenced that care assistants had benefited from ‘in house’ and external training, which had covered the needs of the registered client group. Training had been provided for staff in the awareness and management of dementia related conditions, and staff outlined this to the inspector. Hornegarth House Nursing Home E51-E09 S22342 Hornegarth hs V235685 28.06.05 Stage 4.doc Version 1.40 Page 18 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 and 38. The home appeared to be well managed. Appropriate quality assurance was required to be in place. Financial aspects were correctly addressed and recorded with safeguards to residents. Health and safety issues had been given a high priority and managed well. EVIDENCE: From observations made, discussion with a few service users, and discussions with the deputy manager and staff, it was evident that the home was being run in the interests of service users. Quality assurance is not in place with relation to the new provider and this is to be rectified shortly. Documentation seen evidenced that the views of visiting professionals had also been established, and included in the review process. A check on the records and a discussion with both residents and representatives evidenced that all service users had the opportunity to handle Hornegarth House Nursing Home E51-E09 S22342 Hornegarth hs V235685 28.06.05 Stage 4.doc Version 1.40 Page 19 their own finances and all residents and families had chosen to do so. Day to day monies of residents were checked and money held reconciled with the ledger. Inventories of valuables and belongings brought into the home were seen recorded. No health and safety issues were noted during this inspection, including a tour of the home. The documentation seen for checks and examination of plant and equipment was all correct and up to date. The deputy manager and staff spoken to confirmed that health and safety issues are given a high priority. General risk assessments for the building, external areas and activities in the home are required to be updated. Hornegarth House Nursing Home E51-E09 S22342 Hornegarth hs V235685 28.06.05 Stage 4.doc Version 1.40 Page 20 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 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 2 2 2 x 2 2 2 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 3 3 x x 2 x 3 x x 2 Hornegarth House Nursing Home E51-E09 S22342 Hornegarth hs V235685 28.06.05 Stage 4.doc Version 1.40 Page 21 NO 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 4 Regulation 14(1d) Requirement Timescale for action 1 Month 2. 7.3 3. 4. 5. 7.6 8 8.9 6. 7. 8. 9. 10. 11. 7 16 25 33 38 38.3 A letter of confirmation must be sent to service users or their representative to confirm the assessed needs can be met. Sch 3(3o) Service users who have fallen must have acute care plans commenced and body maps completed. 15 Care records must be signed by service users or relatives Sch 3 (2) Service user care plans must have photographs to assist agency staff 12(1b) Service user weights must be recorded and suitable weighing scales purchased for the immobile. 16 (2n) All service users must have social care plans. 22 The complaints record must be available at all times 23 The building temperatures must be maintained as comfortable for the service users. 24 Quality assurance must be carried out to reflect the National Minimum Standards 13.6 Building risk assessments need updating 37(1) Wardrobes are to be secured to the walls in bedrooms and items E51-E09 S22342 Hornegarth hs V235685 28.06.05 Stage 4.doc 1 Week 1 week 1 Month ! Month 1 Month 1 Day 1Week ! Month 1 Month 1 Day Page 22 Hornegarth House Nursing Home Version 1.40 stored on top removed 12. 24 16 Furniture and fittings must be in good condition and of acceptable level of quality 1 Month 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. 5. 6. 7. Refer to Standard 22 22 21 20 33 26 24 Good Practice Recommendations Lift report to be faxed to CSCI local office PAT testing to be completed for all electrical equipment Bathrooms need refurbishing The hair salon is to be made good and safe Policies and procedures are to reflect the current provider Laundry facilities are reorganised to allow space for folding clothes All service users have lockable facilities in their bedrooms Hornegarth House Nursing Home E51-E09 S22342 Hornegarth hs V235685 28.06.05 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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