Inspection on 03/06/08 for Houndswood House

This inspection was carried out on 3rd June 2008.

CSCI found this care home to be providing an Poor service.

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

Houndswood House 02/12/08

Houndswood House 13/02/08

Houndswood House 11/04/07

Houndswood House 09/11/06

Houndswood House 18/04/06

Houndswood House 05/01/06

Houndswood House 22/06/05

Houndswood House 20/10/04

Houndswood House 04/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Houndswood House Harper Lane Radlett Hertfordshire WD7 7HU Lead Inspector Pat House Unannounced Inspection 3rd June 2008 10:15 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 Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Houndswood House Address Harper Lane Radlett Hertfordshire WD7 7HU 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) 01923 856 819 01923 853 509 houndswood.manager@craegmoor.co.uk www.craegmoor.co.uk Speciality Care (REIT Homes) Ltd Michelle Whitmill (not registered at time of inspection) Care Home 65 Category(ies) of Dementia - over 65 years of age (23), Old age, registration, with number not falling within any other category (48), of places Physical disability over 65 years of age (4) Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. This home may accommodate 4 older people who require personal care. This home may accommodate 4 older people with physical disability who require personal care. The maximum number of service users who can be accommodated is 48. 13th February 2008 Date of last inspection Brief Description of the Service: Houndswood House is a care home providing accommodation, nursing and personal care for older people as set out above. The home is owned by Craegmoor and registered under Speciality Care (REIT Homes) Limited. Houndswood House was opened in 1997 and is situated in a rural area between London Colney and Radlett. It is a period house with modern extensions, set in extensive parkland gardens with pathways a large patio area and a sensory garden area all accessible to people living in the home. The home is divided into two areas, identified by staff as the ‘main house’ and the ‘extension’. The older part of the house has one large ground floor lounge and a small sitting room. The ‘extension’ has communal areas all on the ground floor, which include dining, lounge and conservatory areas. All bedrooms in the new area have en-suite facilities with toilets. A lift serves each end of the home and a wheelchair lift is in place to enable improved access to one part of the older building. The premises are reached via a driveway from Harper Lane. Car parking facilities are provided to the front and rear of the building. Houndswood House is not served by public transport, but is close to Junction 22 of the M25 Motorway. The service user guide includes contact details for the Commission for Social Care Inspection (CSCI) and copies of the latest inspection report are available in the home. Current fees range from £525 - £1000 (As at February 2008). Additional charges apply for newspapers, hairdressing, personal toiletries, chiropody and private dentistry. Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. The information in this report is based on an unannounced visit to the home by two regulation inspectors carrying out the work of the Commission. For the purposes of this report the Commission will be referred to as ‘we’. The key inspection took place over one day and the manager was present throughout. Residents, staff and visitors were spoken with. Interaction between the residents and staff was observed. We visited all areas of the home and examined a selection of records during the visit. One inspector spent their time in the ‘main house’, where most residents have a diagnosis of dementia. The other inspector remained in the ‘extension’ looking especially at the nursing care provided. We have also reviewed the information we have received about this service between inspections. A main or ‘key’ inspection took place in February, this year, but since that time some concerns have been raised about aspects of the care being provided, and this subsequent key inspection took place as a result of those concerns. An investigation about the issues in question is also taking place under Hertfordshire County Council Safeguarding Procedures. What the service does well: All the residents and visitors we spoke with said that the staff in the home are caring and kind. We were also told that the manager is supportive and always listens to the views of residents, visitors and staff. This means that there is an open approach to management in the home and that all parties feel their views are listened to. The home’s complaints procedures are thorough and one relative confirmed that any issues raised are dealt with right away. The new care plan format is good and is based on a person centred approach. The care plans we saw on the nursing unit were generally detailed and well documented and appropriate risk assessments had been completed. This Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 6 means that, when all documentation is completed, staff will have clear information about how to meet the individual needs of all residents. The home was clean and had been well maintained and visitors we spoke with said this was always the case. One relative also said residents always had the correct laundry returned to them after washing and that this was important to both the resident and their family. What has improved since the last inspection? What they could do better: The specialist provision in the home for residents who have a dementia is inadequate. The layout of the dementia unit needs consideration, and appropriate signage and adaptations must be provided. Nutrition and hydration for those who are confused is important and more care must be taken to monitor this aspect of care for those who cannot do this for themselves so that good health is promoted. Reviews of medication must take place regularly, in particular to ensure that those with a dementia do not have sleep induced unnecessarily and so that pain relief is considered for those who cannot ask for it themselves. The poor practice we saw when some staff assisted residents to transfer must stop and all staff must receive up to date training in moving and handling procedures so that neither residents nor staff are put at risk of injury. Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 7 More training for staff in general must be planned and this is especially needed for all aspects of providing dementia care. All staff must also receive up to date training in Safeguarding Adults and in Whistle Blowing. This training is essential so that all residents in the home receive safe and appropriate care and have all their needs met. More specialist and up to date training for the nursing staff would also ensure good practice is maintained. The manager must also ensure that the planning in care plans is actually put into practice and that records of night checks are meaningful and give details of the care provided. This will ensure that proper care is given to all residents at night. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 4. Standard 6 does not apply to this home. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. All new residents have their needs fully assessed before they enter the home. However, people who use the service cannot be confident that the specialist care currently provided for those in the home who have a dementia is adequate to meet the individual needs of the residents concerned. EVIDENCE: At the last visit, we found that people entering the home had had their needs fully assessed and had been given opportunities to visit the home before deciding to become a resident. This meant that residents and their relatives could feel confident that staff at the home could meet individual needs. The home is currently registered with the Commission to provide specialist care for 23 people who have a dementia. A recent application to increase this number was withdrawn by the area manager following discussion with the Regional Registration Team inspector but findings from this inspection visit Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 10 have also highlighted that current specialist services are of a poor standard. During the time we spent in the ‘dementia wing’ we saw some very poor practice undertaken by staff who were clearly not aware that their actions were not acceptable. Generally the staff members we spoke with felt they were providing good care for the residents and clearly cared about people in the home. However, we saw staff regularly walking by residents as if they were not there, we saw staff walk away from residents in the middle of assisting them with feeding, giving no explanation and saw two members of staff transfer one resident into a chair while they were still asleep. The care we saw provided for residents on this unit was ‘task’ led and not led by individual need and we felt that the residents had become ‘objects’ rather than people with individual histories and characters. Further examples of the poor specialist care we saw are included in the following sections of the report and reflect the lack of specialist dementia training, which has been provided for staff in the home to date. We have been informed following the inspection that some staff have actually completed a basic dementia course. However, from the interaction we observed during our inspection it would appear that this training has not resulted in sufficient understanding or of staff competencies being assured in this area. Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People cannot be assured that the care plans will reflect their individual needs, which means that staff are sometimes not aware of peoples’ wishes and some people are not always treated with dignity and respect. Procedures followed for the administration of medication are generally sound although some reviews are needed to ensure that the health of individual residents is promoted at all times. EVIDENCE: We noted in the last inspection report that a new format for care planning had been introduced to the home. These new plans follow a ‘person centred format’ and give more individual information about the person concerned and their wishes for their daily lives. Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 12 We checked a selection of plans in both areas of the home, after spending time speaking with or observing the people concerned. The documents seen in the nursing unit were all very well recorded and contained extensive information about the residents concerned. The plans reflecting the people with nursing needs had appropriate assessments for nutrition, skin care and mobility. A range of risk assessments were in place including those for falls and bed rails. Monthly updates had been completed and most plans had been signed by the individual resident or their relative. Generally the information in the plans accurately reflected the residents we had seen, although not all ‘life histories’ had yet been completed in the plans. We also wanted to track the treatment given to people with pressure sores and saw that some of the relevant records are not kept with the main plans. Some body charts had been completed for residents with broken skin and records described the healing process. We then looked at the corresponding records showing when care staff had ‘turned’ the residents at night and when residents were checked during the night. Staff told us that the procedure followed for these night checks means that care staff complete their tasks at prescribed intervals and sign the nightcheck records, at the end of their shift they give the details to the nurse on duty, who then finalises the documentation. The nightcheck records provide no details of the care provided. We spoke to care staff about the care routine at night and were told that, quite often, nursing staff did not actually work on the floor at night and it was therefore possible for inaccurate information to be given to the nurse, and recorded. We spoke with the manager about this concern as, if night checks were not completed where needed, residents could be put at risk and skin care especially could be neglected. We also felt that it was important for a nursing home of this size to have a nurse with Tissue Viability expertise on the staff so that up to date good practice can be communicated to the staff so to provide care in a timely manner to benefit the residents achieve good skin and wound care. We saw some other evidence that the planning recorded for people may not be happening in practice. One care plan identified a resident as needing their foot elevated whilst sitting, but during the day we noted that their feet remained on the floor. A relative we spoke with also said they had to keep asking staff members to provide elevation for their relative’s legs. It was also not clear, after observing the dinner routine, how staff could assess the food and drink volumes they had recorded for the people who needed this monitored. This concern regarding food intake recording was more worrying on the dementia unit where large amounts of wasted food were seen thrown away together before any records were written. We also observed that residents in this unit were mostly all very frail and quite thin, meaning that accurate monitoring of food intake is essential for assessing and maintaining their health. Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 13 We felt the care plans we saw for those with dementia, although of the same format, were not adequate for giving staff the necessary information they needed for dealing with specialist needs. Plans had no guidelines for how to encourage an individual to eat, what might trigger aggressive behaviour or how to provide individual comfort. We also felt that these care plans did not give enough guidance for the care of pressure areas, which can also be a concern for those with dementia. We observed staff dealing with a confused resident whose dressing needed changing on a pressure area. We noted that the resident concerned had experienced pain during this process, yet the staff had not thought to offer any pain relief, or question whether pain relief should be prescribed. There were no entries on the care plan reflecting this situation. We left an Immediate Requirement that such pain relief must be offered. Confirmation has been received since the inspection that this has been addressed. We acknowledge that the manager said that the care plans on this unit were still being updated and it is hoped that when details are really person centred care staff will be able to fully understand and provide for individual needs. One resident we spoke with, on the nursing extension felt that the facilities in the home no longer provided for their needs, now that their physical health had improved. The resident told us that they wanted to go or be taken out more into the community, and felt there were not enough staff on duty to help them achieve this wish. A person centred plan might well have reflected this aim, and should have looked at the implications. We asked the manager to introduce an advocate to this resident to help them establish their future planning. The residents we spoke with, who could give an opinion, all said that care staff treated them with dignity and respect and relatives said that care staff were kind an did their best for residents. Nevertheless, some of the care practice seen, and described on the dementia unit, was not provided in a way that respected personal dignity, although we felt care staff were not aware of this. Since the last inspection, the manager has addressed a concern we had about medication administration in the home. All nurses have received training from an external company and the manager has checked individual competencies. We saw evidence of this assessment on the staff files checked during the visit. However, we could find no evidence that residents had their prescribed medication reassessed at regular intervals and the nursing staff we spoke with were not aware if this had happened. We had noted during the previous inspection that many of the residents on the dementia unit slept for most of the morning and we observed the same on this Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 14 occasion. At one point we saw a member of staff raise a sleeping resident’s head from the meal table and remove the tablecloth from under them. The staff we spoke with also commented that on the dementia unit the night staff had little to do for the residents as they all slept through the night. We found this unusual as often, people who are confused mix night with day and often like to walk about at night. We asked the manager to review the medication prescribed to the people on this unit and to see if it could be connected to the length of time people were sleeping. Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that the activities provided for residents in the home give them a degree of stimulation and visitors are welcomed in the home enabling residents to maintain family contact. Residents enjoy the food provided although this provision needs reviewing for those on the dementia unit to ensure adequate nutrition is maintained. EVIDENCE: There are two activity coordinators employed in the home. Residents we spoke with said they joined in the events provided, which included quizzes and one-to one games and craft. Visitors we spoke with confirmed that activities were provided on most days. One activity co-ordinator has received some dementia training but we felt that both staff members would benefit from some of the current training offered for activity provision and it is hoped this will be provided soon. Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 16 During the visit, on both units of the home, the televisions were left on the whole time in the lounges, although no one was watching them. On the nursing unit, at one point at, at the same time as the TV was seen to be on (although with no sound) with pop music playing loudly while a balloon throwing activity also took place at one point. Residents were also being hoisted and staff were coming and going throughout. We found the situation chaotic and some of the residents must have felt more confused than they need to have been. We felt that a more structured approach to providing stimulation for people in the home was needed, and may well develop now that there are two co-ordinators established in post. Relatives we spoke with confirmed that they were welcomed in the home at all times, but also commented that the television was always on, although no one watched it. Residents we spoke with said they usually enjoyed the food provided, and could choose from two menus daily. One relative said the food could be good but was sometimes “strange”. The meal seen on the nursing unit was nicely presented, and tables had printed menus and tablecloths on them. Some residents had their meal on an individual table in the lounge and the residents needing assistance were helped discreetly and patiently. However we tasted the food provided on the dementia unit, which was a pasty and hash brown potato. We found the pastry served was tough and the potato hard and not appropriate for those who were confused and needed encouragement to eat. Much of the food on this unit was wasted on that occasion but the manager did indicate that there had been a problem with the food on the day, which did not usually happen. As already noted, we found many of the residents on this unit were very frail and thin and it is important to ensure that their food intake is promoted and encouraged, for their continuing good health. Current guidelines for dementia care recommend the introduction of ‘finger’ or snack food, which can be left for residents to take when they feel inclined. We recommended that the manager reassess how food is provided on the dementia unit and that food intake and weight loss are carefully monitored so that the health of all residents is promoted. Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that the procedures followed for dealing with complaints in the home are thorough and residents and relatives know their concerns will be listened to. However, residents may not be adequately protected from abuse as not all staff have received Safeguarding training. EVIDENCE: The home has written policies for making a complaint and at the last inspection we saw evidence that complaints were thoroughly investigated. A relative we spoke with on this occasion confirmed that the manager and staff listened to any concerns raised and always dealt with them appropriately. We understood, on the last visit that staff had been trained in Safeguarding Adults. However, one newer member of staff we spoke with on this occasion had not received training in Safeguarding or Whistle blowing and an overview of these areas should now be provided as part of induction training to ensure residents are protected at all times. Also, one new care worker has been employed at the home although clearance from the Criminal Records Bureau has not yet been received. Correct procedures had been followed as the manager has received a POVA clearance Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 18 for this person and as guidelines require, the care worker is not left unsupervised in the day. However, the care worker has also been working at night and we reminded the manager that this work must also be supervised until a clear CRB check has been provided. During this inspection the manager provided us with a copy of the staff training overview that we were told, lists all the courses staff have undertaken. We understood that all staff had received appropriate training in Safeguarding, but this matrix indicates otherwise. There appear to be staff, including the manager who have not had any training in Safeguarding. We acknowledge that the manager is fairly new, but other staff have been employed from 2002, 2004 and 2005 onwards. This training also needs reviewing regularly to ensure residents are properly protected, but many of the staff have not received training since 2006. The local authority joint agency safeguarding procedures were updated in July 2007 so staff must be provided with the updated procedures to ensure residents continued protection at all times. Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that the residents enjoy the benefits of living in a home, which is well maintained, hygienic and clean. EVIDENCE: The home was generally clean and well presented on the day we visited. One relative we spoke with said they found the home was usually clean and there were never any unpleasant smells apparent. We looked at many of the bedrooms on the nursing unit and these were well decorated and comfortably warm. One commode chair and one hoist we saw were not completely clean but these were the exceptions. Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 20 One family member we spoke with said that their relative had been supported to bring many of their own possessions and furnishings into the home and that this had enabled the resident to settle very quickly. However, the manager is aware that thought needs to be given to the layout of the dementia unit so that it provides a more appropriate environment for those who are confused and more significant signs and adaptations are needed to assist orientation and independence. Visitors we spoke with praised the laundry at the home and said their relative almost always had their own clothes returned to them. All bathrooms contained liquid soap and paper towels, but we recommended that paper towels should be the softer variety as recommended in current guidelines for good infection control. Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that recruitment procedures in the home are generally sound and help to protect residents from abuse. However, people may not be supported by sufficient numbers of staff who have received training appropriate to meet residents’ needs. EVIDENCE: The relatives we spoke with during this visit said they felt more day staff had been on duty recently but they also said they did wonder if there were enough staff on duty at night. One care worker had told us that the nurses on the nursing unit were not always working on the floor at night, which would leave just two care workers on duty to deal with a large number of people, many of whom needed hoisting. This member of staff did not feel this staff complement was adequate at night and we felt that having only two care staff members for this unit this could put residents at risk of harm from poor handling practices and neglect from a lack of time to deal with all their needs in a timely manner. However, all those we spoke with, both residents and visitors, said that the staff did their best for the people living in the home and were “caring and kind” and always responded to concerns appropriately. We were also told there were Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 22 no real difficulties with communication between residents and staff although English was not everyone’s first language. As already noted we were given a copy of the staff training matrix during the visit. This showed that, although most basic training courses are provided for staff annually, there are some staff who have not completed such essential training. One staff member, employed as a night care worker, and employed since 2003, has had no training in Safeguarding, manual handling, food hygiene, dementia or health and safety. The few courses listed as completed by this member of staff were mainly completed in 2006. Other night care staff have also not been provided with training in manual handling. Of the night care staff listed on the staff rota for one night in June we spot-checked, there were two nights when none of the care workers on duty had completed up to date manual handling training. This situation could mean that residents assisted to transfer during the night could be put at risk from poor handling practices. We also observed some poor practice when we watched residents transferred by staff on the dementia unit during the inspection. Staff members were using a handling belt, which is used to help people stand up from a sitting position. However, we saw staff use the belt inappropriately on several occasions when they used the belt to lift the residents, putting all those involved at risk of injury. We left an Immediate Requirement that this practice must stop. Confirmation has been received since the inspection that this has been addressed. The evidence from the training matrix showed a lack of training in dementia care. The only staff member listed as having completed any dementia training was one of the activity co-ordinators. We have recorded already that care provided in the home for those who are confused provides poor outcomes and this situation directly reflects the lack of staff training or staff understanding in this specialist area. Similarly, as far as the staff files examined or the training matrix indicates, none of the registered nurses have undertaken any up to date specialist training, such as wound care, palliative care or pain relief. As in any professional field, ideas about nursing practices are constantly being updated and we would have expected more training to have been completed by the nurses in this home to ensure fresh ideas and approaches to care practices were constantly introduced. We checked the recruitment files of six nurses and one new care worker. Evidence was seen that all appropriate checks had been in place before employment had commenced. The nurses had completed their Adaptation training (to transfer their nursing qualifications from outside the United Kingdom) while working in a home, which had been owned by the same company. When that home closed these nurses were transferred to Houndswood and had worked there for some years. Some of the nurses’ PIN numbers had expired and two nurses needed evidence that their right to work Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 23 in the country had been extended. The manager said she was aware of these issues and they were being dealt with. Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that residents benefit from living in a home where their views are listened to and acted on by the manager and where procedures followed generally ensure that everyone’s health and safety is promoted. EVIDENCE: The manager of the home had been newly appointed at the time of the last inspection in February 2008. Since that time the new format for care planning has been implemented and, at least in the nursing unit, the planning is well documented. The manager was aware of many of the areas we highlighted within this inspection as needing change and it is acknowledged that there has not been time, since the management appointment to have addressed them Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 25 all. All those we spoke with, residents, visitors and staff said the manager was supportive, approachable and addressed any issues they raised appropriately. Relatives we asked said that the residents had been given quality questionnaires to complete recently, but that families hade not had these provided. The manager explained that the company staggered the questionnaires throughout the year and that all stakeholders would be sent surveys by the end of the year. The most important aspect of quality checks is the summarising and monitoring of the information and this will be especially true for Houndswood as there are so many areas for the manager to review. We will ask for a copy of the quality report to be provided for the Commission when the quality process is complete. During our inspection of the home we saw no areas where hazardous substances had been left out. However, in the dementia unit a dining room chair had been used to prop open the doors. This was creating a hazard to health and safety as, not only were fire doors being held open but residents in wheel chairs were having obvious difficulty in manoeuvring around this obstacle. We left an Immediate Requirement that this practice must cease. Confirmation has been received since the inspection that this has been addressed. We also recommend that the recliner chairs, used for residents in the home, should be risk assessed, as there have been reports of fatal accidents linked to these chairs in some care settings. During the inspection we also saw the lift doors close on a resident who was exiting using a zimmer frame. We had travelled in the lift with this resident and their relative and the time taken to exit the lift had not been excessive. We were able to help the resident who was not hurt, but someone on their own could be put at risk in such circumstances. The manager said she would have the lift and its door closure checked right away. Procedures for handling residents’ personal allowances were checked during the last inspection and the system was found to be thorough, providing protection for those involved. Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 OP4 Regulation Requirement Timescale for action 01/09/08 2 OP7 3 OP7 4 OP8 12(1)(a)& An improvement plan must be (b)&(4)(a) produced which shows how the &(b) specialist care for those with a dementia will be improved. The plan must include details of the layout and fabric of the dementia wing and the signage and adaptations, which will be introduced. 15(1) Care planning for residents with 01/09/08 a dementia must be person centred and must give staff detailed directions of how to deal with individual needs such as challenging behaviour, comfort and communication so that all needs are identified and met. 12(1)(2)( The manager must ensure that 01/09/08 3)&(4) details of individual needs, identified in care plans, are put into practice by staff to ensure the well being of the residents. 12(1)(a)& Residents must be assessed for 04/06/08 13(1)(b)& and prescribed and offered pain (6) relief whenever they experience discomfort so that no resident has to feel unnecessary pain. An immediate requirement Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 28 was left after this inspection that a resident, who has a grade 3 pressure sore, is assessed for, and offered pain relief, when their dressings are changed. This is so that the resident in question does not suffer any unnecessary pain. Confirmation has been received since the inspection that this has been addressed. 5 OP8 12(1)(a)& (b) The manager must ensure that health care and monitoring checks take place as detailed in care planning, including at night to ensure that all residents receive the care they need. A tissue viability specialist nurse must be employed at the home to ensure up to date specialist advice is available to nursing staff in the home. Residents in the home must have their medication reviewed at regular intervals to ensure the drugs prescribed are still appropriate. Care must be taken to ensure that those residents with a dementia are supported in a way which respects their dignity and privacy. Residents with a dementia must be provided with appropriate nutritious food in a manner which current guidelines suggest is preferable for those who are confused to ensure all residents receive proper nourishment. All staff in the home must be provided with training in the Safeguarding of Adults to ensure all residents are protected from abuse. The numbers of staff working in the home at night must be DS0000019459.V365427.R01.S.doc 01/09/08 6 OP8 13(1)(b) 01/09/08 7 OP9 13(1)(b) 01/09/08 8 OP10 12(4)(a)& (b) 01/09/08 9 OP15 16(2)(i) 01/09/08 10 OP18 18(1)(c) (i) 01/09/08 11 OP27 18(10(a) 01/09/08 Page 29 Houndswood House Version 5.2 12 OP30 18(1)(c)(i )&(ii) 13 OP38 13(4)(a) reviewed to ensure that all the needs of residents can be met in an appropriate and timely manner. All staff in the home must 01/09/08 complete up to date training courses which have been identified as necessary for staff to properly fulfil their duties. Courses must include training in Moving and handling and dementia care. Fire doors in the home must not 04/06/08 be held open so that residents are not put at risk in the event of a fire and wheel chair access to all areas of the home must be maintained, and obstructions removed. An Immediate Requirement was left after this inspection that chairs are not used to prop open the doors to the dining room or to any fire doors in the home. This is to protect residents from the possibility of harm from fire and to enable the residents who are in wheel chairs to enter the dining room safely and with ease. Confirmation has been received since the inspection that this has been addressed. 14 OP38 13(5) All staff must use safe systems when assisting residents in the home to transfer, so that both the residents and staff members are protected from injury. An Immediate Requirement was left after this inspection that care staff do not use handling belts inappropriately and to lift people. This is so that 04/06/08 Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 30 residents and staff are not put at risk of harm by poor transfer practices. Confirmation has been received since the inspection that this has been addressed. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 2. Refer to Standard OP15 Good Practice Recommendations The manager should obtain a copy of the CSCI report The Highlight of the Day and carry out an audit of the home’s mealtime experience, involving wherever possible people living in the home, to see if it can be improved or enhanced. This recommendation was made in the previous inspection report. Houndswood House DS0000019459.V365427.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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