Inspection on 15/02/06 for Hourigan House

This inspection was carried out on 15th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Hourigan House 23/02/09

Hourigan House 28/02/07

Hourigan House 14/09/05

Hourigan House 17/01/05

Hourigan House 17/08/04

Hourigan House 21/01/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Hourigan House Myrtle Avenue Leigh Wigan Greater Manchester WN7 5QU Lead Inspector Kath Smethurst Unannounced Inspection 15th February 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hourigan House DS0000005741.V269572.R01.S.doc Version 5.1 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. Hourigan House DS0000005741.V269572.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hourigan House Address Myrtle Avenue Leigh Wigan Greater Manchester WN7 5QU 01942 672922 01942 672104 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) www.clsgroup.org.uk CLS Care Services Limited Mrs Elaine Wilson Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability over 65 years of age (8) of places Hourigan House DS0000005741.V269572.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 40 service users to include:up to 40 service users in the category of OP (Older People) up to 8 service users in the category of PD(E) (Adults with Physical Disability over 65) The service should employ a suitably qualified and experienced Manager who is registered by the CSCI 17th January 2005 2. Date of last inspection Brief Description of the Service: Hourigan House is a two-storey building with well maintained garden areas, situated in the middle of a housing estate, half a mile from Leigh town centre. It is close to shops and other local facilities and is well served by public transport. The Home is spacious with several lounges. All bedrooms are single and some have an ensuite toilet facility. There are ample communal toilets and bathrooms situated throughout the home. Hourigan House provides personal care and support for forty people over the age of sixty five years. The home is owned and managed by CLS Care Services Limited who have 40 plus homes around Cheshire and the Wigan area. Hourigan House DS0000005741.V269572.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and started at 10.15 am. It took place over four and a half hours during the morning and afternoon. The inspector looked around some but not all of the home, observed activities, checked care plans, and some records. To get more information about the home the inspector spoke to five residents, two visitors, the home services manager, the care team leader, the activity co-ordinator and two care staff. What the service does well: What has improved since the last inspection? What they could do better: A review of the number of care staff working at the home needs to be undertaken to make sure residents get the care they need. Although care plans are detailed staff need to make sure they weigh residents regularly and review the plans monthly. While the décor in the home is good plans need to be made for some of the corridors to be decorated as the wallpaper is torn and the paintwork damaged. Hourigan House DS0000005741.V269572.R01.S.doc Version 5.1 Page 6 Staff need to make sure they don’t fill in medication records before they have given residents their medication. 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. Hourigan House DS0000005741.V269572.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Hourigan House DS0000005741.V269572.R01.S.doc Version 5.1 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 the following standard(s): Not inspected during this visit. EVIDENCE: Standards 2 and 3 were examined during the last inspection and were satisfactorily met. Hourigan House DS0000005741.V269572.R01.S.doc Version 5.1 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 the following standard(s): 7,8 & 9 In the main care plans were detailed and reflected the care needed, but some relevant records had not been completed, which meant important information had not been documented. Health care needs were well met with evidence of multi-disciplinary working taking place. The systems for the administration of the administration of medication were in the main satisfactory, but some medication administration records were not correctly maintained and did not accurately record the administration of medication in the home. EVIDENCE: The care team leader advised staff had just begun the process of introducing new care plans. The intention being to give care staff more understanding of residents needs as a whole. While staff have made a start in transferring information to the new format, to date not all care plans had been updated. Understandably this process will take time for all the information to be incorporated into the new plans. During this inspection three care plans were examined and one of the new style plans was included in the sample. The care plans examined contained comprehensive information relating to residents personal, social and health care needs. Daily entries in care notes Hourigan House DS0000005741.V269572.R01.S.doc Version 5.1 Page 10 were completed in all the plans examined and gave a good indication of the care provided and residents well being. There was also written evidence the plans had been signed and agreed by either the resident or their representative. Good practice was noted as their was an extensive amount of personalised information about residents likes/dislikes, preferences and chosen lifestyle. For example on plan read, “ I take pride in my appearance and choose what clothes I want to wear” and “ If I am cold in the night I will press the call system for an extra blanket”. Risk assessments were in place in each of the files inspected. The covered areas such as nutrition, falls, pressure areas and moving and handling. While in the main the care plans were up to date some shortfalls were noted. For example in regard to reviews. The last documented review in all took place in December 2005. It was also noted that one of the records of residents weight there was no entry for January 2006. Both these areas need to be addressed to ensure the standard of care plans remains good. There was evidence that the residents’ health care needs are regularly monitored. Individual care records inspected showed evidence of visits from GPs, district nurse, continence advisor, chiropodist and optician. Records also indicate when residents have visited hospital outpatients departments. Procedures were seen in the Home that described safe medication handling. Medication storage in the home was secure and orderly. A separate system is in place for recording the receipt, disposal and administration of controlled drugs. Controlled drugs are securely stored and a separate system is in place to record their administration. Records of medication received into and leaving the home had been maintained. Medication Administration Records (MAR) were supplied by the pharmacy except for example when additional medication was provide mid-month then, care staff made hand written entries. Where hand written entries had been made they were found not to have been checked and countersigned. This is recommended to reduce the risk of transcription errors. The pre-printed MAR sheets examined were on the whole accurate. However it was noted that three of the lunch time sheets showed medicines signed as being administered when they had not. This appears to have been a genuine error as the remainder of the MAR sheets were looked at and had not been signed as being administered. Nevertheless, current guidance advises that MAR sheets should be completed immediately after administration to each person and staff need to be mindful of this. Hourigan House DS0000005741.V269572.R01.S.doc Version 5.1 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 the following standard(s): 12 & 14 Daily activities within the home are well managed offering choice and interest. Personal support is offered in such a way as to enable residents to exercise choice and control over their lives. EVIDENCE: On the day of the unannounced inspection, the routines of daily living were observed to be flexible. Residents were seen to be having their breakfast at different times, which provided evidence that residents have a choice as to when they get up. The home employs an activity co-ordinator five days a week from 10am to 3pm Monday to Friday. Activities provided are displayed in the entrance to the home. Activities advertised include reminiscence, manicures, handicrafts, gentle exercise and musical entertainment. A meal out is arranged every month. In each of the care plans examined details of the activities each resident has taken part in was recorded. For example the activities undertaken by one resident included, gentle exercise, watching a video, manicure and attending the residents meeting. Regular residents meetings are held regularly and well attended. The minutes of the last meeting were examined and indicated residents were satisfied with the range and frequency of activities available. The Inspector spent some time with residents taking part in a gentle exercise activity. It was evident residents taking part enjoyed the Hourigan House DS0000005741.V269572.R01.S.doc Version 5.1 Page 12 session. There was a good level of conversation and banter between residents and the co-ordinator. Residents spoken with had no adverse comments about the range and frequency of the activities provided. Discussion with the activity co-ordinator indicated the budget for activities was sufficient. Residents wishing to maintain their religious links are encouraged to do so. Care plans contain details of resident’s preferred religion. Residents spoken to expressed satisfaction with care provided and organisation of life at the home. Observation of care practice and information in care plans indicated residents are encouraged to make informed choices. For example in respect to where they spend their day, meals and what clothes they wear. While some residents chose to sit in the lounge a number were observed to spend their time in their own rooms. This was further illustrated in care plans. For example one care plan read, “I can choose my meals from the menu. I will ask for an alternative meal if needed”, and “I take pride in my appearance and choose what clothes I want to wear”. As previously noted regular residents meetings are arranged. The minutes of the last meeting demonstrated residents are consulted as to their preferences in regard to the purchase of some items. For example during the last meeting residents were asked what items they would like obtained. Residents suggested a large screen TV, DVD and awning. It is understood that as a result of feedback from residents these items are soon to be purchased. Hourigan Houses policy on admission is that residents are encouraged to bring in personal items that will help them to settle in to life at the home, the extent of which is agreed prior to admission. Evidence of personalisation was seen in resident’s bedrooms where personal mementoes and photographs were on display. Feedback from residents confirmed they were able to exercise choice. For example in respect to rising and retiring times. One resident spoken with said, “You can please yourself what you do”. Hourigan House DS0000005741.V269572.R01.S.doc Version 5.1 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 the following standard(s): 18 Policies, procedures and training were in place to safeguard residents from abuse or harm, and for taking any concerns seriously. EVIDENCE: A corporate Adult Protection and Prevention of Abuse policy is in place, which incorporates, whistle blowing. The home ensures all staff completes a POVA and CRB (Protection of Vulnerable Adults Register/Criminal Records Bureau) before they commence work. Training in the signs and recognition of abuse is covered during induction. Refresher training in the signs and recognition of abuse is planned for the near future. Staff spoken with were clear about the action to take in the event of an allegation or case of suspected abuse. Hourigan House DS0000005741.V269572.R01.S.doc Version 5.1 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 the following standard(s): 19 The standard of the environment within this home is in the main good providing residents with an attractive, homely and clean place to live. EVIDENCE: In the main the home is well maintained both internally and externally. Since the last inspection the offices and some bedrooms have been redecorated. Hourigan House is spacious with several lounges, a dining area and hairdressing room. These areas are furnished with good quality items. Ornaments, fireplaces, pictures and flowers enhance the homeliness of these areas. The garden areas are tidy, well maintained, safe secure and accessible for residents. During the visit the home was clean and odour control was good. Residents and visitors spoken with made no adverse comments about the environmental standards in the home. In the main environmental standards are good but it was noted that the wallpaper and paintwork in some of the corridors was damaged and showed signs of wear and tear. This needs to be addressed as part of the planned programme of renewal and maintenance to ensure standards in the home don’t Hourigan House DS0000005741.V269572.R01.S.doc Version 5.1 Page 15 fall below an acceptable standard. On the day of the visit it was noted that the lounge (attached to the conservatory) and conservatory were very hot. This needs to be monitored to ensure the temperature in these areas does not become excessively high. Hourigan House DS0000005741.V269572.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 & 30 Staff are caring and committed and work hard to provide a consistent standard of care for people living in the home, but staffing levels need to be reviewed to ensure residents care needs are not compromised. A comprehensive training programme is in place, which equips staff with the skills and knowledge they need to meet residents assessed needs. EVIDENCE: Residents and visitors spoken with said staff looked after them well. One resident said the care “Couldn’t be better and described the staff as being “Very kind”. During previous inspections requirements have been made to keep care staff ratios under review. The requirement was made, as there were some concerns in respect of the role of care team leaders in the evenings, weekends and when the manager is not rotered to work. The main area of concern related to the possibility of administrative and supervisory duties taking care team leaders away from the direct care and supervision of residents. This remains relevant and evidence of this was highlighted during this inspection. During the visit there were 4 care staff working, including the Care Team Leader. The care team leader is counted in staffing but carries out admin and supervisory duties and is responsible for the shift when the manager is not on duty. During this inspection the manager was on a training course and the care team leader was seen to be undertaking admin/management tasks rather than providing direct care. And while domestic and catering staff provided support, the care team leader and three care staff were extremely busy throughout the visit. It was Hourigan House DS0000005741.V269572.R01.S.doc Version 5.1 Page 17 evident the care team leader did not have the time to attend to resident’s personal care needs. Staff spoken with also confirmed this. Although care staff were attentive to residents personal care needs they had very little time to spend quality time with residents. This situation needs to be urgently reviewed particularly when the manager is not on duty. Currently the night shift has two staff on duty, to assist residents to bed and support them throughout the night. Given the layout of the building and the dependency levels of residents this may not be adequate. This needs to be kept under review to ensure ratios at night are sufficient to meet residents care needs. A comprehensive staff development programme is in place and records of training are maintained. There was evidence that new staff undertake induction training that meets the National Training Organisation (NTO) specification following which foundation training is undertaken. Since the last inspection the home has achieved Investors in People status. Each member of staff has a personal development plan. Ongoing training is available and there is ample evidence that these opportunities are taken up. NVQ (National Vocational Qualifications) are actively promoted. Currently of the 21 care staff 17 have achieved NVQ level 2/3. This is commended as the 96 of NVQ qualified staff is significantly above the required standard. Samples of training records were examined. The records confirmed the range of courses that staff had attended. Recent courses undertaken include appraisal & supervisory skills, moving and handling, health and safety and NVQ. Staff spoken with expressed satisfaction with the range and frequency of training provided. Hourigan House DS0000005741.V269572.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 The home was being well managed resulting in a consistent service for the people using it. EVIDENCE: The manager was on a training course during this inspection therefore it was not possible to explore this standard in depth. However findings from previous inspections indicate the registered manager is suitably qualified and experienced. She has worked in residential homes for a number of years and has continued her professional development. The manager has attained the NVQ level 4 registered managers award. There were no adverse comments from staff or residents regarding management of the home. One member of staff described her as being “Very supportive”. There is a clear line of accountability in the home which both residents and staff spoken with are aware of. Given the manager was not present during this inspection this standard will be looked at in more detail during the next inspection. Hourigan House DS0000005741.V269572.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X X X X X X X STAFFING Standard No Score 27 2 28 4 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X X Hourigan House DS0000005741.V269572.R01.S.doc Version 5.1 Page 20 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 OP7 Regulation 15 Requirement Care plans must reflect full details of service users assessed needs and actions necessary to meet identified needs including; regular monthly reviews and monthly records of residents weight. To ensure good practice in the administration of medications, the MAR sheet (medication administration sheet) must always be referred to and completed at the time of administration. As part of planned maintenance damaged wallpaper and paintwork (corridors) must be attended to. To ensure the lounge (attached to the conservatory) and conservatory does not become excessively hot the temperature must be monitored. To ensure staffing levels are sufficient a review of ratios must be undertaken. Details to be forwarded to the CSCI Timescale for action 31/03/06 2. OP9 13 31/03/06 4. OP19 16 & 23 01/03/06 5. OP25 23 01/03/06 6. OP27 18 01/10/05 Hourigan House DS0000005741.V269572.R01.S.doc Version 5.1 Page 21 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. Refer to Standard OP27 OP9 Good Practice Recommendations Consideration should be given to providing an additional member of staff at night. Handwritten MAR entries should be signed, independently checked and countersigned. Hourigan House DS0000005741.V269572.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hourigan House DS0000005741.V269572.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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