Inspection on 19/10/05 for Hovenden House Nursing Home

This inspection was carried out on 19th October 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hovenden House Nursing Home 15/08/07

Hovenden House Nursing Home 20/04/06

Hovenden House Nursing Home 09/05/05

Hovenden House Nursing Home 08/12/04

Hovenden House Nursing Home 07/04/04

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

CARE HOME ADULTS 18-65 Hovenden House Nursing Home Lowgate Fleet Spalding Lincs PE12 8LP Lead Inspector Mr Toby Payne Unannounced Inspection 19th October 2005 08:40 Hovenden House Nursing Home DS0000002538.V258548.R01.S.doc Version 5.0 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 Hovenden House Nursing Home DS0000002538.V258548.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Hovenden House Nursing Home DS0000002538.V258548.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hovenden House Nursing Home Address Lowgate Fleet Spalding Lincs PE12 8LP 01406 423037 01406 425243 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) Leonard Cheshire Mrs Katherine Tipple Care Home 32 Category(ies) of Physical disability (28), Physical disability over registration, with number 65 years of age (4) of places Hovenden House Nursing Home DS0000002538.V258548.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Condition of registration The home is registered to provide personal care with nursing for service users of both sexes whose primary needs fall within the following categories: Physical disability (PD) 28 Physical disability over the age of 65 years of age (PD(E) 4 The category PD applies to service users who are under the age of 65 years The maximum number of service users to be accommodated is 32 2. 3. Date of last inspection 9th May 2005 Brief Description of the Service: Hovenden House is a large country house set in extensive landscaped grounds in a rural setting approximately 3 miles from the market town of Holbeach. The home is one of many run by the Leonard Cheshire Foundation. It is approached from a driveway and there are car parking spaces to the front of the home. There are 3 single storey extensions at the rear of the home where there is a garden and patio area designed for physically disabled people. The care home provides nursing and personal care and accommodation for people with a physical disability. All accommodation, which is accessible by disabled people, is on the ground floor. There is also a shaft lift installed which gives access to the first floor. The Leonard Cheshire charter which is outlined in the service users guide states, we believe that each individual person, whatever his or her disability, is a uniquely valuable individual and that people with disabilities should have the personal freedom to pursue their aspirations and take their own place in the world. Transport is available to enable people living the home to access local services in the community. Hovenden House Nursing Home DS0000002538.V258548.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and started at 8.40 am. It took place over six hours. The inspector spoke to 11 residents, 4 members of staff and the acting manager. The main method was called “case tracking”. This involved selecting one resident and tracking the care they received through the checking of records, discussion with them, the care staff and observation of ho staff responded to their needs and that of the other residents. What the service does well: What has improved since the last inspection? What they could do better: Staff responsible for writing in care records must take care to ensure that all information is included as the lack of clear instructions could cause the residents needs not to be met. It is acknowledged that a new detailed individual service package is being introduced. All staff must receive disability awareness training to enable them to respect residents as people. Hovenden House Nursing Home DS0000002538.V258548.R01.S.doc Version 5.0 Page 6 A system needs to be established to provide an internal audit of care records, medication and care services in order to ensure that there is a consistent approach. The acting manager must ensure that all care staff and nurses receive formal supervision. The manager needs to carry out a survey of residents to obtain their views as to what type of activities they would like in the home and whether the food provided suits what they want. 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. Hovenden House Nursing Home DS0000002538.V258548.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hovenden House Nursing Home DS0000002538.V258548.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4 and 5 Residents living at Hovenden House receive clear information to enable them or their relatives/advocates to make an informed choice as to whether or not they wish to live in this home. Each resident has terms and conditions of residence. EVIDENCE: People are offered a 12-week trial visit to the home, during which an assessment takes place involving the person, their family/advocate and staff in the home. The homes’ admission procedure offers an invitation to visit the home and meet staff and residents. This is also referred to in the service user’s guide. All residents receive a contract/statement of their terms and conditions. This is an attachment to the service user’s guide on admission to the home. This is a very detailed document. Hovenden House Nursing Home DS0000002538.V258548.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 8 Information in the care plans is still not clear and consistent to provide staff with sufficient information to meet the resident’s needs. This has the potential to place residents at risk. EVIDENCE: It is acknowledged that the care planning system is still going through extensive change. All residents care details have been transferred across to a new very detailed person focussed care system. The information is detailed with many pages. However not all information is relevant to each person and needs further refinement in order to allow staff to carry out the assessed needs for each person. Therefore teething problems remain, as some of the required information is incomplete, not dated or signed. Care records included a personal profile some of which had been written by the resident, detailed assessment, nutrition assessment and daily record. The new system will allow additional information to be included where required. There were risk assessments and where possible residents had been involved in identifying their needs. Hovenden House Nursing Home DS0000002538.V258548.R01.S.doc Version 5.0 Page 10 Residents are involved where possible in aspects of life in the home. There is a resident’s council made up of residents. An interview for a member of staff was taking place at the same time as the inspection and a representative of the residents was on the interview panel. Hovenden House Nursing Home DS0000002538.V258548.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15 and 16 Residents are encouraged and supported in a variety of social activities. Activities suit the residents and have been expanded. There is a dedicated transport service provided to enable residents to be independent and participate in the community. Visitors are welcome to visit at any time. EVIDENCE: Activities are wide ranging and include craft, art and computer. There are also links with local clubs and residents are also able to access further education classes. The home also employs a physiotherapist. Residents visit local shops, pubs, cinemas and leisure centres. The home provides 2 mini-buses accessible for wheel chair users. Holidays can also be arranged. Since the last inspection activities in the home have been expanded and now include darts, table tennis and snooker. Residents commented “there are plenty of activities”, “I don’t feel bored”, “things have improved, there are more activities” and “I like the activities”. However staff commented, “I think some residents are bored”, and “some of the activities suit the minority of people living in the home”. Hovenden House Nursing Home DS0000002538.V258548.R01.S.doc Version 5.0 Page 12 The statement of purpose and service user’s guide refer to visitors being welcome at any time. This was also confirmed with service users. There are also regular functions including BBQs and musical entertainment. Hovenden House Nursing Home DS0000002538.V258548.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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 and 19 An educated team of staff delivers care. There is still concern that a number of staff are not respecting the person hood of residents by speaking down to them. This can affect the well being of residents. EVIDENCE: Resident’s care is provided by a trained care team, which includes registered nurses. The home has detailed policies concerning privacy and dignity. This is also in the service user’s guide and statement of purpose. This is also covered during induction for all new staff. Residents said that the staff respected this important aspect of their life. Staff knew the needs of the residents and were observed attending to residents in a calm and respectful manner. Residents commented, “the home has improved”, “some staff are rude and say they are too busy”, “some staff are very kind” and “they tell me off if I don’t do things right”. Hovenden House Nursing Home DS0000002538.V258548.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Any complaints received are taken seriously and there is a comprehensive complaints procedure. Staff are recruited and checked to ensure that they are safe to deliver care to people living in the home. EVIDENCE: Each resident receives a copy of the complaints procedure. The CSCI and the home have received no complaints since the last inspection. An allegation of abuse had been received in March 2005 and was investigated by Lincolnshire County Council’s Social Services Department. This investigation was completed in June 2005. Hovenden House fully co-operated throughout this investigation. There was no evidence to support the allegation. However the home was required to address the issue of security in the home which was found to lax and record all aspects of care. Security has been addressed but care records need further attention. Staff receive training concerning the prevention of abuse during their induction programme. A member of staff confirmed this and knew what abuse was and what she should do if abuse was suspected. Hovenden House Nursing Home DS0000002538.V258548.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 28 Residents live in comfortable accommodation, which is designed for their individual needs. This enables them to access all services and the extensive grounds of the home. There is also a large range of equipment available which staff have been trained to use to enable the residents to be cared for in a safe and dignified manner. The building is also well maintained and any repairs are attended to swiftly. EVIDENCE: All residents spoke of how they liked their bedrooms. Comments were “I like my room” and “I like it here”. There were a variety of wheelchairs to suit the individual needs of the residents. There are a variety of accessible toilets, bathrooms and shower rooms throughout the home with handrails and a number overhead electrical hoists. There are also a number of special accessible baths. There is one large dining room overlooking the garden. There are 2 lounges and sun lounge all on the ground floor. One of the lounges is a dedicated lounge for those who wish to smoke. There is an activities room and a resident’s kitchen/dining room. All these facilities are on the ground floor and wheelchair accessible. Hovenden House Nursing Home DS0000002538.V258548.R01.S.doc Version 5.0 Page 16 Residents were observed to access their bedrooms and the wide corridors with ease. Residents also commented on the cleanliness of the home. Separate housekeeping staff were observed cleaning and vacuuming the home. They spoke of the pride they took in their work. Residents also commented on how well their clothes were laundered and taken care of. Hovenden House Nursing Home DS0000002538.V258548.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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, 32, 34, 35 and 36 There is a well trained and competent staff team. The numbers of staff provided are sufficient for the numbers and dependency of residents. Staff are also correctly recruited and there is a well established team. Staff do not receive formal supervision. EVIDENCE: Residents felt there were sufficient staff to meet their needs. Staff were observed to respond promptly to residents needs. Staff also felt they had sufficient time to care and support the residents. They also spoke of the support they received from nurses and the acting manager. There is a training department with its own training co-ordinator. The post has been vacant since July 2005 but a person has been recruited and will start in November 2005. There is an extensive training programme available, which includes induction, National Vocational Qualifications, internal lectures and training from outside providers. Over 70 of care staff have obtained a care qualification and the rest of the care staff have started courses to achieve this training qualification. Staff commented, “We receive a lot of training” and “I received a very thorough induction”. Hovenden House received an Investors in People award in March 2004 in recognition of the training and support provided. Hovenden House Nursing Home DS0000002538.V258548.R01.S.doc Version 5.0 Page 18 Staff however do not receive formal supervision sessions. Hovenden House Nursing Home DS0000002538.V258548.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The staff are lead by a competent management team even though there is no registered manager. However a suitable person has been appointed and an application is to be sent to the CSCI so that this person can be registered. There is a confident and supported staff team. However, there are a number of practices, which still need to be addressed as they are having a detrimental affect on a number of residents. There are established external audit systems but internal audits need to be provided to ensure that practice is consistent. EVIDENCE: There is no registered manager. The CSCI has been fully informed of this and of the efforts that the foundation was using to recruit a suitable person. However a suitable person has now been appointed who has a wide experience of the home. Staff and residents spoke of the support they received from the management in the home. Comments were “we have been going through a very unsettled period of time but we have been kept fully informed”, “things have improved in the home”, “staff are better”, “we work as one team” and “the staff are very nice”. Hovenden House Nursing Home DS0000002538.V258548.R01.S.doc Version 5.0 Page 20 There is a resident’s committee, which enables residents to voice any concerns they have about the home. Minutes of meetings were displayed on notice boards. There are also regular staff meetings. The management makes monthly unannounced monitoring visits and a detailed report is produced and a copy sent to the CSCI. Hovenden House Nursing Home DS0000002538.V258548.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 x 3 x 3 Standard No 24 25 26 27 28 29 30 STAFFING Score x x x 3 3 x x LIFESTYLES Standard No Score 11 x 12 3 13 x 14 x 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 4 3 3 3 2 CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Hovenden House Nursing Home Score 2 3 x x Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 3 3 x DS0000002538.V258548.R01.S.doc Version 5.0 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15(1) Requirement It is requirement that all responsible for writing in care records complete all relevant sections of the records with dates and signatures in entries. Staff must also be reminded that they are responsible for maintaining clear records. Registered Nurses need to ensure that records are completed in accordance with the Nursing and Midwifery Councils Guidelines for Records and Record Keeping (February 2004). The timescale of 9/6/2005 has not been met. It is a requirement that all staff who have contact with people living in this home receive disability awareness training. The timescale of the 9/7/2005 has not been met. The manager must ensure that all nurses and care staff receive formal supervision 6 times a year. The supervision should include all aspects of practice, the philosophy of the home and their career development needs. Records should be kept. DS0000002538.V258548.R01.S.doc Timescale for action 19/03/06 2 YA32 12(4) 19/03/06 3. YA36 18(2) 19/12/05 Hovenden House Nursing Home Version 5.0 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3 Refer to Standard YA31 YA39 YA39 Good Practice Recommendations It I recommended that all care staff excluding nurses receive a copy and understand the General Social Care Council’s Codes of Practice. It is again recommended that an internal audit is introduced to monitor care records, medication and care practice. It is recommended that the home undertake a survey with the involvement of the residents concerning the range of activities and food available. This is to ensure that all irrespective of disability have activities to suit their needs and prevent boredom. Concerning food; to ensure that residents have a choice of menu to suit their dietary needs and individual preferences. Hovenden House Nursing Home DS0000002538.V258548.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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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