Inspection on 09/05/05 for Hovenden House Nursing Home

This inspection was carried out on 9th May 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 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

Hovenden House Nursing Home 15/08/07

Hovenden House Nursing Home 20/04/06

Hovenden House Nursing Home 19/10/05

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 Toby Payne Unannounced 9 May 2005 08.40 hours The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 C53 C04 2538 Hovenden House 224211 090505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hovenden House Nursing Home Address Lowgate Fleet Spalding Lincs PE12 8LP 01406 423037 01406 425243 dee.meakins@-org.uk Leonard Cheshire Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Vacant CRH Care Home with Nursing 32 Category(ies) of PD 28 registration, with number PD (E) 4 of places Hovenden House Nursing Home C53 C04 2538 Hovenden House 224211 090505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions 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 28 Physical disability over the age of 65 years of age 4 The category Physical Disability applies to service users who are under the age of 65 years The maximum number of service users to be accommodated is 32 Date of last inspection 8th December 2004 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. 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 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 user’s 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”. The home is one of many run by the Leonard Cheshire Foundation. The home is approached from a driveway and there are car parking spaces to the front of the home. Hovenden House Nursing Home C53 C04 2538 Hovenden House 224211 090505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and started at 8.40 a.m. It took place over six and a half hours. The inspector spoke to 8 residents, 2 visitors, 5 members of staff and the acting manager. The main method of inspection was called “case tracking”. This involved selecting three residents and tracking the care they received through the checking of records, discussion with them, the care staff and observation of care records. A pre-inspection questionnaire was completed by the home prior to this inspection. The inspector when planning this inspection used the information from this. What the service does well: What has improved since the last inspection? Radiator covers continue to be installed in order to prevent residents scalding themselves. Safety film has been installed on windows to protect residents from injury. Hovenden House Nursing Home C53 C04 2538 Hovenden House 224211 090505 Stage 4.doc Version 1.30 Page 6 A new bed pan washer has been installed which has lead to a cleaner environment. A programme of redecoration has continued with 2 bedrooms being redecorated following consultation with the people living in the bedrooms. An emergency planning policy has been introduced to enhance the safety of staff and residents in case of an emergency. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hovenden House Nursing Home C53 C04 2538 Hovenden House 224211 090505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Hovenden House Nursing Home C53 C04 2538 Hovenden House 224211 090505 Stage 4.doc Version 1.30 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 standard(s) 1, 2 and 3 All residents are assessed before entering the home and written confirmation is sent to them that the home is able to meet their needs. Residents living in the home have information to help them make an informed decision about whether they wish to live in this home. EVIDENCE: There is a detailed statement of purpose and service user’s guide outlining the services the home provides. There is a detailed admission procedure, which identifies the needs of residents coming into the home. No new person has been admitted to the home since the last inspection but records showed that each person receives a service user’s guide and a costed terms and conditions/contract. Individual records are kept for each resident. All residents are assessed by the acting manager before admission. Information is obtained wherever possible from the resident, relative/advocate and other relevant people. Hovenden House Nursing Home C53 C04 2538 Hovenden House 224211 090505 Stage 4.doc Version 1.30 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 standard(s) 6, 7 and 9 Information in care plans is 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 going through extensive change. There are two systems being used and residents are being transferred across to the new system. There have been teething problems, as some of the required information was 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 C53 C04 2538 Hovenden House 224211 090505 Stage 4.doc Version 1.30 Page 10 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 standard(s) 11, 12, 13 and 17 Residents are encouraged and supported in a variety of social activities. Activities suit the residents but require expanding to ensure residents are not bored. There is a dedicated transport service provided to enable residents to be independent and participate in the community. There is a well planned menu with resident involvement. 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. Holidays can also be arranged. Residents did comment, “ there were not enough activities” and “I feel bored”. Other residents commented, “I like the activities provided”. The home provides 2 mini-buses accessible for wheel chair users. All residents commented on the how the appointment of a new cook has improved the food provided. Comments were “the food is superb”, “we have a Hovenden House Nursing Home C53 C04 2538 Hovenden House 224211 090505 Stage 4.doc Version 1.30 Page 11 new cook who is very nice” and “the new cook has reviewed the menus after asking our views”. Hovenden House Nursing Home C53 C04 2538 Hovenden House 224211 090505 Stage 4.doc Version 1.30 Page 12 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 standard(s) 18, 19 and 20 Care is delivered by an educated team of staff. There is 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. Medication policies and procedures are clear and this ensures that there are safe practices taking place EVIDENCE: Resident’s care is provided by a trained care team, which includes registered nurses. Nurses are responsible for the administration of medication and ensure that all procedures are followed and medication is given correctly. Staff have also received training to enable residents who are fed by tube to receive this nutrition correctly. There were clear directions concerning the administration of medication. Staff knew the needs of service users and staff were observed attending to residents in a calm and respectful manner. A number of residents said, “the home was not as friendly as it was” and “staff talk down to me”. They also commented, “we are not introduced to new staff” and “some staff are rude”. Hovenden House Nursing Home C53 C04 2538 Hovenden House 224211 090505 Stage 4.doc Version 1.30 Page 13 Hovenden House Nursing Home C53 C04 2538 Hovenden House 224211 090505 Stage 4.doc Version 1.30 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 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. Information sent to the CSCI showed that during the last 12 months the home had received 2 complaints. Records showed they had been investigated thoroughly. The CSCI has received no complaints since the last inspection. An allegation of abuse has been received and was being investigated by Lincolnshire County Council’s Social Services Department. This investigation had not been completed and there had been full co-operation by the home throughout this investigation. The CSCI has also been fully informed of the progress of the investigation. Staff receive training concerning the prevention of abuse during their induction programme. Hovenden House Nursing Home C53 C04 2538 Hovenden House 224211 090505 Stage 4.doc Version 1.30 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 standard(s) 24, 25, 26, 29 and 30 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. One resident commented, “I have a new very comfortable wheelchair and this has improved my life”. Residents were observed to access 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. Hovenden House Nursing Home C53 C04 2538 Hovenden House 224211 090505 Stage 4.doc Version 1.30 Page 16 Hovenden House Nursing Home C53 C04 2538 Hovenden House 224211 090505 Stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32 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 EVIDENCE: Staff files examined showed they had been recruited correctly with checks by the Criminal Records Bureau for all staff. 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. There is an extensive training programme available, which includes induction, National Vocational Qualifications, internal lectures and training from outside providers. Hovenden House received an Investors in People award in March 2004 in recognition of the training and support provided. Hovenden House Nursing Home C53 C04 2538 Hovenden House 224211 090505 Stage 4.doc Version 1.30 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38 and 43 The staff are lead by a competent management team even though there is no registered manager despite widespread advertising. This in turn has given rise to a confident and supported staff team. However, there are a number of practices, which 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 is using to recruit a suitable person. Staff and residents spoke of the support they received from the management in the home. There is a residents 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. Hovenden House Nursing Home C53 C04 2538 Hovenden House 224211 090505 Stage 4.doc Version 1.30 Page 19 The management makes monthly unannounced monitoring visits and a detailed report is produced and a copy sent to the CSCI. Hovenden House Nursing Home C53 C04 2538 Hovenden House 224211 090505 Stage 4.doc Version 1.30 Page 20 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 3 3 3 x 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 x x 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 x x x 3 Standard No 31 32 33 34 35 36 Score 3 3 x x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Hovenden House Nursing Home Score 2 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 x x x x 3 C53 C04 2538 Hovenden House 224211 090505 Stage 4.doc Version 1.30 Page 21 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 6 Regulation 15(1) Requirement It is requirement that all responsible for writing in care records complete all relevent 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). It is a requirement that all staff who have contact with people living in this home receive disability awareness training. Timescale for action 9th June 2005 2. 32 12(4) 9th July 2005 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. Refer to Standard 39 Good Practice Recommendations It is recommended that an internal audit is introduced to monitor care records, medication and care practice. C53 C04 2538 Hovenden House 224211 090505 Stage 4.doc Version 1.30 Page 22 Hovenden House Nursing Home Hovenden House Nursing Home C53 C04 2538 Hovenden House 224211 090505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 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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