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Inspection on 21/12/08 for Howlish Hall Care Home

Also see our care home review for Howlish Hall Care Home for more information

This inspection was carried out on 21st December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People get good information about the home and are encouraged to come and visit so that they can make an informed decision about whether to come to live here. The home checks what a new resident might need help with to make sure that it can provide the right care for them. People have good support to get visiting health care services if they need it. There are activities for the residents and opportunities to go out from time to time, if they are able. The home is warm, clean and safe and the bedrooms are nicely decorated. One visitor said the home is "clean and comfortable." Staff have good training in care and many staff have had training in caring for people with dementia needs. The home is well run. The provider takes an active part to make sure it is run in the right way. Staff have training in health and safety, and the home is well maintained to make sure it is safe for the people who live here.

What has improved since the last inspection?

The environment has been improved both inside and outside. The lounge has been re carpeted and new chairs have been purchased. The outside of the grounds and building have been painted and landscaping has been improved providing pleasant areas for people to sit in. There is a memorial garden in the grounds and this is a focal point for the residents. Staff training continues and two staff are undergoing the registered managers award. The activities programme has improved with visiting entertainers being used in the home at least once monthly. All staff training plans are in place and staff are supported at all levels with individual training plans. The majority of the homes policies and procedures have been updated.

What the care home could do better:

The registered provider should confirm in writing to prospective residents that their needs can be met in the home on the basis of the assessment that is provided.The care plans must be written in a way that is specific to the individual person and which is based upon their assessed needs. This will ensure that staff are following the correct procedures to help people. Abbreviations that are currently in use when staff compile the daily nursing notes should not be used with a full explanation always being recorded. This will ensure that there is consistency with the record keeping and the potential for any misunderstanding is reduced. Records of administration must be kept in accordance with the guidance issued by the Royal Pharmaceutical Society. And there should be no unexplained gaps on the medication records. The medicines administration records should include a photograph of the residents and also a list of any allergies they may have. This will ensure that the potential for error is reduced.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Howlish Hall Care Home Howlish Lane Coundon Bishop Auckland Durham DL14 8ED     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Clifford Renwick     Date: 2 1 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Howlish Hall Care Home Howlish Lane Coundon Bishop Auckland Durham DL14 8ED 01388609226 01388606871 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Joyce Spenceley Type of registration: Number of places registered: Williams & Spenceley Limited care home 49 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Day Care: Three day care attendee over the age of 65 may be accommodated commensurate with the home`s Statement of Purpose. Named Individual The home may accommodate a named individual as set out in a letter to the registered person dated 24 May 2006 which establishes the basis on which the individual`s needs will be met by the home. Where necessary the home`s Statement of Purpose shall reflect any changes in service provision required for this arrangement. This condition may not apply to anyone else, other than the named individual, who falls outside the registered category. Physical Disability: Persons with a physical disability over the age of 55 may be accommodated commensurate with the home`s Statement of Purpose. Date of last inspection 0 49 Over 65 49 0 Care Homes for Older People Page 4 of 26 Brief description of the care home Howlish Hall is a Grade 2 listed building, which dates back to the early 17th Century and is set in 2.75 acres of landscaped wooded gardens near to Coundon in County Durham. A frequent bus service is available which provides links to the local towns of Coundon and Bishop Auckland. The home provides 24hr personal care with nursing for older people. Accommodation at the home is provided over two floors, with a mixture of single and double room, some being en-suite. There are a sufficient number of bathrooms and toilets to meet the needs of residents who live there. In addition there is a choice of lounge and one main dining room. Howlish Hall has recently been extended to provide a two-storey extension which allows for a further 17 bedrooms all of which are en-suite. There has also been an increase in the number of toilets, bathrooms and communal areas for use by residents. The current fee varies from £382.00 to £602 per week depending on how a person is funded and what type of care they need. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We have reviewed our practise when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations,but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The last inspection of this service was carried out on the 22nd November 2006. Care Homes for Older People Page 6 of 26 Before the visit we looked at information we have received since the last visit on 22nd November 2006, and information received as part of the last annual service review on 3rd December 2007. We looked at how the service dealt with any complaints & concerns since the last visit. We looked at any changes to how the home is run, for example since the last inspection a new manager has been employed. We made an unannounced visit on 4th December 2008. During the visit we talked with people who use the service, relatives, and staff. We joined residents for a meal and looked at how staff support the people who live here We looked at information about the people who use the service & how well their needs are met. We looked at other records which must be kept by a care service. We checked that staff had the knowledge, skills & training to meet the needs of the people they care for. We looked around the building/parts of the building to make sure it was clean, safe & comfortable. We told the owner and manager what we found. What the care home does well: What has improved since the last inspection? What they could do better: The registered provider should confirm in writing to prospective residents that their needs can be met in the home on the basis of the assessment that is provided. Care Homes for Older People Page 8 of 26 The care plans must be written in a way that is specific to the individual person and which is based upon their assessed needs. This will ensure that staff are following the correct procedures to help people. Abbreviations that are currently in use when staff compile the daily nursing notes should not be used with a full explanation always being recorded. This will ensure that there is consistency with the record keeping and the potential for any misunderstanding is reduced. Records of administration must be kept in accordance with the guidance issued by the Royal Pharmaceutical Society. And there should be no unexplained gaps on the medication records. The medicines administration records should include a photograph of the residents and also a list of any allergies they may have. This will ensure that the potential for error is reduced. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. No one is admitted to the home without an assessment this ensures that only persons whose needs can be met in the home are admitted. Intermediate care is not provided so this standard was not assessed. Evidence: The home have their own pre assessment document that is used to collect information prior to someone being admitted to the service. This looks at individual needs and what help someone will require if they move into the home. Discussion with the manager confirmed that the assessment documents used by the home are in the process of being updated so they they can obtain as much information as possible. In addition to the home completing their own assessment information is also obtained from the placing authority. The home offer respite care or short breaks to people and ensure that an updated Care Homes for Older People Page 11 of 26 Evidence: assessment is always completed prior to admission to check if their individual needs have changed. This then assists the staff in ensuring that the correct plan of care is put into place. The home do not confirm in writing to the prospective service user that their needs can be met in the home as required by regulation. The Care Homes Regulations require that prior to admission that confirmation in writing is given confirming that on the basis of the assessment a service users needs can be met in the home. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although residents have satisfactory support with their health care, the gaps on the administration of medicines records potentially places service users at risk. Evidence: Care plans are records that are used by all care services to show what sort of help each person needs and how staff will provide that care. For example how to help people with their mobility, diet, and dementia care needs. We looked at three care plans and these confirmed that the care plans are sufficiently detailed, easy to follow, and are evaluated on a monthly basis. The care records also show that peoples health care needs are assessed and regularly checked. The home has clear assessment records of peoples mobility, nutrition, risk of falling, Care Homes for Older People Page 13 of 26 Evidence: and risk of skin pressure. These are reviewed every month to check any changes. The care plan documents that are in use are standard printed sheets and contain the same areas of care for people as opposed to being personalised to individual assessed needs. And though peoples assessed needs are being met the written care plan is not always an accurate reflection of what actions staff are carrying out to meet the assessed needs. For example for one person the care plan states a person has a poor diet and staff are to maintain a minimum fluid and food intake to prevent dehydration. However there are no steps in the care plan to show how this is achieved by staff. Records of weight charts show no significant concerns and discussion with staff indicated that they ensure that diet and fluid balances are maintained even though it is not recorded in the care plan how they do this. Some areas of care that are listed in the pre printed care plan sheet are not always relevant to the person and are not a reflection of their assessed needs. For example in the assessment it states no help required with meals, though the care plan states help to be given with meals. And in discussion with staff it was confirmed that no assistance is required though staff will observe to assess whether there is a change in needs. This was discussed with the manager and advice offered as to how care plans should be written in a way that are personal to the individual. And which are based upon their individual assessed needs. In discussion with staff it was clear that they have a good understanding of individual residents needs even though there may not be accurately reflected in the care plan. The registered nurses take responsibility for managing medication. Medication is stored securely and safely, and records of the administration of medication were generally up to date though there were some unexplained gaps. There were several gaps for several people where it could not be determined if medicines had been given or omitted on certain days. Care Homes for Older People Page 14 of 26 Evidence: The new manager was aware of this and had audited the records 2 days prior to our visit. And as a result of this would be speaking with the nurses about gaps on the administration records. The manager also had steps in place to carry out regular audits of the system to ensure that the records are maintained in accordance with the guidance issued by the Royal Pharmaceutical Society. This would ensure that if there any unexplained gaps then a written reason is recorded. It is good that the new manager has identified issues with the administration records and has steps in place to deal with this. Observations of staff practises confirmed that they are respectful towards the residents using their preferred form of address. Personal care tasks were carried out in the privacy of service users rooms and dignity was being maintained. Care Homes for Older People Page 15 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are supported to lead fulfilling lives and exercise choice over how they spend their day. And a wholesome and balanced diet ensures that their health and well being is supported. Evidence: Activities are carried out on a daily basis and residents can also take part in entertainment and outings dependent upon the weather. Photographs are available of some of the activities that have been carried out. Activities that are offered are varied and this is due to the different level of needs that individual people have some of which can limit them from taking part in all activities. In discussion with one person who attends the home for daycare they said that there is always enough to do when they visit the home. The owner stated that they always attempt to have an outside entertainer visit the home at least once monthly. Care Homes for Older People Page 16 of 26 Evidence: Birthdays and special occasions are always celebrated. At the time of our visit a carol service was being held in the afternoon. There are no restrictions on visiting the home and the owner encourages the residents to retain contact with relatives and friends. Residents who are able can follow their own chosen daily routines and some residents did prefer to spend time in their rooms. The menus are varied and include residents choice of meals. As well as a range of traditional meals the menus also incorporate dishes such as bolognese pasta. Discussion with the residents confirmed that they receive a good variety of food and it is always well cooked and plentiful. They said there is always something on the go such as biscuits and snacks in between meals. And if they did not like what was on the menu or changed their mind an alternative dish was always provided. Hot and cold drinks were available throughout the meal and staff offered support to those residents who required help to eat their meal. Special diets that include softened food are available to those people who require them. The mealtime was unhurried and the atmosphere was relaxed which made eating an enjoyable experience. Care Homes for Older People Page 17 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their representatives have clear information so they would know how to make a complaint. The staff team have had suitable training so they should know how to protect residents from abuse. Evidence: The home has a written complaints procedure and all residents, staff and families are aware of this. Information received in the surveys confirmed that all of the residents know who to complaint to if they had any concerns. People responded positively in the surveys stating that they had no complaints. The manager and staff are aware of safeguarding adults and have policies and procedures in place to prevent any abuse occurring. Almost all of the staff have completed an e-learning course in safeguarding adults with an external training agency. This has ensured that they are up to date with current practise. Care Homes for Older People Page 18 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall the home provides safe, well maintained accommodation for the people who live here. Evidence: The environment is well maintained, clean and comfortable and free of any noticeable hazards. The home employ their own maintenance person and this ensures that any repairs are dealt with immediately. All areas of the building were viewed during our visit. There is a good standard of decor throughout the home and it was good to see that many of the residents had personalised their bedrooms with small items of furniture and personal effects. The owner is continuing to make improvements within the building and is considering converting shared rooms to single occupancy and installing an en suite toilet. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides suitable, trained staff to meet residents physical care needs. Evidence: Staffing rotas confirmed that there are sufficient trained and experienced staff to meet the needs of the residents. Many of the staff have worked in the home for a long time. And discussion with the manager confirmed that staff rarely leave to seek employment elsewhere.This has ensured that there is stability within the staff team. Each member of staff has an individual training records that lists all training they have received. One of the trained nurses and the deputy manager are undergoing the registered managers award and 3 staff are currently undergoing NVQ Level 3 training. A high percentage of the staff team have undergone training in NVQ Level 2. Some staff have also received training in dementia awareness and infection control. A lot of the training is done through distance learning courses organised by Middlesbrough college. As previously stated staff rarely cease to work in the home but when recruiting staff the owner confirmed that rigorous recruitment procedures are in place. Appropriate references are sought as well as the necessary criminal record check and also a full employment history. This ensures that only persons suitable to work with Care Homes for Older People Page 20 of 26 Evidence: vulnerable older people are employed. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An experienced and qualified person is managing the service to ensure that it is run in the best interests of the residents. Evidence: Since the last visit the owner has employed a manager who has recently commenced work in the home. Though the owner is still working on a daily basis it is her intention to ensure that the new manager takes over the role of day to day management in the home. The manager is a qualified nurse and has completed an NVQ Level 4 management award and is also an NVQ work based assessor. This qualifies her to teach staff. In addition to this the manager has also been a registered manager in care homes for older people. Care Homes for Older People Page 22 of 26 Evidence: The manager has ensured that she has undergone periodic training to update her knowledge and skills. This has included undergoing training in the safe handling of medications and also undergoing specialist training related to dementia and Alzheimers disease. The manager confirmed that she is in the process of updating all residents care files and also auditing policies and procedures to ensure that improvements continue to be made. Annual satisfaction questionnaires are sent out to families of residents and any information received is used to improve the service. Staff receive yearly appraisals to identify any issues, problems and also to identify future training needs. Residents personal finances are dealt with by the homes administrator and appropriate records are kept. Good records are kept to ensure that health and safety is maintained in the home and there manager is ensuring that all staff are receiving appropriate health and safety training. Staff are currently undergoing training in moving and handling and have completed updated training in fire safety. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person must 28/12/2008 ensure that appropriate arrangements are in place for the recording of service users prescribed medication. Ensuring that there are no unexplained gaps on the records. This will ensure that a record is maintained that confirms service users are receiving their prescribed medicines. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 Confirmation in writing should always be given to the service user/ and or their representative. Confirming that on the basis of the assessment their needs can be met in the home. The registered person should ensure that care plans are developed in a way that is personal to each service user and which is based on the assessment of that persons needs. 2 7 Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!