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Inspection on 14/12/05 for Hoylake Cottage Hospital

Also see our care home review for Hoylake Cottage Hospital for more information

This inspection was carried out on 14th December 2005.

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.

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

Health and safety issues are addressed in a timely manner. Meals offered to service users were appetising and attractively served. A choice of meals is offered at each meal time.

What has improved since the last inspection?

A number of bedrooms have been redecorated since the last inspection to provide service users with a homely environment.

What the care home could do better:

Considerable work is required to provide sufficient documentation to indicate the care required by and afforded to the service users. Pre admission assessments are to contain all information regarding the service users care needs and the plans should reflect those needs. Risk assessments should be in place for all equipment used and for health needs.

CARE HOMES FOR OLDER PEOPLE Hoylake Cottage Hospital Birkenhead Road Hoylake Wirral CH47 5AG Lead Inspector Jeanette Fielding Unannounced Inspection 14th December 2005 10:30 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 Hoylake Cottage Hospital DS0000020909.V276811.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. Hoylake Cottage Hospital DS0000020909.V276811.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hoylake Cottage Hospital Address Birkenhead Road Hoylake Wirral CH47 5AG 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) 0151 632 3381 0151 632 4544 Hoylake Cottage Hospital Trust Limited Maureen Patricia Keymer Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Hoylake Cottage Hospital DS0000020909.V276811.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Three named persons under the age of 65 years Date of last inspection 23rd May 2005 Brief Description of the Service: Hoylake Cottage Hospital is a nursing home for elderly people set within the Cottage Hospital environment. It is registered to provide nursing care to forty elderly people. The home is located on the main thoroughfare through Hoylake and is fully accessible by public transport. The building is a former hospital that has had some internal modifications to enable it to operate as a nursing home. Twenty-eight of the bedrooms are for single occupancy with six double rooms being available. Plans have been prepared to replace this home with a purpose built, modern building, to provide a high quality facility for the care of elderly people. The new building is not expected to be completed until late 2006. Hoylake Cottage Hospital DS0000020909.V276811.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted in one day, during which time, staff service users and visitors to the home were consulted regarding the service provided. Records relating to the care required by and afforded to service users were inspected and were found to be in a poor condition. Requirements have been made for these to be attended to within a short time frame. A follow up visit will be made to the home to ensure compliance. Staff records were inspected and were found to contain all necessary information regarding the checks made on them prior to their employment, and the training undertaken. Safety records were inspected and were found to be well maintained and up to date. Meals were appetising and a choice of meal is always available. A tour of the premises shows that improvements continue to take place. What the service does well: What has improved since the last inspection? 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. Hoylake Cottage Hospital DS0000020909.V276811.R01.S.doc Version 5.1 Page 6 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 Hoylake Cottage Hospital DS0000020909.V276811.R01.S.doc Version 5.1 Page 7 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): 1, 3 Pre-admission assessments were poor and did not contain sufficient information regarding the care needs of prospective service users thereby having the potential for placing them at risk. EVIDENCE: The Statement of Purpose and Service User Guide are regularly reviewed and updated to reflect the changes within the home. These documents are informative and give all necessary information regarding the service offered by the home. Copies of these documents are held in the home and are available on request. The care manager, or one of the qualified nurses, holds responsibility for undertaking a pre admission assessment to ensure that the home can meet the specific needs of each prospective service user. These however, have not always been adequately undertaken, particularly for those service users admitted for short term or respite care. Reliance is often placed on the report prepared by the social worker and the information held from previous admissions. This is not sufficient to ensure that all the needs of the service Hoylake Cottage Hospital DS0000020909.V276811.R01.S.doc Version 5.1 Page 8 user are identified and that sufficient time is allowed for specialist equipment to be provided. This was discussed with the manager of the home at the time of the inspection who informed the inspector that plans were already in place to address this issue. It is imperative that a comprehensive assessment is made on all prospective service users prior to their admission to the home, irrespective of the information already held from previous admissions. Hoylake Cottage Hospital DS0000020909.V276811.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, 9,10 The care plans are inadequate and do not provide staff with the necessary information to provide service users with the care they require. EVIDENCE: Care plans are prepared for all service users, however it was found that some of these did not contain sufficient information to enable the staff to provide the appropriate level of care. One care plan referred to the service user has having diabetes but no plan of care had been prepared in respect of this. No instruction was detailed regarding the testing of the service user to ensure that the diabetes was maintained adequately. One service user who has a history of high blood pressure had not had his blood pressure taken for two months according to the documentation held. Several care plans had not been reviewed for several months and did not reflect the changing needs of the service users. Staff spoken to regarding these service users, were fully aware of the individual service users needs, however, little information was recorded. Hoylake Cottage Hospital DS0000020909.V276811.R01.S.doc Version 5.1 Page 10 The risk assessments on several files had not been updated, or in some cases, not prepared at all. Risk assessments were not adequate in respect of the use of bedrails, manual handling and nutrition. The tissue viability nurse had requested that one service user who has pressure sores, be turned two hourly. The home was unable to demonstrate through the use of turn charts or daily records, that the appropriate care had been given. No nutritional assessment had been prepared despite a request from the tissue viability nurse that this be undertaken. The daily reports completed by staff were found to have improved at the last inspection but it is evident that this improvement has not been maintained. It is evident that the staff have failed to adequately complete the necessary documentation to provide evidence of the actual care required by or afforded to service users. Service users and relatives spoken to during the inspection confirmed that the service users were treated with respect at all times and that the staff strived to provide a homely environment. Medications are generally handled appropriately by the nurses although care must be taken to ensure that medications are signed for immediately following administration. Hoylake Cottage Hospital DS0000020909.V276811.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, 13, 14, 15 A comprehensive programme of activities is provided to enrich service users social opportunities. EVIDENCE: A high number of activities are provided for the service users. The activities co-ordinator provides a variety of activities and social stimulations for the service users. Relatives are often involved and many were seen to be attending the carol singing on the day of the inspection. Relatives spoken to after the event commented on how much they had enjoyed the occasion. Ministers visit the home on a regular basis to provide services to meet service users spiritual needs. Visitors are welcome at any time and some service users are taken out by their relatives and friends. Staff take service users out to shops and the local promenade when time allows. Service users take their meal in the dining areas or in their bedroom as they choose. A selection of meals is available at each meal time and inspection of the menus provides evidence that a varied and balanced diet is offered. Hoylake Cottage Hospital DS0000020909.V276811.R01.S.doc Version 5.1 Page 12 Special diets can be provided either on request or on the advice of GP or dietician. The kitchen area was clean and well stocked. Hoylake Cottage Hospital DS0000020909.V276811.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): 16, 18 Staff have a good knowledge and understanding of Adult Protection issues to protect service users from abuse. EVIDENCE: The home has a comprehensive complaints procedure which is regularly reviewed and updated. Information on how to complain is detailed in the Statement of Purpose, the Service User Guide and is displayed on the notice board within the home. No complaints have been received by the home since the last inspection. Training has been given to staff on all aspects of adult protection and staff spoken to were aware of the whistle blowing policy. The care manager, and the staff spoken to were able to demonstrate their knowledge of adult protection protocols and of their own role within this. Hoylake Cottage Hospital DS0000020909.V276811.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, 26 Recent investment continues to improve the facilities for service users creating a more comfortable environment for service users. EVIDENCE: All bedrooms and communal areas are located on the ground floor of the building and are fully accessible. The home provides 28 single bedrooms and six double room. Six rooms are provided with en-suite facilities. The washing and toilet facilities in some areas remain unsatisfactory. Some bedrooms do not have a washbasin and so service user are required to wash in bathrooms or at the washbasins located behind curtains. This issue will be addressed by the provision of the new home. Work is currently taking place to enable three rooms to be used as bedrooms during the building of the new home. These rooms meet the minimum size required and are being provided with the necessary facilities prior to use by service users. Hoylake Cottage Hospital DS0000020909.V276811.R01.S.doc Version 5.1 Page 15 The home was found to be clean throughout with appropriate infection control procedures in place. Service users personal laundry is dealt with by the home and from observation, this is handled carefully by the laundry staff. Hoylake Cottage Hospital DS0000020909.V276811.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, 29, 30 The home has a robust recruitment policy and procedure to ensure the protection of service users. EVIDENCE: The home employs qualified nurses who are supported by care staff at all times. In the morning, two qualified nurses are supported by eight care staff, two qualified nurses with six care staff later in the day and one qualified nurse with five care staff at night. The hours worked by the manager and deputy manager/care manager, are supernumerary. The home has a robust recruitment procedure and the staff files inspected provided evidence that all checks are made on staff prior to them commencing work at the home. Staff records were found to be in order. A programme of recruitment has currently taken place and it has proved extremely difficult to recruit both nurses and care staff who meet the criteria for employment with the home. The home is committed to ensuring that staff training continues. Records are held of all training undertaken by staff and a list of forthcoming training opportunities was displayed. The home now employs 60 of staff who have attained NVQ qualifications and additional staff are currently working towards this. Hoylake Cottage Hospital DS0000020909.V276811.R01.S.doc Version 5.1 Page 17 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, 33, 35, 38 The systems for service user consultation are good with a variety of evidence that indicates that service users views are both sought and acted upon. EVIDENCE: The manager of the home is a qualified nurse who has considerable experience in the management of a home for elderly persons. Regular questionnaires are sent to service users to obtain their views. The most recent questionnaire was in relation to food and the meal provision. This generated suggestions from service users which have now been implemented. Questionnaires on other subjects are being prepared and will involve family members and other health care professionals. The home holds Investors In People quality monitoring accreditation. Hoylake Cottage Hospital DS0000020909.V276811.R01.S.doc Version 5.1 Page 18 The home does not deal with any of the service users personal finances. Purchases made on service users behalf are invoiced to the service user or their family as necessary. Training in health and safety has been given to all staff. The manager, deputy manager or caretaker attend to health and safety issues that are raised as appropriate. Risk assessments have been undertaken on the premises to ensure service users protection. These are held in the home. Safety records and certificates were inspected and were found to be up to date. Checks are made on all fire detection equipment on a regular basis and are duly recorded as required. Copies of reports made by a representative of the Trust during the monthly visit are held in the home and were available for inspection. Hoylake Cottage Hospital DS0000020909.V276811.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 3 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Hoylake Cottage Hospital DS0000020909.V276811.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 OP3 Regulation 14(1)&(2) Requirement Timescale for action 14/12/05 2 OP7 15(1)&(2) 3 OP8 17(1)(a) 4 OP9 13(2) The registered person must ensure that new service users are admitted only on the basis of a full assessment undertaken by people trained to do so, and to which the prospective service user, his/her representatives and relevant professionals have been party. The registered person must 27/01/06 ensure that a service user plan of care generated from a comprehensive assessment (see Standard 3) is drawn up with each service user and provides the basis for the care to be delivered. The registered person must 14/12/05 ensure that the home meets the assessed needs of the service user and that evidence of this is recorded. The registered person must 14/12/05 ensure that staff adhere to the procedures for the receipt, recording, storage, handling administration and disposal of medicines. Hoylake Cottage Hospital DS0000020909.V276811.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. Refer to Standard Good Practice Recommendations Hoylake Cottage Hospital DS0000020909.V276811.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Hoylake Cottage Hospital DS0000020909.V276811.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. 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!