Inspection on 13/06/08 for Hulcott Nursing Home

This inspection was carried out on 13th June 2008.

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

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

Hulcott Nursing Home 05/05/09

Hulcott Nursing Home 12/01/09

Hulcott Nursing Home 15/10/08

Hulcott Nursing Home 23/09/08

Hulcott Nursing Home 18/06/07

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hulcott Nursing Home The Old Rectory Hulcott Aylesbury Buckinghamshire HP22 5AX     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: Christine Sidwell     Date: 1 9 0 6 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 © (2008) 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: Hulcott Nursing Home The Old Rectory Hulcott Aylesbury Buckinghamshire HP22 5AX 01296 488229 01296 330834 hulcott@caringhomes.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Hulcott Limited vacant post care home 49 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 1 8 0 6 2 0 0 7 0 Over 65 49 Date of last inspection Brief description of the care home Hulcott nursing home is located a few miles outside of the centre of Aylesbury in a quiet hamlet location overlooking a green. The home is registered to provide accommodation for up to forty-nine service users requiring nursing input. The building has been attractively arranged to provide a pleasant environment for the people living there, with good quality furnishing and fittings. Nine of the bedrooms are shared rooms for two people. The majority of bedrooms have en suite facilities and all but two rooms are fully wheelchair accessible. There are three lounge areas, a large conservatory and a quiet area by the main entrance. Care Homes for Older People Page 4 of 26 The grounds are well maintained with a patio area and backs onto farmland. There are no public transport links and shops are some distance away. 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: The inspection was conducted over the course of five days and included an unannounced visit to the home. The key standards for older people’s services were covered. Information received about the home since the last inspection was taken into account in the planning of the visit. Prior to the visit, the manager completed an annual quality assurance self-assessment and questionnaires were distributed to residents, visiting health and social care professionals and staff. Residents and families were spoken to on the days of the unannounced visits. Discussions took place with the manager, nursing, care and ancillary staff. Care practice was observed. A tour of the premises and examination of some of the required records was also undertaken. The homes approach to equality and diversity was considered throughout. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? A new manager has been appointed since the last inspection and she has worked hard to improve the home. The requirements of the previous inspection have been addressed. Records have been updated, a programme of activities has been implemented and quality assurance and health and safety systems have been Care Homes for Older People Page 7 of 26 consolidated. There has been a programme of redecoration. The residents spoken to said that they had confidence in the manager to continue these improvements. What they could do better: 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. 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 9 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. There is information available to residents about the home and their care needs are assessed with them, prior to their move to the home to ensure that they can be met. Evidence: The home has information available to prospective residents in the form of a statement of purpose, service user’s guide and coloured brochure. The manager visits them before they move to the home to meet them and to assess their needs. Prospective residents and their families may visit the home prior to moving to the home, although many move following a stay in hospital. Two service users were spoken to and said that they had visited the home before they moved. The home offers respite care, which can be an introduction to the home. The home does not offer intermediate care for those in need of rehabilitation. Care Homes for Older People Page 10 of 26 Care Homes for Older People Page 11 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. Resident’s personal, healthcare and medication needs are met, promoting their dignity and wellbeing. Evidence: The care of three residents was followed through. All had care plans, which had been updated regularly. Resident’s personal and healthcare needs were identified, risk assessments were undertaken and a plan to address these was documented. Residents had had a nutritional assessment, had been weighed regularly and those who had more that one weight recorded had maintained their weight since moving to the home. One resident had a very high risk of nutritional deficiency on moving to the home. This had been recognised and a dietician had assessed her and supplements had been provided. Her weight was increasing. Resident’s risk of developing pressure damage was assessed and documented. Where appropriate residents had the appropriate mattresses to help relieve pressure. There was evidence in the care plans Care Homes for Older People Page 12 of 26 that the general practitioner visits regularly and that staff take action promptly if a resident’s health deteriorates. The general practitioner had had some concerns about the homes communication with the practice. This had improved following a meeting with the manager and agreed protocols being implemented. Residents were well groomed and their clothing was in a good state of repair. Staff were observed to be courteous to them and to respond to their wishes promptly. The residents spoken to said that they did not have to wait long for a response to their call bell. All the residents seen had a call bell within reach. Residents said that their care is given in their rooms and that they always see the doctor in their rooms. One resident said that he was ‘feeling much better since he moved to Hulcott, I am eating better and getting my energy back’. There are medication management policies and procedures in place and the staff spoken to were aware of these. Storage facilities are satisfactory. Records are kept of medication entering and leaving the home. The medication administration records were accurately completed. Controlled drugs were stored satisfactorily and all entries to the controlled drug register were signed. One entry was checked at random and it was found that the stock levels did not match the amounts held. This proved to be a counting error and the stock levels were correct. At the last inspection it was recommended that the home obtain a calculating tool for checking tablets. This has not yet been done and is recommended that the home do this to improve the management of medication in the home and reduce the risk of counting errors. There were no handwritten entries on the medication charts. A contract is held for the disposal of unused medication. The registered nurses spoken to said that medication was not administered covertly. If a resident refused medication this would be recorded. If the medication was essential and the resident lacked the capacity to make the decision, the doctor and family would be informed and a way forward agreed. None of the residents in the home managed their own medication at present although there is a policy to facilitate this if a resident wishes. Care Homes for Older People Page 13 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 home offers flexible care, in line with resident’s abilities and supports their autonomy. There is an activities programme to bring interest and activity to the day for residents. The standard of food is good and mealtimes were seen to be a sociable, relaxed time for residents. Evidence: There are two part time activities coordinators in post, They arrange a programme of activities, which include games, quizzes and coffee mornings, including a gentleman’s coffee morning. There is regular entertainment, tea parties and individual reminiscence. Outings are arranged. A highlight was a visit to the local RAF base open day for two gentlemen who had RAF connections. A social history is undertaken for all residents to support them to remember things that are meaningful for them and to give carers greater understanding of residents likes and dislikes when they cannot articulate them for themselves. Residents said that they had a choice and could choose not to participate in organised activities if they preferred. Care Homes for Older People Page 14 of 26 Families said that they could always see their family member in private if they wished and confirmed that they were made welcome at any time. Information about local advocacy services was displayed in the front entrance of the home. There is a varied menu. There is a choice of breakfast and a choice at supper of a light cooked meal or soup and sandwiches. Late night drinks with biscuits are served. There is a choice of main meal and most food is ‘home cooked’. The chef was aware of residents likes and dislikes and said that he could always offer another alternative if necessary. He said that he could provide meals to meet resident’s cultural and religious needs and endeavoured to provide variety on the menu. The dining room has been recently redecorated and the tables were laid up well with, cutlery and crockery. The care staff were observed to be helping those who could not eat unaided discretely. Residents said that they enjoyed their meals saying ‘the food is very good’, ‘plenty of choice’, ‘they cook what I like’. ‘Residents can choose whether to eat in the dining room or in their rooms. Care Homes for Older People Page 15 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. There are complaints, whistle blowing and safeguarding policies and procedures in place to protect residents from harm and to respond to their concerns. Evidence: There are complaints policies and procedures in place. The manager said that she records both verbal and written complaints. The complaints records were seen. Verbal concerns are recorded and clear action plans are described to address the issues. There have been no complaints since the last inspection. Both families spoken to on the day of the unannounced visit said that they knew who to speak to if they were unhappy. There has been a reduction in complaints since the appointment of the new manager. One family member said that the ‘new manager is very open and helpful’. The home has an up to date copy of the local multi-agency strategy for safeguarding vulnerable adults. Most staff have had safeguarding training and those spoken to said that they would have no hesitation in reporting any concerns about resident’s welfare. There are whistle blowing policies and procedures in place. The home is secure and the manager said that restraint was not used. None was observed. The Commission for Social Care Inspection has been told of one complaint, which was investigated by the manager and the local social services department and an agreed Care Homes for Older People Page 16 of 26 plan of improvements for the resident has been agreed. The Commission for Social Care Inspection has not been notified of any safeguarding allegations made to the local authority, which is the lead agency in these matters. Care Homes for Older People Page 17 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and comfortable. Residents are supported to personalise their own rooms in line with their own tastes and memories. Their clothes are cared for protecting their dignity and self esteem. The infection control policies and procedures should be reviewed to ensure that are in line with the latest guidance from the Department of Health, to protect residents from acquired infection. Evidence: The home is situated in pleasant rural surroundings. The ground floor rooms open on to the garden or small patios. The external paintwork is in need of redecoration and this should be addressed. There is a rolling programme of redecoration in the home and most communal areas have been redecorated. Bedrooms are redecorated when they are vacated. Bedrooms vary in size. Residents are encouraged to personalise them and many had chosen to do so. One resident said ‘this is my space and I enjoy it’. Residents can have keys to their rooms if they wish. The home has four heightdjustable beds for residents,which is not sufficient. The manager said that another three had been ordered and that she had permission to purchase three per month until there were sufficient for all residents who needed one, to have one. The home Care Homes for Older People Page 18 of 26 was clean and tidy on the day of the unannounced visit. There were no offensive odours. There are infection control policies and procedures in place, which have been updated since the Department of Health’s latest guidance, which was issued in June 2006. Staff were observed to be wearing protective clothing and were observed to wash their hands and had had training in infection control. The manager said that residents had their own sliding sheets where they needed them. Residents do however share hoist slings, which is not in line with the Department of Health’s guidance and should be reviewed. The manager said that she was addressing this. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels and recruitment procedures are good and there are sufficient staff to meet resident’s needs. Good progress has been made to establish a regular training programme to ensure that staff have the necessary skills and knowledge to meet residents needs safely and effectively, although this has not yet been rolled out to all staff. Evidence: There is a consistent staff team who know the residents well. The manager said that she almost had a full staff complement at the moment. There are 2 registered nurses supported by a team of carers on duty during the day and one registered nurse and three carers at night. Most residents spoken to were very complimentary about the staff saying’ they can’t do enough for you’, ‘they are very kind’ and ‘they always come when I ring the bell’. One said ‘they are very kind but I cannot always understand all of them’. The manager said she was addressing this and had found a course in the local college for those whose first language was not English, to improve their language skills. The recruitment files of three recently recruited members of staff were reviewed. All Care Homes for Older People Page 20 of 26 had the required documentation to show that checks as to the potential staff member’s identity and suitability to work with vulnerable people had been undertaken. All had submitted an application form, which showed their work history. Criminal Records Bureau checks had been undertaken and references had been sought before the staff member commenced work. Interview records had been kept. Copies of the staff member’s passport and work permit were on file. The manager said that there had been very little training in the home before she started. She has focussed on updating staff skills in manual handling and ensuring that all staff have had safeguarding training. The training matrix showed that good progress has been made. The manager has clear plans to complete fire safety, infection control, health and safety and food hygiene training. There are also plans for training in dementia care. 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. The home is well managed by an experienced manager and there are quality assurance systems in place to ensure that the care residents receive improves and that action is taken when deficits in care are noted. Residents and their family’s views are taken into account in the running of the home. Evidence: There is an experienced manager in post. She is a Registered Nurse and is undertaking the National Vocational Qualifications in Management at level 4. The lines of accountability within the organisation are clear. The residents and staff spoken to say that the new manager is approachable and listened to their views. Care Homes for Older People Page 22 of 26 The home has a quality assurance system in place. Regular resident, family and staff meetings are held. An annual residents survey has been undertaken and an action plan to address any concerns expressed agreed. The organisations quality manager has asked for the results of the survey to be displayed in the front entrance of the home. A member of the organisations management team visits the home regularly and records are kept of these visits as is required. The requirements made following the previous inspection have been addressed. The home does not manage residents’ financial affairs and there is no facility for residents to hold a personal allowance in the home, unless they keep it in the locked drawer in their rooms. Residents are able to make purchases and to go out and relatives would be invoiced afterwards. There are health and safety policies and procedures in place. Regular health and safety meetings are held with key staff. The information sent prior to the visit showed that service and maintenance records are up to date. Plans are in place to ensure that all staff have updated training in safe working practices. Fire safety records are kept and were up to date. The staff spoken to were aware of the fire evacuation procedures. Records are kept of safety checks of hot water temperatures, particularly baths and showers. Accidents are recorded. The maintenance man is very organised and has put in place robust systems to ensure that checks are carried out at the required frequencies. 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 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 10 9 The home should buy a counting tool to count tablets, to reduce the risk of counting errors when checking stock levels. Residents needing nursing care in bed should have a height adjustable bed. The poor state of some of the external paintwork should be addressed. The infection control policies and procedures should be reviewed to ensure that are in line with the latest guidance from the Department of Health, to protect residents from acquired infection. Residents should not share hoist slings. Staff whose first language is not English should be supported to improve their language skills where this is necessary. The planned training programme in safe working practices should be implemented. 11 12 13 24 26 26 14 30 15 30 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 © (2008) 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!