Inspection on 15/10/08 for Hulcott Nursing Home

This inspection was carried out on 15th October 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hulcott Nursing Home 05/05/09

Hulcott Nursing Home 12/01/09

Hulcott Nursing Home 23/09/08

Hulcott Nursing Home 13/06/08

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 31/03/2009.

Inspecting for better lives Random 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: The rating was made on: two star good service 19/06/2008 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. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Chris Sidwell Date: 1 5 1 0 2 0 0 8 Information about the care home Name of care home: Address: Hulcott Nursing Home The Old Rectory Hulcott Aylesbury Buckinghamshire HP22 5AX 01296488229 01296330834 hulcott@caringhomes.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Hulcott Limited The registered provider is responsible for running the service care home 49 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category 0 Over 65 49 Conditions of registration: 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. Care Homes for Older People Page 2 of 11 1 9 0 6 2 0 0 8 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. 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 3 of 11 What we found: A Random Focused Inspection was undertaken on the 25th September 2008 following a safeguarding review, which raised concerns about the care of residents. At that inspection it was found that there were shortfalls in the quality of care being offered to residents and ten requirements for improvement were made. These included ensuring that residents did not develop serious pressure ulcers, ensuring that residents nutritional status was not compromised and improvements to the management arrangements at the home. At that time the provider organisation was aware of the serious issues in the home and had started to address them. Eight of the ten requirements must be complied with by 31 October 2008 and two, which involved training of staff and purchase of equipment, by 30 November 2008. These requirements are not shown as outstanding in this report as the deadline for meeting them in full has not yet been reached. The purpose of this unannounced inspection was to ensure that the organisation had taken effective steps to ensure that residents care needs were met, that no other residents had developed pressure damage and to ensure that the management arrangements in the home were satisfactory. Christine Sidwell, Regulation Inspector, and Sandra Lemon, Regulation Manager undertook the inspection. The inspection included a review of the information held about the home, an unannounced visit to the home of seven hours and discussions with the Operations Manager of Caring Homes Limited (the provider organisation) and staff. Care practice was observed and the care of those residents who had developed pressure damage and others who had specific problems was followed through. The provider organisation has recognised the serious of the issues and has taken a number of steps to improve the care of residents. A temporary manager is covering the home in the absence of the manager who has planned holiday. The Operations Manager has been in the home on an almost daily basis, including weekends. The home has worked with care managers from the local authority, who are reviewing residents, and healthcare professionals from the local Primary Care Trust who have been assessing residents to ensure their healthcare needs are being met. There has been investment in equipment. Eight new pressure-relieving mattresses have been purchased. Digital scales to improve the accuracy with which residents nutritional status and weight can be monitored have also been purchased. Two new hoists have also been ordered. Two additional care staff have been employed on each shift between 8am and 8pm. Since the last inspection staff have had training in safeguarding vulnerable adults, preventing pressure damage and record keeping, from the provider organisations own training company. The Operations Manager also said that she had interviewed and was hoping to appoint a deputy manager for the home shortly. At this inspection it was found that six residents had pressure damage and two had leg ulcers. All had been reviewed by the Tissue Viability Nurse (TVN) Specialist from the local Primary Care Trust (PCT). Another resident had an infection following surgery and was also being seen by the TVN. Their care plans had been reviewed and their care specified. Records of dressing changes were being kept. The care plans were not clear Care Homes for Older People Page 4 of 11 in all cases, one resident had two care plans in the folder, the old plan and the new one, which could have caused confusion. There were records of dressing changes, although the frequency with which dressing changes should be made was not always specified in the care plan. Some photographs had been taken to measure improvement or deterioration in the pressure damage although this did not appear consistent as yet. Some residents had more than one area of pressure damage and the care plans were not specific about each area. All residents who had pressure damage were seen. They all had appropriate mattresses and repositioning and food and fluid intake charts had been maintained. One residents repositioning chart showed that she should have been on her right side although she was clearly lying on her back. She was asleep at the time and the nurse said that she would have been able to change her position and that she felt the resident had rolled on to her back. The Operations Manager said that no other residents had developed pressure damage and the registered nurses confirmed this. The chef had been told who was at risk of losing weight and had a list in the kitchen. He had begun to implement the dietitians recommendations and increase the calorific content of meals with the use of full fat milks and yoghurts. The meal times were observed to be busy and needed better organisation. The operational manager said she would be looking at the organisation of the home and would include mealtimes in that review. The care plans seen showed that residents had been assessed as to their risk of nutritional deficiency and this had been reviewed monthly. One resident was however identified as needing to be referred to the dietitian at the monthly review but the referral had not been made. The operational manager said she would address this. The reports of quality monitoring visits undertaken by the provider on the 28/08/08 and the 03/09/08 and audits undertaken since February 2008 were available. They had not however identified the problems that became apparent when the initial safeguarding alert was made in early September. The Operations Manager said that the provider was reviewing the systems in place to monitor the quality of care in the home. Overall it was felt that the provider had recognised the deficits in care experienced by some residents and had taken initial steps to address them. They had also begun to address the requirements of the previous report, although these had not yet been addressed in full. The provider has also agreed not to admit residents to the home until it was able to show that it was providing a safe service and was able to ensure the health safety and welfare of those resident currently living in the home. The Commission for Social Care Inspection will continue to monitor the home. What the care home does well: What they could do better: No new requirements were made at this inspection. The requirements made following the previous inspection, which was undertaken on the 29th September 2008, are not shown as outstanding in this report as the deadlines for meeting them have not yet been reached. They must however be met in full, by the deadlines stated. If the organisation cannot meet them for any reason they must inform The Commission for Social Care Inspection promptly. Care Homes for Older People Page 5 of 11 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 2. Care Homes for Older People Page 6 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 7 15 All residents who have 31/10/2008 pressure damage must have an accurate care plan which sets out in detail the care that they need and when it should be given. The care given must be evaluated regularly for it effectiveness. To ensure that staff are clear as to the action needed to prevent deterioration of the residents condition and to promote healing of the damage. 2 7 15 The organisation must 31/10/2008 ensure that all residents are correctly assessed as to their risk of developing pressure damage or losing weight. In order to maintain their health and well being 3 8 12 The organisation must 31/10/2008 ensure that residents do not develop pressure damage. The advice of the Tissue Viability Nurse specialist should be sought at an early stage if a residents pressure damage is not responding to treatment. To prevent harm to residents and to ensure they have the most effective care. Care Homes for Older People Page 7 of 11 4 8 12 Residents weight must be monitored carefuly and appropriate action taken to prevent weight loss. To maintain residents health and wellbeing 30/11/2008 5 22 23 The organisation must 31/10/2008 provide sufficient pressure relieving mattresses which are in good working order to allow all those at risk to have the appropriate mattress. To prevent residents developing pressure damage and to prevent it deteriorating should it develop. 6 30 18 All staff must have training to help them recognise the early signs of pressure damage and to take the appriate action. In order that they can support residents effectively 30/11/2008 7 31 18 The organisation must 31/10/2008 ensure that there are suitable arrangements in place for the management of the home in the absence of the manager. To ensure that the welfare of residents is not compromised by the absence of effective management. 8 33 24 The organisation must ensure that its quality assurance systems identify sudden deterioration in the care that service users are receiving and take prompt action to address it. To ensure that the standard 31/10/2008 Care Homes for Older People Page 8 of 11 of care is consistent and that residents do not come to any harm. 9 33 26 The organisation must 31/10/2008 ensure that regular quality monitoring visits are undertaken and that a report of those visit is kept in the home. To ensure that care is consistent and of a good quality 10 33 37 The organisation must ensure that appropriate notifications are made of serious or adverse events in the home which affect the wellbeing of residents. To ensure that appropriate action is taken to protect residents. 31/10/2008 Care Homes for Older People Page 9 of 11 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 Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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. 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