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: 2 5 0 9 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 Name of registered manager (if applicable) vacant post Type of registration: Number of places registered: care home 49 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. Care Homes for Older People
Page 2 of 11 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. 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:
This focused unannounced inspection was undertaken because The Commission for Social Care Inspection had been made aware of a safeguarding referral, made to the Local Authority, which raised concerns about whether the healthcare needs of residents were being met. The home had a key inspection on the 19th June 2008. The quality rating at that time was that this was a 2 star service, which meant that people who use the service experienced good quality outcomes. The information held about the service was reviewed and an unannounced visit was made to the home. A second planned visit was made to the home, two days later. The care records of all residents were examined. Care was observed and discussions were held with the manager and a number of other staff. Residents were observed in the lounges and in their rooms. The records showed that all residents had care plans and all had been assessed for their risk of developing pressure damage and of losing weight, using a recognised assessment tool. There were inconsistencies in the way in which these were completed and it was clear that not all staff understood how these tools should be applied. Of the 21 people identified as at low risk of developing pressure damage, 3 already had some pressure damage. The nutritional assessment tools were incomplete. Although most residents had been reassessed in August, the tools had gaps in the data collected and did not therefore reflect the real risk to the resident of nutritional deficiency and weight loss. Eight residents had pressure damage. The level of damage ranged from 1 resident who had grade 1 pressure damage, 2 who had grade 2 damage, 4 who had grade 3 damage and 1 resident who had grade 4 damage, the most severe. The care plans were inconsistent. In some cases there was a clear care plan and in others the plans were unclear, had not been evaluated regularly and were unclear as to the number of pressure sores. It was not possible in all cases to see when the pressure damage had arisen and what action had been taken. The Tissue Viability Nurse Specialist from the local Primary Care Trust had seen the residents and advised on dressing and the frequency of dressing change. The record of the dressing changes showed that the recommended frequency of dressing change was not adhered to in all cases. Photographs of the pressure damage to measure progress or deterioration were incomplete. One ulcer had not been photographed and the notes state the camera memory was full. In some cases the advice of the Tissue Viability Nurse specialist was not sought until the pressure damage had reached a more severe state. The home has a number of different types of pressure relieving mattresses. All residents who had developed pressure damage were on a pressure relieving mattress although the records of when these had been put in place were unclear. A report by an operational manager in September 2008 had found that a number of mattresses were not functioning or were turned off. On the day of the unannounced visit, two were not set at the correct pressure and there was some confusion as to whether another two were upside down in the bed. This was dealt with immediately. One resident who had developed the most severe pressure damage had moved to the home on 6th August 2008. Her admission notes show that she had no pressure damage on admission. The records show that she had developed redness of the skin on the sacrum on 19th Care Homes for Older People Page 4 of 11 August, which gradually deteriorated to a grade 4 pressure sore on the 4th September when she was seen by the Tissue Viability Nurse. She was also found to have a second sore on her hip for which the records were incomplete. A number of residents had lost weight. The weight of some however fluctuated, with one gentleman gaining 4 kilograms one month and losing 6 kilograms the next. The manager felt that the scales may be inaccurate or residents were being weighed on different surfaces. The scales had been serviced in April 2008. Other residents had lost weight although the risk assessments had not recognised this. Most residents who were losing weight had seen the dietician and had nutritional supplements prescribed, which were being given. The dietician had also given general guidance on increasing the calorific value of meals. The second chef was spoken to and was not aware of this guidance or who was losing weight. She has a board in the kitchen which shows residents who require a special diet for medical reasons and who need food to be pureed. The board did not show those who were losing weight. The home has a permanent manager who has not yet registered with The Commission for Social Care Inspection. She was away from the home between 5th August 2008 and22nd September 2008 for unavoidable reasons. A temporary manager was not put in place. A senior registered nurse was in overall charge of the home. The job description for a senior registered nurse does not state that they should deputise for the manager in her absence. The signing in book at the door of the home shows that the operational manager for the home visited the home on the 18th and 29th August and the 3rd and 9th September 2008 prior to going on annual leave. There was no record of the findings following her visits in the home and no record of the August quality monitoring report that should be undertaken and kept at the home as required by Regulation 26 of the Care Homes Regulations. The Commission for Social Care Inspection had not been notified of the development of pressure sores as required by Regulation 37 of the Care Homes Regulations. Another operational manager was asked to visit the home following concerns about the care of a resident who was the subject of a safeguarding meeting on the 9th September. She visited the home on the home on the 15th, 16th, 17th, 19th and 20th September. She wrote a full report of her findings which included the extent of the pressure damage suffered by eight residents and initiated a number of steps to protect all residents. She asked for a full clinical audit to be carried out by the organisations central audit team and a mattress audit to be undertaken to be clear about which residents had a mattress and the type of mattress in use. The clinical quality audit was being undertaken on the first day of the unannounced inspection and the mattress audit was being undertaken. She also requested that staff have additional training and ordered training from the regional trainer to facilitate this. This was undertaken on the 25th and 26th September. She also asked that all residents were checked and the results recorded on an individual body map in their records. This was in progress. She asked that the appropriate notifications were made to the Commission for Social Care Inspection. An overall action plan has been developed, which the manager has been proactive in implementing since her return to work on the 22nd September. What the care home does well:
Care Homes for Older People
Page 5 of 11 This was not assessed at this inspection. 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 2. Care Homes for Older People Page 6 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 7 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 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 Care Homes for Older People Page 8 of 11 treatment. To prevent harm to residents and to ensure they have the most effective care. 4 8 12 Residents weight must be monitored carefuly and appropriate action taken to prevent weight loss. To maintain residents health and wellbeing 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 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 26 The organisation must 31/10/2008 ensure that regular quality monitoring visits are undertaken and that a report
Page 9 of 11 30/11/2008 30/11/2008 Care Homes for Older People of those visit is kept in the home. To ensure that care is consistent and of a good quality 9 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 of care is consistent and that residents do not come to any harm. 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. 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 31/10/2008 31/10/2008 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. Care Homes for Older People Page 11 of 11 - 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!
