Inspection on 07/06/07 for Hulton Care Home

This inspection was carried out on 7th June 2007.

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

Other inspections for this house

Hulton Care Home 16/08/06

Hulton Care Home 12/01/06

Hulton Care Home 04/08/05

Hulton Care Home 01/02/05

Hulton Care Home 16/08/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hulton Care Home Hulton Drive Off Halifax Road Nelson Lancashire BB9 0EY Lead Inspector Mrs Pat White Key Unannounced Inspection 10:00 7 and 12th June 2007 th 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 Hulton Care Home DS0000022503.V336992.R02.S.doc Version 5.2 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. Hulton Care Home DS0000022503.V336992.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hulton Care Home Address Hulton Drive Off Halifax Road Nelson Lancashire BB9 0EY 01282 617773 01282 614445 hultonnelson@schealthcare.co.uk 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) Southern Cross Care Homes Limited Donna Marie Laird Care Home 30 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (5), Old age, not falling within any other of places category (22), Physical disability (1) Hulton Care Home DS0000022503.V336992.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 30 service users to include:*Up to 2 service users in the category of DE (Dementia) *Up to 5 service users in the category of DE (E) (Dementia over 65 years of age) *Up to 22 service users in the category of OP (Old age not falling within any other category). *Up to 1 service user in the category of PD (Physical disability) 16th August 2006 Date of last inspection Brief Description of the Service: Hulton Care Centre is a purpose built care home situated in a residential area on the outskirts of Nelson. It is owned by a national organisation called Southern Cross. There are extensive grounds to the front and sides of the home which are pleasant, well kept and accessible, and include lawned areas and car parking space. The home is able to accommodate up to thirty people, both men and women. Twenty-two places are available for older persons who require personal care and there is a seven-bed unit, for service users who have dementia. All the bedrooms in the home are single rooms, and include ensuite toilet and hand basin. There are a number of lounges, including a smoking lounge, and dining areas. Fees charged per week are between £324.50 and £485, with additional charges for hairdressing, chiropody and some activities. The home has a Statement of Purpose and Service User Guide providing information about the care provided, the qualifications and experience of the owner and staff and the services residents can expect if they choose to live at the home. A copy of the Service User Guide and most recent inspection report is issued to all prospective residents and their relatives/representatives to help them make an informed choice about whether to move into the home. Hulton Care Home DS0000022503.V336992.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit, carried out on the 7th and 12th June 2007, was part of an inspection to determine an overall assessment on the quality of the services provided by the home. This included checking important areas of life in the home that should be checked against the National Minimum Standards for Older People, and checking the progress made on the matters that needed improving from the previous inspection. The inspection included: talking to residents, touring the premises, observation of life in the home, looking at residents’ care records and other documents, discussion with members of staff and discussion with the manager, Mrs Donna Laird. In addition an Annual Quality Assurance Assessment (AQAA) was completed for the Commission and information from this is included in the report. Survey questionnaires from the Commission were sent to the home for residents and relatives to complete. Seven residents and 3 relatives returned these questionnaires. Seven residents and 3 relatives were spoken with in some detail, including a resident and her relative in the dementia unit, and there views are included in the report. Others were spoken to but were unable to give their views about the home. What the service does well: The admission procedures in the home made sure that people’s care needs were assessed and written down so that a decision could be made about whether or not Hulton Care was a suitable place for them. Residents and relatives who were spoken with and who completed questionnaires were complimentary about the care in the home. One resident said the home was “excellent”, one relative said that the “staff work very hard to make sure the needs of the residents are attended to”. Another relative said, “the home couldn’t be better” The written plans for residents’ care were detailed and well written, and contained useful information regarding the residents’ health, personal and social care needs. These plans for care were regularly reviewed and updated. The residents’ health was monitored carefully and appropriate action taken. Routines were flexible enough to suit individual preferences and residents were satisfied with the level of choice they had. The home employed an activities organiser, and there was a wide programme of interesting and enjoyable activities, including trips out. Residents said that there was “plenty going on”. Hulton Care Home DS0000022503.V336992.R02.S.doc Version 5.2 Page 6 Residents complimented the meals, and the menus showed that the food served was nutritious and appetising. One resident said, “the food is marvellous”. Hulton Care Home provided modern, pleasant, bright and well - maintained accommodation throughout, which was decorated and furnished to a high standard. Residents said they appreciated their bedrooms and the outside areas. A high proportion of the staff in the home had gained the qualifications recommended for people working in care homes and the further training that staff undertook was relevant and useful and helped them understand the needs of the residents. The home provided a safe place for residents to live in and for staff to work in. What has improved since the last inspection? What they could do better: The written information about the home could be further improved so that people know that Hulton Care has a separate unit for people with dementia and what specialist care and facilities there are for these residents. The way identified risks to residents are managed in the home should be improved. The written information about risks and how these are managed safely such as nutrition, the use of bedrails, challenging behaviour should be Hulton Care Home DS0000022503.V336992.R02.S.doc Version 5.2 Page 7 correct and up to date, specific to individual residents, and should include individual plans to minimise or eliminate the risk. Medication management in the home must be further improved for the well being of the residents so that residents do not run out of medication. The leisure activities programme could be developed to include specific individual plans for people with dementia. The hot water supply should be consistently within the recommended temperature range for the comfort and safety of the residents. The quality monitoring exercises should include a formal consultation process with the residents as well as the relatives so that residents’ views can be clearly identified and used to develop services. 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. The summary of this inspection report can be made available in other formats on request. Hulton Care Home DS0000022503.V336992.R02.S.doc Version 5.2 Page 8 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 Hulton Care Home DS0000022503.V336992.R02.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 & 5. Standard 6 was not applicable. Quality in this outcome area is good. This judgement has been made using available evidence, including a site visit to this service. There was information about the home to help people make a choice about whether or not to live in the home but did not inform people of the specialist services provided for people with dementia. The home’s admission procedures, including pre admission assessments, helped to determine whether or not the home could meet people’s needs and residents and relatives were confident that their needs were being met in the home. EVIDENCE: The Statement of Purpose and the Service User Guide provided information about the home to residents, prospective residents and visitors. These had been updated since the previous inspection and were seen in residents’ rooms. However the Statement of Purpose still did not explain that the home had a specific dementia unit for those people needing specialist care. This is outstanding from previous inspections and should be rectified in order to give those people involved a clearer picture of the home. The Service User Guide Hulton Care Home DS0000022503.V336992.R02.S.doc Version 5.2 Page 10 did not explain the specialist facilities and care for people living in the dementia unit. All 7 residents who completed the questionnaires said they had enough information to help them make a decision about whether or not to live in the home and 2 out of 3 relatives also said they had enough information, 1 said they “usually” had enough information. There was evidence from the records viewed, and talking to relatives, that the manager carried out a suitable assessment of needs with prospective residents before admission, to help determine whether or not the home could meet their needs. After this assessment the home also confirmed the outcome of the assessment in writing. Residents and relatives had the opportunity of visiting the home prior to a decision being made and some residents said that their relatives chosen Hulton Care. However the records of one resident in the dementia unit, who had been transferred from the older person’s part of the home, did not clearly demonstrate that a suitable mental health assessment had been undertaken prior to the transfer which determined that she needed specialist care in the unit. Discussion with residents and relatives, and the survey questionnaires, indicated that those involved felt the home in general met the diverse needs of the different residents, including those with dementia and the needs of an Asian resident. Hulton Care Home DS0000022503.V336992.R02.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a site visit to this service. The care plans were detailed and well written and contained useful information about most aspects of residents’ health, personal and social care needs, to assist the care staff in providing care to residents. However some written information about risks to residents and staff and the management of risk, was incomplete. The residents’ medical care needs were promoted, but medication management could be improved to safeguard residents’ health. Residents’ privacy and dignity were respected. EVIDENCE: All the residents had detailed care plans that were developed from the assessment. The records looked at had risk assessments for most aspects of care, including for pressure areas, continence, nutrition, moving and handling, medication, falls and bed rails/ wedges. Care plans were developed from these assessments and risk assessments, and these were detailed in most areas. There was evidence that the care plans were reviewed frequently and that residents and relatives were involved in the care plans. Hulton Care Home DS0000022503.V336992.R02.S.doc Version 5.2 Page 12 However on the care plans viewed there were the following observations. The care plan of one person in the dementia unit did not include details of the specialist care needed and provided, for example stimulating activities and behaviour management. Another care plan looked at did not state how personal care should be provided and what the resident could do for himself. The written risk assessments for bed restraints that were viewed did not demonstrate why rails or wedges were being used and in terms of which was the safest method for individuals. One nutrition assessment was incorrect, and one resident whose records referred to “challenging behaviour” did not have a risk assessment or management strategies to help protect staff and other residents from this behaviour. There was evidence that the residents’ health was monitored and maintained and residents had access to all the health care services. Most health matters were recorded in detail on the care plans, including pressure areas and continence issues. The intervention required to prevent pressure areas was also detailed and told staff what to do. Medical appointments and district nurses’ visits were recorded and showed that residents had access to the appropriate medical services including the mental health services for older people. There were detailed policies and procedures for handling and recording medication, and the procedures and practices carried out by staff had improved since the previous inspection and a specific pharmacy inspection. More rigorous auditing by senior members of staff had ensured practices had improved and this helped to ensure that medication was being administered more safely. Examination of Medication Administration Record charts (MARs), together with an audit of medication present for 3 residents, showed that accurate records were now being kept of all medication being received into the home and administered to residents. Accurate records were also being kept of medication being returned to the pharmacist. However one of the residents on admission had wanted to continue to apply his cream. Staff had assessed that this was not safe, but there was no risk assessment to support this decision. For another resident the instructions “PRN” (when required) had been handwritten on the MAR for two creams. There was no supporting explanation for this change of administration from the original instructions, and the handwritten entry was not signed, witnessed or dated. In addition for this resident and some other residents there was no written information about the indicators of when “when required” (PRN) medication should be administered, such as painkillers and medication for angina. In addition one resident whose medication was checked had run out of a supply of one medication 3 days prior to the site visit. The inspector was informed that this had been ordered but the prescription had not been received. Ordering procedures had not been followed in this instance and this potentially put the health of this service user at risk. Hulton Care Home DS0000022503.V336992.R02.S.doc Version 5.2 Page 13 The importance of respecting residents’ privacy and dignity was part of the staff Induction training. Bedroom doors had appropriate locks and some residents had keys. There was a lockable facility in the bedrooms and all bedrooms were single and en - suite. Residents spoken with stated that staff respected their rights to privacy and dignity and provided personal care in an appropriate way and that they could also spend time alone in their rooms if wished. Hulton Care Home DS0000022503.V336992.R02.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a site visit to this service. Routines were flexible enough to suit individual preferences and they had reasonable choices in their every day lives, including enjoyable and interesting activities. Residents were encouraged to maintain links with family and the outside community. The food served was appetising, wholesome and suited residents’ preferences. EVIDENCE: Residents spoken with at the site visit confirmed that some routines were flexible to suit individual preferences such as rising and retiring times and being able to spend time in the privacy of their own room. Some of these preferences and hobbies and interests were recorded on the care plans. The home employed an activities organiser who ensured a variety of activities and events. A pool table had been purchased since the previous inspection. The residents in the dementia unit also had the opportunity of taking part in activities, though there was no evidence of activities specifically suited to people with dementia. Residents enjoyed being outside in the attractive grounds in good weather. Hulton Care Home DS0000022503.V336992.R02.S.doc Version 5.2 Page 15 There was evidence that residents’ religious preferences were respected and ministers from different denominations and faiths attended the home. Of the seven residents who completed questionnaires most said there were suitable activities and one relative confirmed that staff took his father swimming each week. Visitors were welcome in the home at any reasonable time. The three relatives spoken with at the time of the inspection confirmed this. The visiting policy was outlined in the Service User Guide. There was sufficient space in the home for people to visit residents in private. Residents kept in touch with the local community through visits by clergymen, events for the local community held in the home and trips out. The relatives spoken with and those who completed questionnaires felt that staff communicated well and were usually available when needed. They felt staff were approachable and were made welcome in the home at any reasonable time. Residents were encouraged to be as independent as possible and exercise choices, such as being able to smoke in the smoking lounge. Residents could bring items of furniture with them and bedrooms were personalised. Residents meetings were held which enabled residents to air views on, for example what food should be served and what leisure activities they preferred. Residents who completed the questionnaires said that the staff listened to them and acted upon what they had to say. Relatives also felt that residents were allowed to live the life they chose. The food served on the day of the inspection was appetising, wholesome and nutritious and offered the residents a choice of food at tea - time. The dietary preferences and cultural requirements of residents were accommodated, such as the provision of Halal meat. Residents ate in the dining room but could have their meals in their bedrooms if they wished. There was no choice of meals at lunch – time, though the cook knew what people liked and disliked and would make alternatives. Residents were assisted as required. There was written information in the kitchen about the requirements of those residents with diabetes. The residents spoken with at the site and those who completed the questionnaires praised the food served. Hulton Care Home DS0000022503.V336992.R02.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was a clear complaints procedure accessible to residents and relatives in the information pack given to people on admission. Residents and relatives knew how to make a complaint and were confident that their concerns would be taken seriously. The home had appropriate policies and procedures to protect the residents from abuse. EVIDENCE: According to the AQAA and discussions with the manager there had been no recorded complaints since the previous inspection. However the everyday grumbles and concerns appeared to be taken seriously and acted upon. The home had a complaints procedure that was given to residents and relatives as part of the admission pack. Residents spoken with stated that they had no complaints and those who completed the survey questionnaires stated that they knew who to speak to if they were not happy with anything and knew how to make a complaint. Relatives who were also involved in the inspection indicated that they knew how to make a complaint and were satisfied that their concerns were listened to and acted upon. There were policies and procedures to protect the residents from different kinds of abuse. These included a “whistle blowing” procedure and step –by step procedures for staff to follow in the event of a suspicion or allegation of abuse. Since the previous inspection there had been no recent allegations or suspicions of abuse invoving a resident. Hulton Care Home DS0000022503.V336992.R02.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a site visit to this service. The home provided a clean, pleasant and comfortable environment, including communal and bedroom space, for the residents. However the hot water maintenance could be improved for residents’ safety and comfort. EVIDENCE: Hulton Care is a purpose built care home and there was a separate self contained unit for seven residents with a diagnosis of dementia and in need of specialist care. The premises at the time of the inspection were well maintained and pleasantly decorated and furnished throughout. The home had a programme of redecorating and refurbishment and a maintenance person was employed in the home. Since the previous inspection some bedrooms had been redecorated and there were improvements to the dementia unit that made it Hulton Care Home DS0000022503.V336992.R02.S.doc Version 5.2 Page 18 more homely. The communal areas comprised of a dining room, a non smoking lounge, a smoking lounge and a conservatory, and offered the residents space and choice. There were attractive additions to some of the communal areas such as candles, ornaments and flowers. The grounds were also well maintained and attractive with seating areas. A fire safety inspection last year had confirmed that the home met the Fire Regulations. All bedrooms were single and en suite with WC and hand basin. The bedrooms were pleasantly decorated and furnished. Residents had small items of their own furniture and the bedrooms met individual’s needs. Despite regular water temperature checks being carried out, the hot water of the bath on the first floor was too hot and potentially put residents at risk. This was corrected before the end of the site visit. However the records of temperature checks showed that in general throughout the home the water at many hot water outlets frequently ran lower than the recommended range and could be too cool for the residents’ comfort. The home was adequately clean and fresh in all areas that were seen, and the laundry procedures had improved since the last inspection so that dirty laundry from other parts of the building was no longer being carried through the dementia unit. The majority of staff carried out infection control training in June 2006. Hulton Care Home DS0000022503.V336992.R02.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a site visit to this service. The home had sufficient numbers of staff on duty with sufficient training and qualifications to meet the needs of the residents. The home’s staff recruitment policies and procedures were thorough enough to protect the residents from unsuitable staff. The home had a good staff training programme that was being developed to meet the needs of the residents and the staff group. EVIDENCE: On the day of the site visit to the home the number of staff on duty and the skills of the staff team appeared sufficient for meeting the needs of the residents. However the staffing rotas and the manager confirmed that there was only one member of staff in the dementia unit at the times of the day when residents are getting up and going to bed. Staff said that at the present time, only on rare occasions was a member of staff called from the main part of the home to assist in the dementia unit. However this still meant there was a possibility of residents in both parts of the home having to wait for assistance, particularly at weekends, when the manager was not on duty. Whilst there was no evidence that this was a problem at the time of the site visit, the manager was advised that this must be kept under review, as changes in the staff group and dependency levels of residents will affect this. One visitor commented that sometimes there didn’t appear to be enough staff Hulton Care Home DS0000022503.V336992.R02.S.doc Version 5.2 Page 20 around at meal times particularly at the weekends and that some residents had to wait for assistance. A cook and a cleaner were employed in the home for sufficient hours to enable good standards of food and hygiene to be maintained. Information supplied for this inspection stated that 12 out of 19 of the permanent care staff, that is 63 , and 80 of agency staff, were qualified to at last NVQ level 2. Staff records showed that staff recruitment procedures were in accordance with the Care Homes Regulations and staff did not commence work unsupervised until all police checks and written references had been obtained. There was also evidence that both members of staff whose records were viewed had completed comprehensive Induction training. However the procedures could be further improved according to good practice. For one member of staff whose records were viewed, one written reference was from a friend and neighbour, and this was not an authentic character reference. For the other member of staff whose records were viewed two previous employers of care organisations had not been used as referees. Staff had undertaken a variety of short training courses in addition to NVQ courses, and according to their own needs and those of the residents, such as fire safety, moving and handling, first aid, palliative care, understanding diabetes and stoma care. Staff working in the dementia unit had undertaken a short course on caring for people with dementia to help them understand these residents’ needs. The home’s induction training programme had been developed in accordance with Government guidance. Hulton Care Home DS0000022503.V336992.R02.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 & 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a site visit to this service. The manager was qualified and competent to run the home. There were quality monitoring procedures, but the residents were not consulted formally about their views on the home. Corporate health and safety policies and procedures ensured a safe environment for residents and staff. EVIDENCE: The manager had been in post for about two years and was registered with the Commission. She had the Registered Managers Award and at the time of the inspection she was studying for a further qualification recommended for the managers of care homes. An Operations Manager of Southern Cross visited the home regularly, and included monthly unannounced visits as required under Regulation 26 of the Care Homes Regulations. Hulton Care Home DS0000022503.V336992.R02.S.doc Version 5.2 Page 22 Hulton Care carried out quality monitoring measures according to Southern Cross company policy that included an annual relative survey using questionnaires. Residents meetings were held regularly and informal conversations with residents were also used to influence the way the home was run. However the manager stated that there were no formal residents’ consultation exercises. Internal audits were carried out e.g. medication, health and safety and environment. The management of residents’ finances was not assessed fully but the records viewed of residents’ fees were up to date and well kept. Residents’ personal allowances were pooled, and though this is not regarded as good practice, there was no evidence that residents were disadvantaged because of this. Individual’s withdrawals and deposits were recorded giving a running total of each resident’s amount. Receipts of goods purchased by individuals were also kept. The health and safety of the residents and staff was promoted. According to the AQAA, and records kept in the home, all appliances and equipment, including fire equipment had been tested appropriately and had current certificates. Radiators were covered and residents were therefore protected from the hazards of hot surfaces. However records showed that the temperature of the hot water in residents’ bedrooms was consistently below the range recommended and could be too low to suit some people’s preferences. Also hazardous substances were not stored securely at the time of the site visit – the store cupboard door was open. There was a rolling programme of moving and handling training to ensure that all staff had up to date skills and assisted residents safely. Staff also undertook training in first aid and infection control. Accidents and falls were recorded appropriately and the records showed that there was a marked variation in the numbers of falls from month to month. One resident was particularly susceptible to falls and this was discussed with the manager who confirmed that measures were being taken to reduce these. Hulton Care Home DS0000022503.V336992.R02.S.doc Version 5.2 Page 23 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 2 X 2 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 3 3 2 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 2 Hulton Care Home DS0000022503.V336992.R02.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation 4&5 Requirement Timescale for action 31/08/07 2. OP7 13(4)(b) (c) 3. OP9 13(2) The Statement of Purpose must explain that the home has a separate specific unit for people who need specialised care. This document must also explain the specialised care provided. (Previous timescales of 31/03/06 and 31/10/06 not met) 30/06/07 Written risk assessments must be accurate and up to date and for the use of bed restraints must be fully completed to demonstrate that the safest measure is being used. Risk assessments must also be completed for people with challenging behaviour and these should included the management of this behaviour that reduces and minimises the risk. The registered person must 26/06/07 ensure that there are adequate supplies of medication available for each resident at all times. Ordering procedures must be followed (Previous timescale of 15/09/06 not met) Hulton Care Home DS0000022503.V336992.R02.S.doc Version 5.2 Page 25 4. OP9 13 (2) Verbal changes to medication 30/06/07 administration, including medication changed to PRN should be accurately entered onto Medication Administration Record charts with staff signature, witness signature, date and authority where appropriate. Verbal changes should be confirmed in writing by the prescriber. (Previous timescale of 15/09/06 not met) The registered person must ensure that hazardous substances are stored safely at all times so that residents are not at risk. 26/06/07 5. OP38 13 (4)(a) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP3 Good Practice Recommendations The Service User Guide should contain details of the specialist facilities and care provided in the dementia unit. The manager should ensure that the mental health assessments undertaken before residents transfer to the dementia unit are clearly documented and clearly demonstrate the specific needs for specialist care. The care plans could contain more details about how personal care should be provided and more details of the specialist care required by people in the dementia unit. Criteria for the administration of when required and variable dose medication should be clearly defined and recorded for all service users prescribed such items. Decisions made by staff that it is not safe for residents to administer some or all of their medication, when they wish to continue to do so, should be supported by a risk assessment. DS0000022503.V336992.R02.S.doc Version 5.2 Page 26 3. 4. OP7 OP9 5. OP9 Hulton Care Home 6. 7. OP25 OP29 8. 9. OP33 OP35 The hot water outlets should be regulated so that hot water runs within the recommended range to ensure the comfort and safety of the residents. It is recommended that references for staff being recruited always include one from a previous position in this is an option and also if character references are used that these are authentic and not friends and neighbours It is recommended that the quality monitoring procedures include a formal consultation exercise with the residents. It is recommended that the practice of pooling residents’ money ceases. Hulton Care Home DS0000022503.V336992.R02.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: 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 © 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 Hulton Care Home DS0000022503.V336992.R02.S.doc Version 5.2 Page 28 - 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. 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