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Inspection on 04/05/05 for Hungerford Care Centre

Also see our care home review for Hungerford Care Centre for more information

This inspection was carried out on 4th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is warm and friendly and is generally maintained, decorated and furnished to a high standard. Staff work well as a team and have clear lines of communication with each other and with health and social care professionals to ensure the needs of the residents are met. Care plans are detailed and reviewed regularly and relatives are involved and informed of changing plans of care for example as stated by a visitor, "we haven`t actually seen the care plans, but seen the benefits of it, well I`ve seen the way they look after her, and they discuss things with us" and "you can talk to people very freely", and as quoted by another visitor "we had an assessment about a month ago and if anything is wrong I would see senior staff or a carer".

What has improved since the last inspection?

The home has redecorated and refurbished areas within the home and met the requirements made at the last inspection with exception to some redecoration required in The Martins.

What the care home could do better:

The home could improve continence management and ensure residents` dignity is protected, and should use their questionnaires to obtain the views of residents and others. The home could make use of the communal space in The Martins to create a homely environment. Equipment must be available to control the spread of infection, fire records should be available, and documentation that refers to cleaning products and fluid-monitoring charts could be improved.

CARE HOMES FOR OLDER PEOPLE HUNGERFORD Wantage Road Hungerford Berks RG17 OPY Lead Inspector Yvonne Souden Unannouced 4 May 2005 10:00 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 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. HUNGERFORD H52-HO1 S10995 Hungerford Care Centre V217435 040505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hungerford Care Centre Address Wantage Road Hungerford Berks RG17 OPY 01488682002 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Exceler Healthcare Services Limited, Ashbourne Healthcare Sandra Kay Owens Care Home 59 Category(ies) of Old age, not falling within any other category registration, with number of places HUNGERFORD H52-HO1 S10995 Hungerford Care Centre V217435 040505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. One designated person under 60 years of age is accommodated by prior agreement. 2. In the area of the home known as The Martins the number of persons for whom accomodation is provided at any one time shall not exceed 21 with dementia (DE). 3. That a satisfactory CRB check is received for the Manager, Mrs Sandra Owens. Date of last inspection 16 October 2005 Brief Description of the Service: The home is situated in a large detached house surrounded by woods and farmland. The main house has been extended and provides a large area for nursing residents, and a secure area for residents with memory loss that is called The Martins. The garden extends round the house to provide a large grassed area with flowerbeds, and there is an enclosed sensory garden with a patio area for residents who have memory loss. The accommodation is largely provided in single rooms some with en-suite facilities. In the main house the rooms are generally spacious and individual in arrangement. In the new extension all of the rooms have en-suite facilities HUNGERFORD H52-HO1 S10995 Hungerford Care Centre V217435 040505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a Wednesday from 10:00 to 18:00 by Yvonne Souden (lead inspector) and Stuart Mynott. About 60 of the inspection was spent talking to management, staff, residents, visitors and general observation of care practice; the rest of the time was spent assessing the environment, care plans and records. The inspectors were able to spend time with residents but those visited had limited verbal communication skills. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. HUNGERFORD H52-HO1 S10995 Hungerford Care Centre V217435 040505 Stage 4.doc Version 1.30 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection HUNGERFORD H52-HO1 S10995 Hungerford Care Centre V217435 040505 Stage 4.doc Version 1.30 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Standard 1-6 were not assessed at this inspection. EVIDENCE: HUNGERFORD H52-HO1 S10995 Hungerford Care Centre V217435 040505 Stage 4.doc Version 1.30 Page 8 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 The home has a dedicated staff team who follow procedures in place to ensure the health and social care needs of the service users are met. Excellent records are kept however the home falls short within their documentation of service users fluid intake and ensuring service users dignity is respected. EVIDENCE: The inspectors’ case tracked the files of four service users; each file contained detailed and regularly reviewed assessed needs and associated risks that individual care plans are evidently drawn from. External health and social care professionals are involved in meeting and reviewing the needs of the service user, evident from records and observations of a visiting physiotherapist, Community Psychiatric Nurse and from discussions between staff on a service users condition and the being G.P notified. Discussions with relatives of service users and records seen show they are fully informed and involved in decisions made of care delivery. Pressure care equipment is used and charts are used to record pressure care and fluid intake. Drinks between meals were observed to be available and given to service users but fluid charts indicate that service users are not receiving fluids between meals. The home follows a monitored dosage system within the administering of service users medication and the inspection process identified that stock in place matched records kept. The homes medication policy is broken down into sections and is signed by HUNGERFORD H52-HO1 S10995 Hungerford Care Centre V217435 040505 Stage 4.doc Version 1.30 Page 9 staff to confirm they have read and understood each section. Staff spoke of training received for example catheter care, wound care and dementia and records supported this. Staff were observed to be courteous to the service users and had an awareness of their individual needs, however on two occasions service users dignity was not protected and one visitor was concerned that a toileting routine prevents good continence management, and records support concerns raised with an action plan in place following a multi agency review. HUNGERFORD H52-HO1 S10995 Hungerford Care Centre V217435 040505 Stage 4.doc Version 1.30 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Standards 11 to 15 were not assessed at this inspection. EVIDENCE: HUNGERFORD H52-HO1 S10995 Hungerford Care Centre V217435 040505 Stage 4.doc Version 1.30 Page 11 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Standard 16 to 18 were not assessed at this inspection. EVIDENCE: HUNGERFORD H52-HO1 S10995 Hungerford Care Centre V217435 040505 Stage 4.doc Version 1.30 Page 12 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 The décor and furnishings within the home provide a homely, comfortable environment that is clean and tidy and protected by infection control policies in place, however offensive odours were detected and infection control policies were not strictly adhered to. EVIDENCE: Sluicing and laundering equipment is serviced and a clinical waste disposal contract is in place. Clinical bags, protective clothing and hand washing facilities were not readily available within some areas of the home where they are necessary to ensure infection control. The home was clean, tidy and free from offensive odours with the exception to two rooms that had an offensive odour present. Furnishings and décor is of a good quality but the hallway in The Martins requires redecoration as was required at the previous inspection; a programme of maintance and repair is in place. Only one of the two sitting rooms within The Martins is used creating an institutional environment as service users sit in a full circle with no space between each chair. The new manager aims to improve the situation and encourage full use of the two communal rooms, and make use of the sensory garden that leads off the room that is currently not in use; this would be viewed as a positive step forward. HUNGERFORD H52-HO1 S10995 Hungerford Care Centre V217435 040505 Stage 4.doc Version 1.30 Page 13 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29 Staff numbers are sufficient to meet the dependency levels of the service users currently in residence, and management ensure their recruitment policy and procedure is followed to protect the service user. EVIDENCE: The staff rota identifies a mix of qualified and unqualified staff and show staff numbers are greater in the morning than the afternoon and are reduced at night to four. A review of the dependency levels in The Martins has taken place since the last inspection to ensure appropriate staff numbers. Staff feel staff numbers are sufficient to meet the needs of the current service users and that continuity of care has improved since care vacancies have been filled. There is sufficient domestic staff employed to ensure the environment is clean and tidy despite a requirement made within standard twenty-six of this report, as the unpleasant odours present within the two rooms could be resolved with good continence management and timely cleaning of a service users room. The home follows its recruitment policy and procedure, evident from the files of two recently recruited staff members; the record shows that employment history, identification, CRB and references are obtained prior to commencement of employment. HUNGERFORD H52-HO1 S10995 Hungerford Care Centre V217435 040505 Stage 4.doc Version 1.30 Page 14 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 & 38 Health and safety is promoted and audit-monitoring systems are in place but access to safety records could be improved. EVIDENCE: Discussions with staff and records seen demonstrate that staff receive mandatory training to ensure safe practice. Staff received Containment of Substances Hazardous to Health (COSHH) training on the 6th April 2005 but when asked staff were hesitant to the location of COSHH data/risk assessments, and on locating them it proved difficult to find a particular data sheet; cleaning products were observed to be securely stored. Safety measures are in place to protect service users from burns and scalds and food safety monitoring checks are maintained. A record of maintenance and repair also records fire safety checks, but the fire logbook could not be located. Safety signs are in place and fire doors have magnetic closures. The home has a structured audit system and has questionnaires to obtain the views of the service from service users, family/friends and from health and social care professionals, but they are not put into practice. HUNGERFORD H52-HO1 S10995 Hungerford Care Centre V217435 040505 Stage 4.doc Version 1.30 Page 15 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x 2 x x x x 2 HUNGERFORD H52-HO1 S10995 Hungerford Care Centre V217435 040505 Stage 4.doc Version 1.30 Page 16 yes Are there any outstanding requirements from the last inspection? 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 8 Regulation 12.(1) Requirement Indavidual service users fluid charts must detail fluid intake between meals to ensure accurate monitoring and prevention of dehydration. The home must promote service users dignity and in doing this where necessary, liaise with the representative of the service user to ensure the service user has choice and is provided with appropriate clothing. The ground floor of The Martins must be redecorated. This was a requirment at the previous inspection and has been partly met, therefore a new timescale has been given to complete the work. (timescale 01/12/04 not met) The home must promote continence management and put into place a system of timely cleaning of an indavidual service users room, so as to prevent offensive odours occuring. The home must ensure disposable gloves, handpaper towels and soap is a available within the laundry and sluice rooms, and that clinical bags are Timescale for action 05/05/05 2. 10 12.(4) 4/06/04 3. 19 23.(2) 04/07/05 4. 8 & 26 12.(1)(b) & 23.(2)(d) 04/06/05 5. 26 13.3 05/05/05 HUNGERFORD H52-HO1 S10995 Hungerford Care Centre V217435 040505 Stage 4.doc Version 1.30 Page 17 in place within the sluice rooms. 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 19 33 Good Practice Recommendations The two lounges within The Martins should be facilitated to discourage institutionalism and encourage a homely comfortable enviorment for those service users. The home should obtain the views of the service provided from service users, family/friends and from health and social care professionals from the questionairs they have in place. The home had records of fire safety checks but should ensure the updated fire log book is available for inspection. COSHH records should be collated in a user friendly file to ensure quick access. 3. 4. 38 38 HUNGERFORD H52-HO1 S10995 Hungerford Care Centre V217435 040505 Stage 4.doc Version 1.30 Page 18 Commission for Social Care Inspection 2nd Floor 1015 Arlington Business Park Theale Reading RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI HUNGERFORD H52-HO1 S10995 Hungerford Care Centre V217435 040505 Stage 4.doc Version 1.30 Page 19 - 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!