Inspection on 15/01/07 for Hungerford House

This inspection was carried out on 15th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Hungerford House 05/12/05

Hungerford House 29/06/05

Hungerford House 12/01/05

Hungerford House 26/07/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Hungerford House Beechfield Road Corsham Wiltshire SN13 9DR Lead Inspector Alison Duffy Unannounced Inspection 15th January 2007 09:40 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 Hungerford House DS0000028283.V298370.R01.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. Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hungerford House Address Beechfield Road Corsham Wiltshire SN13 9DR 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) 01249 712107 The Orders Of St John Care Trust Vacant Care Home 48 Category(ies) of Dementia - over 65 years of age (19), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (4), Old age, not falling within any other category (25) Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May from time to time admit persons between the ages of 60 and 65 Date of last inspection 5th December 2005 Brief Description of the Service: The building was originally purpose built by the local authority in the 1970s. The Orders of St John Care Trust took over the care provision on 1st October 2000. There are 48 single bedrooms, which are all on the ground floor. The home offers 2 respite care beds. The home is registered to provide 19 places for people who have a diagnosis of dementia. The home is divided into three units namely: Roberts, Lilley and Hall. These units have their own sitting room, dining room, small kitchen area, bathroom and toilets. There is a separate day service for up to 25 people each day. Staffing levels are generally maintained at 6 or 7 care staff including a care leader, during the morning. There are 4 staff in the afternoon and 5 or 6 care staff including a care leader in the evening. There are 3 waking night staff. The home also employs cooks, housekeepers, a maintenance person, an administrator and an activities coordinator. Ms Jane Ridgewell is currently managing the home and has recently submitted her application to CSCI to become the registered manager. The fees for living at the home are from £370.57 - £486.39 a week dependent on dependency levels and the room accommodated. This does not include chiropody, hairdressing, dry cleaning and personal items. Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place initially on the 15th January 2007 between the hours of 9.40am and 5.30pm. The inspection was concluded on the 6th February 2007 between 9.30am and 5.20pm. On the first day of the inspection, discussion took place initially with Ms Jane Ridgewell regarding care provision. Ms Ridgewell then assisted with a tour of the accommodation. Ms Ridgewell left at lunchtime to attend a budget meeting at the organisation’s area office. During this time, the care leaders within the home assisted as required. Ms Ridgewell returned later in the afternoon to receive feedback on the inspection. Ms Ridgewell was available throughout the second day of the inspection. Discussion took place with residents in the communal areas and within the privacy of individual rooms. Discussion also took place with staff when further touring the accommodation. The inspector observed the serving of lunch and viewed care planning information and daily records. On the second day of the inspection, staffing information such as training and recruitment documentation was viewed. The inspector observed an afternoon handover and spoke further to staff. The medication systems and the safe keeping of residents’ personal monies were also examined. As part of the inspection process, surveys were sent to the home for residents to complete if they wanted to. Comments cards were also distributed to residents’ relatives. Some GPs and care managers were contacted for their views. Feedback is reported upon within the main text of this report. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: Residents are encouraged to follow their preferred routines and give their views regarding service provision. Medication is orderly managed, which minimises the risk of error. Residents have regular access to health care professionals and are seen by the GP and District Nurse, as required on a regular basis. Residents are able to personalise their own rooms and receive visitors at any time. Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 6 Training is encouraged and various subjects are arranged as part of the organisation’s training programme. Robust recruitment procedures are in place and a high level of health and safety material is available for staff reference. What has improved since the last inspection? What they could do better: While Ms Ridgewell reported that care plans have been developed, significant shortfalls remain. The care plans viewed did not reflect residents’ needs and were not up to date. The management of specific conditions such as diabetes were not fully evidenced. The plans did not clarify how certain conditions, such as dementia, were portrayed. There was little evidence of staff assessing residents’ individual risk of developing a pressure sore. Other risks such as nutrition and falling were inadequately addressed. Some terms such as ‘communication poor’ and follow up action within residents’ daily records would benefit from greater detail and clarity. While it is acknowledged that the organisation is reviewing staffing levels, existing levels are minimal. More care hours, would enable greater consideration to be given to residents’ individual needs and for staff to complete their other responsibilities, such as care planning, more efficiently. Many residents appeared satisfied with the level of activity provision available, yet with only 20 hours allocated to such provision, identifying and addressing individual needs is limited. This is particularly evident with those residents with a dementia who may benefit from more detailed, one-to one work, with a member of staff. As the home is able to accommodate 19 residents with dementia, further systems to promote communication and orientation would be also be of benefit. Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 7 While refurbishment in some areas of the home is currently taking place, other areas such as corridors and residents’ bedrooms also need attention. While it is acknowledged that the organisation has developed a five-year plan of refurbishment, this needs to be re-visited with agreed timescales for future works. Greater attention to cleanliness, with particular attention to the cleaning of toilets, is required. Training is encouraged and the organisation and the home’s manager arrange various subjects. Consideration should however be given to adult protection training, which takes into account local reporting procedures. Any unexplained bruising to a resident must also be investigated appropriately. Due to the shortfalls in the content of care plans, consideration should also be given to care planning training. Medication training and further opportunities in relation to dementia care training are also recommended. 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. Hungerford House DS0000028283.V298370.R01.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 Hungerford House DS0000028283.V298370.R01.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): 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are assessed before their admission, yet documentation does not fully target the potential complexity of residents needs. Greater detail within documentation would ensure sufficient information is gained so that individual needs are fully addressed. Standard 6 is not applicable to this service, as intermediate care is not provided within the home. EVIDENCE: A number of residents spoken with reported that they had lived at the home for a number of years. They reported that they had chosen Hungerford House due to either living within the area or through previous knowledge of the home. While some residents could not remember, others reported that they had the choice to visit, before making a decision to move in. One reported that their relative had chosen the home. Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 10 Ms Ridgewell confirmed that all prospective residents are assessed before a placement is considered. They also receive an assessment period of a month following their admission to the home. Documentation from care managers or other interested parties are also gained. Assessment documentation of the most recent resident to the home was viewed. This contained a discharge summary from hospital and a community care assessment written by the resident’s care manager. The home had a number of documents evidencing their assessment process. These included a dependency rating tool, an organisational assessment form and a long-term needs assessment. The dependency-rating tool used a tick box system to evidence the resident’s ability. Due to the style of the form, specific detail was not apparent. Aspects, such as health conditions and required support, preferred routines and factors contributing to quality of life were also not evident. At the end of the assessment, a numeric rating highlighted the resident’s level of dependency. The format appeared to assist with funding agreements, yet did not give sufficient information to successfully co-ordinate the resident’s care plan. The organisation’s assessment form on this occasion was partially completed. Matters such as a medication profile and required health care provision were not stated. Issues highlighted within the hospital discharge summary and the community care assessment were also not clearly identified. Ms Ridgewell reported that the organisational form is a supplementary document and can be used to gain additional information if required. It is not an integral part of the assessment process. Ms Ridgewell confirmed that the majority of information gained is recorded on the long-term needs assessment. It was noted that the content of this form, contained greater detail. Through discussion with Ms Ridgewell, it was evident that she is clear regarding the needs that can be met within the home. Assessments are also undertaken on any resident who may have been admitted to hospital and is ready for discharge. Hungerford House DS0000028283.V298370.R01.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 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While developments have been made to care planning documentation, not all plans reflect residents’ needs and the support required. Residents’ benefit from regular access to health care personnel. Medication systems are well managed therefore minimising any risk of error. Staff appeared to have good relationships with residents but not all respected the individual’s right to privacy. EVIDENCE: All residents have a care plan containing a long-term need and assessment form, together with short-term care plans. The plans viewed however, did not fully reflect individual need and a number of shortfalls were apparent. Due to the structured headings within the long-term need and assessment form, primary needs associated with specific health care conditions, were not clearly identified. In one instance, a member of staff had recorded Alzheimer’s disease. There was no information however, regarding how the condition affected the resident or the support required. Another form highlighted diabetes, yet there was no detail about its management. There were also Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 12 terms such as ‘personality very good,’ ‘usually content’ and ‘communication poor,’ which would benefit from greater clarity. One assessment form had been reviewed and added to, following repeated respite care admissions. Each short-term care plan generally followed the same format, yet this was not always relevant for the individual. For example, a heading highlighting blood tests and X rays often started each plan, yet this was irrelevant for many. Ms Ridgewell reported that the previous manager had developed this, as a starting point because previously, care-planning information was extremely minimal. Ms Ridgewell confirmed that with the support of the last manager, staff had made significant progress with care planning documentation. Ms Ridgewell acknowledged however, that there is more work to do. Within one short-term care plan, information was very limited and very out of date. Despite the residents’ very complex needs, written documentation only detailed information about bathing and that staff should encourage involvement within activities. Other required care provision was not identified. Various dates such as 2003, 2004 and 2005 were evident, yet any other more up to date information was not apparent. Another care plan did not reflect the changing need of a resident and the care they required. For example, the care plan stated that remembering the location of the toilet was an issue. Within discussion however, it was evident that that the resident was being nursed in bed. This was not stated within care planning information. Ms Ridgewell reported that, in the staffs’ defence, the resident had deteriorated very quickly and a care review was planned. This resident was assisted to drink, by using a syringe. There was no evidence within the care plan that this level of care was required. A mattress had been placed on the floor, to minimise the risk of injury, if the resident fell out of bed. This also, was not identified within written documentation and had not been discussed with the resident’s social worker. Within the care plan, terminal care was stated. This term was detailed under sections of the care plan, such as social activity. Observations did not portray the need for this level of intervention. There was also no evidence regarding whom and on what basis, the decision for terminal care had been made. Ms Ridgewell reported that the District Nurse had expressed the need for terminal care although the resident was still getting up with staff assistance. A member of staff reported that the resident was being nursed in bed. Clarity must therefore be given to the actual support required, which must be clearly reflected with the resident’s plan of care. Within some formats, greater detail was evident. This included guidelines of what to do in the event of varying blood sugar levels. However, the responsibility of taking the levels, the procedure and the times for doing so, were not identified. Within daily records, a consistent record of blood sugar levels was not apparent. Manual handling assessments were not up to date and gave limited information. One assessment was dated 6.12.02. There were no tissue viability, nutritional or falls assessments. Within one care plan a possibility of pressure sores was highlighted. The plan continued with an Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 13 instruction to check all areas such as heels, hips and elbows. Further detail of the assessment and other preventative measures were not available. Within another plan, there was no reference to tissue viability. Attention is required to address these areas, as a matter of priority. Risk assessments were also minimal. For example, one assessment highlighted going out unattended, but no other risks were identified. Another only detailed a resident having their door open at night. Within care plans of those residents with dementia, aspects such as communication, individual wishes, preferences and exercising choice were limited. Guidelines for staff regarding the management of behaviours or potential resistance were also not available. Daily records were up to date and highlighted particular incidents and general wellbeing. While some matters were fully detailed, follow up action was not always apparent. For example ‘heel looking sore,’ and ‘complaining of being unwell’ were stated, but further information or intervention was not evidenced. Within comment cards, four residents reported that they ‘usually’ receive the care and support they need. Two said ‘always.’ One resident confirmed that they have a good carer. They continued to state ‘she keeps an eye on me and looks after my needs.’ While many relatives confirmed satisfaction with care provision, two relatives expressed dissatisfaction. The reasons for this however, were not stipulated. Another relative stated ‘we feel the overall care is adequate but as XX has no nominated carer on a regular basis, its fortunate we are able to visit often.’ One relative demonstrated within their comment card, that they were in between ‘being satisfied’ and ‘not satisfied.’ One relative felt there was not enough personal care including bathing, hair washing, nail clipping and dental inspection. Within the inspection, a district nurse expressed satisfaction with the home. She confirmed that they visit on a daily basis to administer insulin and to undertake other tasks, such as dressings. Ms Ridgewell confirmed this and reported that their input is invaluable and gives access to regular advice as required. Within daily records, it was evident that residents have regular access to their GP. One resident said ‘you tell a member of staff if you’re not very well and they get the doctor.’ Within comment cards, specific comments included ‘I am lucky. I can see my doctor if necessary and XX visits Hungerford House quite often.’ Also ‘we are taken care of and supported i.e. hospital appointments. We have the support of doctors and nurses who come in most days.’ One resident stated ‘the medical care is first class.’ Medication was discussed with a care leader who has responsibility for the system. The care leader reported that she undertakes all the ordering and receipt of medication, as well as the general monitoring of the systems and staff competency checks. The care leader reported that she has had medication training although staff, other than the information she has provided, have not. Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 14 All medication was stored appropriately and a separate fridge contained items as required. The medication administration sheets were well maintained with staff signing to demonstrate the medications’ administration. Hand written instructions however need to be countersigned. Eye drops identified the dates that they were opened. There were a number of medications used as homely remedies. A GP had signed documentation authorising their use. One resident is responsible for their own medication. A risk assessment was in place and the care leader reported that the ordering of medication is closely monitored to identify any error. At the last inspection a requirement was made to ensure that any medication, which is self medicated is appropriately stored. The care leader reported that lockable storage has been provided and the situation is regularly monitored, to ensure the facility is utilised. Within the inspection, positive interactions were noted between residents and staff. This included general banter and good communication when undertaking tasks such as assisting a resident to eat. Staff appeared knowledgeable regarding residents needs and through discussion, demonstrated ways in which they would manage potential challenging behaviours. Staff appeared respectful in their interactions. On a tour of the accommodation however it was noted that one resident was receiving personal care with the door open. Those residents spoken with did not raise any issues in relation to their privacy. Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 15 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. While residents generally appear satisfied with the level of activity provided, the hours deployed to activity provision are minimal and do not address the social needs of all residents, both in the home and within the wider community. Residents are able to follow their preferred routines although systems to enable decision making, of those residents with a dementia, could be improved upon. Meal provision has recently been developed and appeared satisfactory to the majority of residents. EVIDENCE: The home has a day centre, which can accommodate up to 25 clients a day. The day centre has its own staff and provides a structured activity programme. One resident reported that they sometimes join in with these activities. The main home has an Activities Coordinator who works 20 hours a week. While it is acknowledged that various activities such as quizzes are undertaken, the number of hours allocated is minimal. This is specifically so, due to the high level of need some residents portray due to their dementia. On the day of the inspection, a member of staff was reading the newspaper to a group of residents. This turned into a general discussion group. There was not however any other activity observed. Within the communal lounges some residents Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 16 were watching television, some were knitting or reading the newspaper and others were asleep. There were varied opinions from residents about activities. These included being satisfied and happy to follow solitary interests, through to feeling opportunities could be improved upon. Within comment cards received from residents, three residents reported that there are usually activities arranged by the home that they can join in with. Another reported there are always activities available. One resident reported that they would like to see more activities during the day - particularly at weekends when the day centre is not available e.g. concerts and whist drives. Another resident stated, ‘there is always activities in the home. We have card games, quizzes and skittles and Jumble Sales, all taken care of by XX.’ Another resident stated ‘I am limited in certain activities by being disabled.’ A relative however stated ‘I have never seen a staff member actually sitting and chatting to a resident. Contact is of the bright, breezy and short variety – jollying along. Not good enough for those who are still able to converse – exaggerates their isolation.’ Ms Ridgewell confirmed that various activities are organised and staff do make sure that they spend time with residents. This may not however be at busy times of the day, such as in the morning, when many residents are being given assistance to get up. The activities organiser reported that on many occasions, many residents are reluctant to join in with any activity. For example, on the second day of the inspection, skittles were planned. The activities organiser confirmed that encouragement would be needed to ensure involvement. There is a small shop within the home although due to complex licensing procedures, Ms Ridgewell reported that the bar is no longer available. There is a visiting hairdresser and residents are able to take Holy Communion on a regular basis. Residents confirmed that they are able to follow their preferred routines and stay in their room, for example if they wish. This was confirmed by one resident stating, within their comment card ‘I do what I want, go where I can, observe what is going on.’ Residents confirmed that they are able to have visitors when they wish. There are no visiting hours. One resident reported that they are looking forward to going out with their family more, now that the better weather is coming. All comment cards received from relatives stated that staff are always very welcoming. One relative confirmed that staff are very friendly. There were however, three comments identifying negativity about the procedure for entering and leaving the home. One comment stated ‘whilst I realise the need for security, at the weekends when they are short staffed you have to go looking for somebody to let you out and more importantly you could be taking them away from a more important task.’ Another relative stated ‘the exit procedure for visitors is very time consuming. It takes the staff a long time to respond (when they are needed for more important matters.)’ Ms Ridgewell reported that this has been a longstanding problem, yet visitors are now able to enter the first door, so they are not waiting outside. Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 17 The home has a rolling five-week menu. This contains a choice at each meal. A cooked breakfast is available twice a week with a boiled egg, cereals, porridge and toast available throughout the week. The main cooked meal is served at lunchtime and there is a hot snack at teatime. There are three dining rooms yet at present, due to refurbishment, only two rooms are being utilised. Residents generally use the dining room nearest their bedroom. The serving of the lunchtime meal was observed in one dining room. Food was served from a heated trolley and appeared in accordance with individual wishes. One resident was observed being assisted to eat. This was undertaken in a sensitive manner. Another resident ate their meal in the lounge. Residents expressed satisfaction with the food. This was generally confirmed in comment cards although one resident reported that ‘more variety of meals is required.’ Another resident reported that some foods such as eggs are a regular occurrence and more variety is needed with tea. They continued to report that ‘dinners are very good’ but would they would like soup to make a three-course lunch on a Wednesday and a Sunday. Ms Ridgewell reported that this is being addressed. Within documentation it was evident that one formal complaint had been made regarding the food. This was investigated and strategies were put in place to remedy perceived problems. Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 18 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure as required by regulation, yet there are no additional formal systems in place, to enable those residents with a dementia, to give their views. Staff demonstrated an awareness of adult protection, yet information for reference, would benefit from being more readily accessible. EVIDENCE: Within discussion with residents, many reported that they would tell a member of staff or Jane, the manageress, if they had any problems. One resident, very clearly reported that they didn’t have anything to moan about. If they did they would be straight to the manager. Another resident spoke of residents meetings. The home has a complaints procedure, which was displayed on notice boards around the home. A member of staff reported that it was important to notice signs, which may signal that a resident is unhappy. This could include repetitive speech or body language. Other than recognising signs of distress, there was little evidence of systems in place, to enable those residents with a dementia to express their views. Within comment cards, one resident reported that they have never had anything to complain about. Another said ‘I don’t make any.’ One resident confirmed ‘I have no complaints about staff. They try to sort things out for you. They are only human and have to put up with a lot but keep smiling.’ Three relatives reported that they are aware of the home’s complaint Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 19 procedure yet three were not. Ms Ridgewell was advised to forward a copy of the procedure to residents’ relatives. Discussion took place with one member of staff regarding adult protection. It was reported that lessons had been learnt through recently going through the Vulnerable Adults procedure. The member of staff reported that staff are now aware of the need to report all incidents. They confirmed that some abuse training is provided. This is undertaken in house and an external trainer is not utilised. The member of staff was not clear that local reporting procedures were included in the training. Another member of staff, although aware of the ‘No Secrets’ documentation, was unable to find a copy of the documentation within the home. The member of staff was aware of the procedure and showed referral forms that would be used. Contact details of the local Vulnerable Adults Unit were highlighted on the notice board. Ms Ridgewell reported that all staff have been given a copy of ‘No Secrets’ although reported that she would re-issue the documentation to ensure staff’s knowledge. Within one daily record it was identified that a resident had a bruise from her shoulder down to her elbow. The record identified that the resident was not in any pain, yet there was no investigation into the cause or any other further detail. Ms Ridgewell reported that she was not aware of the incident although body maps stored within a separate file should be in place. A body map identifying this bruise was not evident. Ms Ridgewell reported that she would investigate this matter. Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 20 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 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Current refurbishment is improving the environment yet further shortfalls require attention to enable residents’ greater comfort. Residents are able to personalise their own room, yet redecoration would enhance some individual’s personal space. Some aspects of cleanliness require attention to ensure a satisfactory standard throughout the home. EVIDENCE: The home is divided into three areas. Each area has a dining room, lounge, bathroom, a number of toilets and a kitchenette. On the day of the inspection, one of kitchenettes was being refurbished. This was significantly improving the area. Ms Ridgewell reported that the other kitchenettes were also due to be refurbished as part of the home’s refurbishment programme. It was agreed that this work was definitely overdue, as the kitchenettes were of a poor standard and very difficult to keep clean. Ms Ridgewell reported that one of the lounge carpets, dining area and corridor is being replaced shortly and the Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 21 smoking area is being relocated. Some areas have been refurbished with new carpets and redecoration. Repairs have also been made to the roof. A large amount of refurbishment work however, remains. This includes areas such as corridors and some residents’ bedrooms. Ms Ridgewell reported that further refurbishment work is anticipated. An updated refurbishment plan for the coming year was in the process of being approved. Ms Ridgewell reported that the plan would be forwarded to CSCI when available. Many residents’ bedrooms are below the advised space requirements. However all are personalised. Residents reported that they were able to bring items with them on admission. Identifying the best use of space through moving items around had also proved positive. All have a call bell system which residents had easy access to. Radiators covers are in place and hot water regulators have been fitted to all hot water outlets. Within one toilet however, the hot water was running at 45°C. Ms Ridgewell reported that all were randomly checked last week although agreed that the outlet would be investigated. Within toilets, raised toilet seats were evident. Soap dispensers and paper towels were also in place. Although cleanliness was of a satisfactory standard, greater attention is needed to the cleaning of toilets. A number had brown splashes and also brown deposits around the toilet seat hinge. Toilet brushes were also stained and had brown particles within the bristles and the bottom of the container. Cleaning the brushes in line with infection control guidance is required. On the day of the inspection the laundry was staffed and therefore ordered. Ms Ridgewell reported that she was currently in the process of investigating options for the laundry, as equipment was insufficient to fully meet existing need. Within comment cards received from residents, three residents reported that the home is always fresh and clean. Two said’ ‘usually’ and one said ‘sometimes.’ One resident confirmed ‘we are having new kitchens put in and that should help. Also, new dining area and carpets so that should freshen and clean the place up, then we can get back into Robert, Lilly and Hall sections by Easter.’ Another resident confirmed ‘the toilets are cleaner now than they were six months ago but could still improve.’ A relative reported ‘I am very dissatisfied with the standard of cleanliness. Cleaning does not just consist of hoovering and surface cleaning.’ Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 22 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels, although maintained in line with the previous registration authority, are insufficient to meet residents’ individual needs and assure satisfaction from residents and their relatives. Residents are given greater protection through a well-managed, robust recruitment procedure. Training is given priority although as the home can accommodate 19 residents with dementia, further training in this area would be of benefit. EVIDENCE: At the last inspection, a requirement was made to address staffing levels in order to ensure that residents’ care, and social and environmental needs were met. Ms Ridgewell reported that some progress had been made in this area, although due to being new in post, specific details were not available. Ms Ridgewell reported that additional staffing hours have been identified within the home’s budget for the next financial year. The increase is not known at this time. Within this inspection there was further evidence from residents and their families, that current staffing levels remain insufficient. The inspector suggested also, that insufficient staff time was a potential contributory factor to some care plans being out of date. This was confirmed when a care leader reported that when they are busy, ‘paperwork’ is obviously placed secondary to residents’ care. Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 23 On both afternoons of the inspection, a care leader was contacting staff by telephone, to ask for their assistance with covering the forthcoming roster. The member of staff reported that staffing is often tight, especially when staff are on holiday and others go sick. Although being counted as a member of care staff, care leaders usually aim to be in the office by approximately 10.30am. This is so that they are able to complete their other responsibilities, such as arranging appointments, liaising with healthcare professionals and undertaking staff supervision. The member of staff reported that they might assist with the serving of lunch or undertake medication administration yet they do not routinely, after this time undertake any personal care. Mrs Ridgewell sent a copy of the previous month’s staffing rosters to the inspector before the inspection. The documentation demonstrated that during the weekday mornings, there continues to be generally six or seven care staff on duty. This included one or more, care leaders. During the evening there were four or five carers with a care leader. At weekends, levels reduce to generally five staff and a care leader on each shift. In addition, to the care staff team, there are domestic and catering staff. There is also an administrator, a maintenance person and an activities coordinator. Two additional staff members are on duty throughout the day to manage the day centre. There are also three members of waking night staff on duty each night. Ms Ridgewell confirmed that there are generally two or three domestic staff and two catering staff on duty during the day. There is also a laundry assistant on duty during the week although not always at weekends. In the laundry assistant’s absence, care staff are responsible for the role. This has implications to the amount of time available for care provision especially as the levels of care staff are reduced over the weekend period. Within comment cards received from residents, five residents reported that staff always listen and they are ‘usually’ available when you need them. One said ‘they are all nice carers.’ Another confirmed ‘the staff are usually around when you require them. They are kept busy so one must be patient, as they are very busy with patients at times.’ A further resident stated ‘the staff as a rule are available, but sometimes take ten minutes or more to attend to you.’ Another reported, ‘the staff listen to what you have to say but the action taken is ‘usually’ – they say they will be back in a minute and never come back. The worst offenders are night staff when we want the commode emptying. In the mornings no one is ever around to do it. They say they will come back but never do.’ Ms Ridgewell agreed that residents might need to wait for tasks such as emptying commodes at key times, especially in the mornings. This was explained, as giving priority to those residents needing assistance with personal care. Within comment cards received from relatives, eight reported that there are insufficient staff on duty. One confirmed ‘the staff are always helpful and very kind but they are being stretched in the workplace.’ Ms Ridgewell reported that Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 24 staff are busy, yet often organisation and the best use of time is key. Ms Ridgewell confirmed that staff are encouraged to spend time talking to residents, yet this may not be seen when visitors visit, at busy times of the day. Recruitment documentation of the most three recent members of staff were viewed. All contained the required information including an application form, two written references and a medical declaration. Documentation highlighting the interview process was also evident. A POVAFirst and CRB disclosure were in place as required. Ms Ridgewell reported that all new staff must now complete an induction programme on the computer known as e-learning. Ms Ridgewell demonstrated this and confirmed that topics, such as abuse and infection control are covered. Ms Ridgewell confirmed that staff must provide satisfactory responses, before the programme can be completed. Ms Ridgewell reported that this system assures staff have understood and retained the required information. Staff and Ms Ridgewell confirmed that staffing is given high priority and many options are available. From information sent before the inspection, it was confirmed that twelve members of staff have NVQ level 2. One member of staff has NVQ level 3. Ms Ridgewell confirmed, that on the day of the inspection, three members of staff have NVQ level 3 and fifteen have NVQ level 2. Ms Ridgewell confirmed that staff are generally up to date with their mandatory training and explained that topics such as mental health, dementia, tissue viability and stoma care have also been undertaken. Sensory loss training has been arranged. Ms Ridgewell reported that the dementia care training consists of a two-day course and the majority of staff have now completed it. The home does not however have an ongoing dementia care training programme. Ms Ridgewell reported that the organisation is currently giving their attention to this matter. The inspector reported that due to the many residents currently living in the home with a dementia, this development would be of significant benefit. Within the training matrix sent to CSCI before the inspection, care planning was highlighted. Staff had not however undertaken this and therefore due to shortfalls in care planning, this is recommended. Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 25 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, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have the benefit of an experienced manager who is motivated to further develop the home. Various systems are in place to assess service provision, yet greater attention needs to be given to addressing particular shortfalls. Clear systems are in place to manage residents’ personal monies therefore reducing the risk of error. Health and safety is given priority although further consideration to individual risk, would ensure residents’ greater protection. EVIDENCE: Ms Ridgewell took up her post of manager in October 2006. Ms Ridgewell is currently applying to the CSCI to become the registered manager. Ms Ridgewell has many years experience of working with older people within residential settings. This has previously included managing other care homes Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 26 within the organisation. Within discussion with residents there was positive feedback about Ms Ridgewell. Within a comment card, one resident stated ‘we have a new manageress who I feel will communicate with staff and clients.’ The home has a quality assurance system that is used within all of the homes within the organisation. The system consists of various audits. There are also questionnaires, which are sent to all residents on an annual basis. These were undertaken during the summer period of 2006. As yet, questionnaires to target other stakeholders have not been developed. Ms Ridgewell reported that family members were asked to assist residents with completing the forms if they wanted to. Therefore, although the organisation does not have a specific questionnaire related to relatives, family contributions were welcomed through this forum. The results gained in 2006, were summarised and given to residents. They were also summarised within percentage form. Certain areas such as activity and laundry were noted, as areas of required development. In response to shortfalls within the laundry, a solution of a new washing machine was stated. Within later documentation, it was noted, that the funding for this, had not been agreed. Ms Ridgewell reported she is expecting this to be addressed within the next budget. Various members of the senior management team undertake monthly visits as part of regulation 26. A report of each visit is readily available. It was noted however, under sections of the environment that shortfalls in the decoration of the environment were not reported upon. Terms such as ‘clean and tidy’ were mentioned, which although accurate, do not fully reflect the shortfalls and the need for refurbishment of particular areas. Ms Ridgewell reported that residents also commented very little about the shortfalls within their quality assurance questionnaires. Ms Ridgewell suggested a familiarity with the environment might be the potential cause. The administrator reported that residents generally pay their fees through standing order. The home does not manage residents’ finances although a number of residents have chosen to place small amounts of their personal monies, for the home to hold safely. The systems for managing this were examined. A recent audit had been undertaken by the organisation. This identified a number of issues that have since been addressed. A number of cash amounts were checked against the balance sheets and all were found to correspond. Staff sign and check each transaction. Another member of staff countersigns the record. Receipts were also in place to demonstrate expenditures. Health and safety is given priority and the organisation has developed significant documentation within this area. There are a large number of policies, procedures and generic risk assessments. However, as stated earlier in this report, risk assessments in relation to the individuality of residents have not been addressed. The safety of the environment has been given consideration through the installation of radiator covers and hot water Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 27 regulators. Various forms of equipment such as hoists are serviced regularly with documentation available to demonstrate such checks. Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 28 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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 15 (2)(b) and (c) Timescale for action Unless it is impracticable to carry 30/04/07 out such consultation, the registered person shall after consultation with the service user, or representative of his, prepare a written plan (“the service user’s plan”) as to how the service user’s needs in respect of his health and welfare are to be met. (All care plans must be regularly reviewed and identify any change in need. Plans must identify individual care needs and how these are to be met.) This requirement was first identified in July 2004. At the last inspection in December 2005, it was reported that good progress was being made. However, shortfalls remain. Unless it is impracticable to carry 30/04/07 out such consultation, the registered person shall after consultation with the service user, or representative of his, prepare a written plan (“the service user’s plan”) as to how the service user’s needs in DS0000028283.V298370.R01.S.doc Version 5.2 Page 30 Requirement 2 OP7 12(1)(a) Hungerford House 3 OP7 12(1)(a) 4 OP7 13(4)(c) 5 OP18 12(1)(a) respect of his health and welfare are to be met. (The management of any health care condition such as diabetes must be clearly identified within the resident’s care plan.) The registered person shall 31/03/07 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. (All residents must have their risk of developing pressure sores assessed. Outcomes and action to be taken must be identified in each care plan. The registered person shall 31/03/07 ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. (All residents must have an up to date manual handling assessment. Additional risks, such as the risk of falling must be addressed within the risk assessment process.) 06/02/07 The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. (Any identified bruising found on a resident must be investigated and addressed appropriately. The results of the investigation must be documented within the resident’s records.) Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 31 6 OP21 23(2)(d) The registered person shall 31/03/07 having regard to the number and needs of the service users ensure that all parts of the care home are kept clean and reasonably decorated. (The five-year refurbishment plan must be revised and plans submitted to CSCI regarding how any outstanding works are to be addressed.) At the inspection in 2004, a similar requirement was made. At the last inspection, it was noted that progress was being made. This continues to be so, although progress is slow and a large amount of work remains. The registered person shall 06/02/07 having regard to the number and needs of the service users ensure that all parts of the care home are kept clean and reasonably decorated. (Cleaning schedules must be revised to ensure that all areas of the home, with particular attention to toilets and toilet brushes, are cleaned to a satisfactory standard.) This was identified at the last inspection yet some toilets continue not to be cleaned to infection control standards. The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users, ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for DS0000028283.V298370.R01.S.doc 7 OP26 23(2)(d) 8 OP27 18(1)(a) 31/03/07 Hungerford House Version 5.2 Page 32 the health and welfare of service users. (Staffing levels must be sufficient to meet the individual needs of residents and undertake additional tasks such as care planning efficiently. The CSCI must be informed when the details of the increased staffing levels are known.) 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 Refer to Standard OP3 Good Practice Recommendations The registered person should ensure that all information gained in relation to the assessment process is fully completed and coordinated. The documentation should ensure sufficient information is in place, to enable the prospective resident’s needs to be met within the home and a care plan to be devised. The registered person should ensure that details of how specific health care conditions, such as Alzheimer’s disease, are portrayed and clearly stated within the resident’s care plan. The registered person should ensure that terms such as ‘communication poor’ are clearly defined. The registered person should ensure that systems to promote communication with those residents, who have a dementia, are clearly stated within the resident’s care plan. The registered person should ensure that any matter such as ill health that is identified within residents’ daily records, also identifies follow up action. The registered person should ensure that all staff who administer medication have specific medication training. The registered person should ensure that all staff countersign any handwritten medication instruction. The registered person should ensure that a review of activity provision is undertaken in line with residents’ preferred interests. Following this, the amount of hours required to implement such provision should be DS0000028283.V298370.R01.S.doc Version 5.2 Page 33 2 OP7 3 4 OP7 OP7 5 6 7 8 OP7 OP9 OP9 OP12 Hungerford House 9 10 11 12 OP16 OP18 OP30 OP33 recalculated. The registered person should ensure that the complaints procedure is readily accessible to all residents and their relatives. The registered person should ensure that all staff have adult protection training, facilitated by an external trainer, that takes into account local reporting procedures. The Registered Person should ensure that all care staff undertake care planning training. The registered person should ensure that systems are devised to enable other stakeholders to give their views as part of the home’s quality assurance system. Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Hungerford House DS0000028283.V298370.R01.S.doc Version 5.2 Page 35 - 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. 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