Inspection on 26/08/09 for Hunter Hall

This inspection was carried out on 26th August 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hunter Hall 10/03/09

Hunter Hall 23/10/08

Hunter Hall 08/04/08

Hunter Hall 10/04/07

Hunter Hall 17/07/06

Hunter Hall 26/09/05

Hunter Hall 14/06/05

Hunter Hall 22/02/05

Hunter Hall 26/07/04

Hunter Hall 16/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Hunter Hall Kent Avenue Wallsend Tyne & Wear NE28 0JE     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Janet Thompson     Date: 2 6 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Hunter Hall Kent Avenue Wallsend Tyne & Wear NE28 0JE 01912639436 01912623633 hunter.hall@fshc.co.uk www.fshc.co.uk Tamaris Healthcare (England) Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 46 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who may be accommodated is 46. The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia Code DE, maximum number of places: 1 Dementia, over the age of 65 years of age Code DE(E), maximum number of places: 45 Date of last inspection Brief description of the care home Hunter Hall is a care home that provides residential and nursing care for older people with mental health needs. It is located in a residential area of Wallsend close to local shops and good public transport links. The home is owned and managed by Four Seasons Healthcare Limited, a large national care provider. Care in the home is provided by Registered Mental Nurses (RMNs) Care Homes for Older People Page 4 of 26 Over 65 45 1 2 3 1 0 2 0 0 8 Brief description of the care home supported by care staff. Forty-six single bedrooms, all with en-suite facilities, are located at ground and first floor levels. On each floor there are separate lounge areas, a dining room, bathrooms and toilets. The home shares kitchen and laundry facilities with an adjacent home. There is a nice, enclosed garden and patio area at the rear of the home. Depending on the type of care provided fees are between £408 - £530. The home has a statement of purpose and service user guide that give people information to help them decide whether their needs can be met. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. We have reviewed our practice when making requirements. Some requirements from previous inspection reports may have been deleted or carried forward to this report as recommendations. This will only happen when it is considered that people who use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Before the visit we looked at information we received since the last visit to the home. This includes how the service dealt with any complaints, changes to how the home is run, the views of people who use the service and the managers views of how well they Care Homes for Older People Page 6 of 26 care for people. We sent questionnaires to people who use the service and some of the staff at the service. Ten staff and seven residents questionnaires were returned to us. An unannounced visit was made on 26th August. During the visit we talked with people who use the service, some staff and the manager. We looked at information about people who use the service and other records which must be kept. We checked that staff had the knowledge, skills and training to meet the needs of the people they care for and we looked around the building to make sure it was clean, safe and comfortable. Following the inspection feedback was given to the manager who has only been at the home for five weeks. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: We have advised that, when agency staff are used, increased monitoring of medication takes place. The activities programme meets the minimum standard expected for a care home of this category but could be developed to give more variety and interest. The record of peoples involvement in activities was not up to date and some sheets were not dated. The premises was generally clean but more could be done to prevent the spread of infectious diseases. We found that waste bins did not have lids to contain potentially Care Homes for Older People Page 8 of 26 contaminated waste, light pull cords were dirty and the treatment room was untidy and dusty. A window on the first floor was open wide enough for residents to fall from. This was fitted with restrictors but they had been overridden. Internal health and safety checks had not been carried out, or, the record could not be found. These are usually carried out by the handyman who is off sick. These are important checks because they cover areas such as hot water regulating valves. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are properly assessed, taking account of their needs and wishes, so that they can be assured this is a suitable home and receive an individual care service. Evidence: Two pre-admission assessments were seen. They contained enough information to enable staff to assess if they could meet the individual needs of people before admission. Information from other health professionals and carers was included in the assessment. Staff confirmed that they are given information about people before they enter the home. This enables them to plan the initial care needs of the resident. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal care that is well planned and takes account of their diverse needs. Evidence: Three care plans were examined and two were case tracked. This means that we spoke to the individual residents or observed their care then matched our observations to what was written in the care plan. Both case tracked care plans did reflect the actual care needed by the residents. Care plans took account of peoples diverse and differing needs. People were supported to achieve independence and meet individual goals. Other health professionals contributed to the planning of care. These contributions were clearly recorded. Care plans were in place regarding peoples capacity to make decisions about their personal care, these took account of whether those decisions affected the well being of the resident. One resident was experiencing end of life care, good plans were in place to deal with possible complications. Directives were in place for non medical interventions, these had been signed by the appropriate people. Care Homes for Older People Page 12 of 26 Evidence: The actual care people received appeared to be good. We noted that most people were well dressed and looked clean and cared for. Some residents were without stockings or socks, this was raised with the manager who stated that they might not wish to wear them or removed them due to aspects of their dementia behavior. We advised that this should always be recorded in the care plan. He agreed to review this with staff. We observed staff supporting residents to wash their hands and change clothes. Staff were knowledgeable about individual needs. Medication ordering, administration, storage and disposal were examined. All medicines were accounted for and most of those administered were signed for. There had been some recent gaps due to the use of agency nurses. Agency nurses had been used in the last two weeks to cover unexpected sickness. Prior to this the administration of medication was good. Regular audits are carried out on medication and we have recommended that this is increased during periods when the homes own staff are not on duty. Three amounts of controlled drug were checked and were correct. Staff were seen to treat residents politely and respectfully. Small incidents of potential challenging behavior were successfully avoided through distraction. Staff told us that most of them had worked at the home for a number of years and were very familiar with the needs of the residents. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to lead a healthy and fulfilling personal lifestyle. This takes account of their wishes and diverse abilities. Evidence: There is a staff member in charge of activities. She supports residents to use a range of services within the local community. Residents are encouraged to be in control of their own lives as far as possible. There is a broad plan of activities which showed that residents are offered things such as music, entertainment and one to one time. We thought the activities were a little repetitive but did meet the minimum expectation for a care home. Staff told us that residents enjoy a weekly session called Tea at the Ritz, this is usually themed to a decade and residents are served with cucumber sandwiches, tea and scones. Social history and life stories were in place for residents in care plans. There is also a good record of social progress and activities plans for individuals, however these were not up to date. The activities plans were not dated so it was difficult to tell how much people had actually done. The activities co-ordinator said that she tries to take some residents out of the home but transport was not always available. She reported that residents were well supported by their families and attendance at events was good. Residents keep in Care Homes for Older People Page 14 of 26 Evidence: touch with the community and everyday life by this involvement and visitor interactions. Residents appeared to like the food. Two options are taken to the dining room and residents make their choice there and then. We ate the food at the home. It was well presented. The food was hot enough and very tasty. The standard of the cooking was good. Dining tables were attractively set and residents who required assistance to eat were helped to do so. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are protected from harm through thorough policies, procedures and staff training Evidence: Staff follow the homes policies and procedures relating to the management of complaints and allegations of abuse. Staff have been trained in the protection of vulnerable adults. Residents and their representatives are told how to complain through the complaints procedure. This was clearly visible within the home. The procedure needs to be updated to reflect the fact that CQC does not undertake complaint investigations on behalf of individuals. The complaints that were recorded for 2009 had been thoroughly investigated to the satisfaction of the complainants. Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safe comfortable home that is generally pleasant and clean. Evidence: The home was generally clean and free from odours. The furniture and general decor provides residents with a comfortable homely environment. A great deal of upgrading has taken place. In the past year the provider has replaced carpets and furniture in sitting rooms, dinning rooms and corridors. New bedroom furniture is currently being installed. New large, wall mounted TVs have been purchased and many places redecorated. The corridors are waiting to be dressed with pictures and the manager plans to theme each area for added interest. The external grounds are well maintained and pleasant. The garden is secure for residents to use and staff told us that residents generally enjoyed being outside in good weather. There were adequate numbers of bathrooms and toilets throughout the home but two bathrooms were used as storage areas. The Provider has agreed to review the use of these and bring them back to operation. The laundry was clean and well organised. The laundry is fitted with machines that cope with soiled and infected linen to control the risk of infection. Although the home was generally clean there some areas relating to infection control that could be improved. For example there were several bins without lids, these should be fitted Care Homes for Older People Page 17 of 26 Evidence: with lids to contain potentially contaminated material and be foot operated. The light pull cords were dirty and should be replaced. The treatment room was untidy and dusty. Paint was flaking from sluice walls rendering them permeable to infection, similarly some laminate was missing from workstations in the dining areas. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported and protected through sufficient staff numbers, skill and ability. Staff are suitably screened before employment. Evidence: The home was adequately staffed on the day of inspection and enough staff were scheduled to be on duty in the near future. There have been a number of vacancies for nurses, the first of which has just been filled. There are adequate numbers of domestic staff on duty. The manager confirmed that over 50 of staff had achieved or were training for NVQ level 2. Most staff were up to date with essential training, where they were not up to date they were booked onto a training course in the near future. The areas where training had lapsed were mostly infection control. Staff spoken to told us that they receive a good amount of training. In questionnaires staff told us that they had received adequate induction training before starting full care duties. Staff have also had training in subjects relating to care of elderly people with dementia. More of this training is planned. Five staff recruitment files were examined. These were for four care staff on duty that day and one newly recruited nurse. All contained good information. Thorough Care Homes for Older People Page 19 of 26 Evidence: background checks had been carried out before employment. Residents were protected through checking of criminal records information for all employees. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are not fully protected through reflective management which takes account of the diverse needs of the service. Evidence: The manager has only been in post five weeks, two of which he has been on holiday. The manager has not had time to assess all of the management systems and is still learning about the organisation. Recently the home has been operating without the manager, the deputy or the permanent nurses. This situation should now have been resolved because the manager and deputy have now returned to work and recruitment is ongoing for registered nurses. The home does operate a quality assurance system. Residents, their relatives and professionals are consulted about the service provided. The latest consultation was in spring 2009 and the results were positive. The manager was holding a residents and Care Homes for Older People Page 21 of 26 Evidence: relatives meeting on the day of the inspection. Servicing and maintenance agreements are in place for facilities and equipment. Risks in the environment and tasks, including safe working practices are assessed and reviewed. Internal safety checks, usually carried out by the handyman, were not available. The information that was available indicated that these checks had not been carried out for some time. The internal checks are important because they relate to the safety of residents in relation to hot water and bed rail equipment. Window restrictors are fitted to all windows, however, one of these had been overridden and was open enough that a resident could fall out. The window was in an unlocked bathroom on the first floor. There were no obvious trip hazards in the home. Fire exits were clear of obstruction and all hazardous fluids locked away. Residents personal money appeared to be well managed by the administrator at the home. Individual records are kept electronically. These are checked weekly by the manager and administrator. The money is kept in one central pot and banked in one account therefore we were unable to count it. Although all of the information relating to staff employment and training could be found the actual files were disorganised. Most training and recruitment records were mixed up, for example recruitment information in a training file. One set of documents was not in any file. One contained personal information relating to a carer and this was in a training file. This makes auditing difficult and could lead to a breach of confidentiality. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 26 13 Provide foot operated bins with lids. Replace light pull cords. Tidy and keep clean the treatment room. Redecorate the sluice. Regulation 13 requires care homes to take steps to reduce the risk of the spread of infection. 01/10/2009 2 38 13 Ensure window restrictors are not overridden. Ensure all health and safety check are up to date. Regulation 13(4) requires that unnecessary risks are identified and eliminated and all parts of the home accessed by residents are free from hazards to their safety. 01/10/2009 Care Homes for Older People Page 24 of 26 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 9 12 Increase auditing of medication during periods where agency staff are used on a regular basis. Social records should be kept up to date. A more extensive social programme should be developed. 3 4 5 6 16 21 31 37 Update the complaints procedure to accurately reflect CQCs role in complaint investigations. Ensure bathrooms are kept clear of unwanted equipment. The manager should seek registration with CQC. The standard of record keeping must improve. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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!