Inspection on 08/04/08 for Hunter Hall

This inspection was carried out on 8th April 2008.

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

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

Other inspections for this house

Hunter Hall 26/08/09

Hunter Hall 10/03/09

Hunter Hall 23/10/08

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Hunter Hall Kent Avenue Wallsend Tyne & Wear NE28 0JE Lead Inspector Elaine Charlton Key Unannounced Inspection 10:00 8 and 29 April 2008, and 1 May 2008 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 Hunter Hall DS0000028817.V363889.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. Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hunter Hall Address Kent Avenue Wallsend Tyne & Wear NE28 0JE 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) 0191 263 9436 0191 262 3633 hunter.hall@fshc.co.uk www.fshc.co.uk Tamaris Healthcare (England) Ltd Mrs Valerie Appleby Care Home 46 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (45) of places Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 The maximum number of service users who may be accommodated is 46. 10th April 2007 2. Date of last inspection Brief Description of the Service: 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) 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. Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star, this means that the people who use this service experience poor quality outcomes. An unannounced visit was made on the 8 April 2008, with further follow up visits on the 28 April and 1 May. A total of 12 hours were spent in the home at various times of the day. The manager or her deputy was present during each visit. Before the visit we looked at: Information we have received since the last visit on 10 April 2007; How the home has dealt with any complaints and concerns since the last visit; Any changes to how the home is run; The provider’s view of how well they care for people; The views of people who use the service, their relatives, staff and other professionals who visit the service. During the visit we: Talked with six people who use the service, five staff, two relatives and the manager; Arranged for an inspection of medicines and the medication administration systems to be carried out by a CSCI Pharmacist; Looked at information about the people who use the service and how well their needs are met; Looked at other records which must be kept; Checked that staff had the knowledge, skills and training to meet the needs of the people they care for; Looked around the building/parts of the building to make sure it was clean, safe and comfortable; Checked what improvements had been made since the last visit; Left “Have your say” questionnaires for residents, who were able, to complete (two were sent back to us); Sent “Have your say” questionnaires to the home for relatives and staff to complete (four relative and seven staff questionnaires were sent back to us). We told the manager what we found and gave her additional time to provide information that was not available during the inspection and could affect the judgements we made. This information did not arrive by email or post. The Regional Operations Manager did provide this information as soon as she knew we needed it. Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 6 What the service does well: The home receives and carries out full assessments of residents’ needs to make sure the right care and support can be provided. All areas of the home and the enclosed garden provide a safe environment for people to live in. We observed and were told that people communicate with relatives and health care professionals in a sensitive and knowledgeable way. People are protected and supported by good financial procedures and systems for the management of their money. Some staff showed a good understanding of people’s needs and were very sensitive in their recordings protecting and promoting privacy and dignity. Staff think it is important and involve relatives to help them get valuable information about how people might like their care to be provided when they are not able to say this for themselves. People are able to attend services and continue to take communion which helps to promote their spiritual well-being. Relatives said: “My relative is just settling in, I find the staff excellent. They have a very specialist job and are very patient”. “I am delighted at their warmth and patience with all of the patients”. “They have infinite patience”. “They get to know the persons needs well, understanding them”. “Just about everything”. Staff said: “Important information is always passed on. Especially if someone is ill or had a fall. If any changes to care plans occur it usually filters through the staff eventually. However, there is no care staff handover from the qualified at the beginning of every shift and I feel personally this would be an improvement to information transfer.” “The company is very good at encouraging education.” Nursing and care staff who took part in the inspection were very helpful and co-operated at all times. Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Improve the quality and content of care plans, evaluations and guidance so that staff know the needs of the person they are helping. Improve the systems and practice associated with the administration of medication within the home so that people are kept safe and can be sure they are getting the right medicines. Best practice guidance and the providers current procedures must be followed when medicines are received into the home and when giving and recording all medicines. This will help demonstrate that medicines are being given as prescribed thereby protecting the health of people living in the home and keep them safe. Provide staff with training and support so that they are able to carry out their job well. This will mean that people living in the home get the right care and support. Promote privacy, dignity, equality and diversity issues within the home so that people living there are always treated with respect and sensitivity. Deliver the planned programme of social activities and opportunities for people to get out and about in the local community. Provide CSCI with a programme of refurbishment and redecoration of the home for the comfort of the people living there. Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 8 Improve the water supply to the laundry so that staff working there can use all the washing machines. This will promote infection control and a better flow of clean clothes and other items. Properly follow recruitment and selection procedures at all times, including checking the suitability of people to work with vulnerable people. This will mean that people are kept safe. Provided CSCI with a completed copy of the Annual Quality Assurance Document (AQAA). This will help to demonstrated that the provider and manager are continually assessing the quality of services they provide. Provide training in wound management, communicating with people with dementia, safeguarding adults, and ensure all mandatory training is up to date. Provide a plan of improvement for the premises for the comfort of the residents. Ensure staff following recruitment and selection procedures and carry out all necessary checks before people start work in the home. Relatives said: “When I visit I always take lots of drinks for my relative and they drink as much as I can provide. I am never confident that they are encouraged by the home at meal times to eat and drink enough as there are simply not enough carers to attend to everyone’s needs”. “Apart from the usual problems of clothes going astray, they rarely make sure that glasses are clean and worn. For someone with advanced dementia life is confusing enough without not being able to see clearly”. When asked how the home could improve a relative said: “Provide more stimulation in the form of activities specifically for people with advanced dementia. Staff should be encouraged to initiate interaction with the less able residents and have a more inclusive rather than a reactive approach. Turn off televisions in the lounge and play music instead. Often the television is watched only by the carers. Television is the easy and lazy option”. When asked what the service could do better staff said: “Improve the environment by updating the décor and furniture. Staff having more time to spend with clients other than just seeing to their care needs.” “Support staff.” Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 9 “There is no care staff handover from the qualified at the beginning of every shift and I feel personally this would be an improvement to information transfer.” 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. Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 10 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 Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 11 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): Standards 3 and 6. People who use the service experience good quality outcomes in this area. People are properly assessed, taking into account their needs and wishes, so that they can receive a flexible, consistent and reliable service. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Residents, their relatives and staff were asked to complete questionnaires. Those returned reflected the views of residents with very differing needs and/or their relatives. People living in the home who sent back questionnaires said they got enough information to help them decide whether the home could meet their needs. The records of four residents were seen. Three were for people recently admitted to the home and one was for a person who has been resident for some time. Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 12 Copies of assessments from health care professionals or care managers referring people for care were seen in residents’ files. The organisation has a Dependency Assessment Rating Tool (DART) that is used as part of the assessment process. The front sheets of the DART assessments seen had been dated and signed. We were told that monthly DART evaluations should be carried out and that these identify any need for additional care plans. Some staff are making better use of the DART document than others. When fully and properly completed the scoring system shows whether a person should receive residential or nursing care and what level of care that is. A nurse we spoke to told us that relationships with healthcare professionals had improved and referrals for new residents were being regularly received. We were also told that relatives are usually told when the DART assessment is going to be done in case they want to be there. The home does not provide intermediate care. Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 13 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): Standards 7, 8, 9 and 10. People who use the service experience poor quality outcomes in this area. People receive care and support that is not always well planned or sufficient to meet their diverse needs. Their privacy and dignity is not always promoted. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Nurses are in the process of updating all the residents’ records. We saw three new files and one old one. The new files and the information in them are much better but the range of care plans is still limited. One file did not include a care plan or advice about how carers could diffuse or manage situations for a resident who they had been told could be physically and verbally aggressive. Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 14 Care plans written by a newly appointed nurse were seen to be very sensitive and showed that relatives had been closely involved. References were also made about helping a resident maintain their dignity and self-respect. A care plan about communicating with a resident included clear advice for carers about the tone of voice they should use and how loudly they should speak. They were also told that the person needed to be given time to understand what had been said. Blank documents were also seen in files and it was not clear whether this was because they had not been completed or were not needed. We were told that the practice of putting a range of forms in every file was being reconsidered. Monthly evaluations of care plans were not being regularly carried out. Some staff are more able to record outcome based evaluations in a sensitive and respectful way. Poor handwriting meant that not all records were easy to read. Recordings in two files showed that relatives had been closely involved in talking about, and recording, how a resident would like their personal care (in particular mouth care) to be provided. Another recorded what the person would have chosen to wear if they had been able to make this decision for themselves. Evidence was seen of tissue viability nurses and community matrons being involved in the care of residents as and when their needs dictated. People who live in the home, and their relatives, who sent back questionnaires feel they receive the care and support they need, and that enough staff are usually available to meet their needs. Relatives and residents also told us that medical support is always or usually available when it is needed. During the inspection we saw residents receiving foot care in a communal lounge, on the first floor, whilst other people were sat around. They had not been offered the chance to go to a private area where they could have been relaxed and their privacy and dignity would have been maintained. A complaint had been received from a visitor who had seen a carer shave several gentlemen in a lounge area with the same shaver. This had been confirmed through discussion between a nurse and the care staff involved. No thought had been given to promoting the residents’ dignity or infection control. The company has a procedure for staff that are supporting residents who are reaching the end of their life and need extra support. This details the need to Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 15 involve a range of healthcare professionals including the community matron, Macmillan nurse and Marie Curie. Staff have not received training to help them provide end of life care for people who are suffering with a dementia. They also need input to improve their understanding of privacy and dignity, values and attitudes and equality and diversity. Care staff were heard, on each visit to the home, shouting to each other along the corridors. No thought appeared to be given to the person they were assisting or people who may be in their bedrooms. The new nurse and a continence advisor had carried out fifteen re-assessments of residents needs to make sure that they were getting the right support and being provided with the correct continence products. A senior carer was heard speaking to a GP on the telephone. She gave a clear and sensitive description of a resident’s symptoms and agreed a course of treatment with the GP. Relatives gave very different responses to the question about whether the home met the needs of their relative. These ranged from always to never. The response was the same about whether people could live the life they choose. Relatives said: “My relative is just settling in, I find the staff excellent. They have a very specialist job and are very patient”. “When I visit I always take lots of drinks for my relative and they drink as much as I can provide. I am never confident that they are encouraged by the home at meal times to eat and drink enough as there are simply not enough carers to attend to everyone’s needs”. “Apart from the usual problems of clothes going astray, they rarely make sure that glasses are clean and worn. For someone with advanced dementia life is confusing enough without not being able to see clearly”. When asked what the home did well, people said: “I am delighted at their warmth and patience with all of the patients”. “They have infinite patience”. “They get to know the persons needs well, understanding them”. “Just about everything”. As a result of our initial examination of medication a CSCI pharmacy inspector was asked to carry out full audit of medication and systems in the home. Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 16 A number of requirements and recommendations have been made by the pharmacist who noted “aalthough the administration process I observed was satisfactory poor record keeping in the home together with some gaps on the medication administration records (MAR) charts indicates poor systems for medicines management overall”. Company medication policy and procedures are kept in the nursing station. They were due for review in March 2008. Documentation does not reflect the current requirements for the disposal of medicines using a waste contractor and disposal through a pharmacy is still taking place. There was no record to show that staff have read and understood the policies. No one who lives in the home is able to look after their own medication. Medicines are normally administered by registered nurses but occasionally by two senior carers if a nurse is not available. The process of giving out medication was observed on the first floor during the morning. A registered nurse was carrying out this task and, because they had not been internally assessed as competent to administer medicines, were being supervised by a second registered and assessed nurse. Good practice was seen including washing hands between medication administrations, wearing gloves when administering eye ointments, correct selection of resident and medication, offering plenty of encouragement and drinks. MAR sheets were signed after doses had been accepted. MAR charts for both floors were seen. They are kept in divided ring binders, one for each floor, and include each residents’ photograph and their room number. Details of allergies are recorded in a box on the MAR chart and we saw evidence of this in use. The staff signature list identifying those authorised to administer medicines was not up to date, was not dated and contained about 50 specimen signatures many of which now not relevant. Examples of hand written entries on MAR charts not being countersigned, quantities of medicines not recorded, not dated and with no signature at all were seen. All medication is kept in the treatment room on the first floor. The room is cramped and untidy with little usable worktop space. Other issues identified included: • Window open to reduce temperature but internal bars fitted. Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 17 • • • • • Medicines for disposal stored in three unlocked medicine delivery boxes plus one plastic carton. A supply of empty medicines waste bins were available in room but were not in use There was a box of Movicol sachets that were no longer in use on the window shelf. The refrigerator was not locked and the key was in the lock. The refrigerator was in need of defrosting. Some gaps were seen on the sheet for recording refrigerator temperatures. This had occurred on five days out on 30 in April. No dates had been recorded when some eye ointments, drops and nasal ointments with a limited life had been opened. Staff could not locate a current register showing drugs sent for disposal. One book was new and had no entries in it and another book, with the last recorded entries being made in April 2007, were seen. The manager told us that medicines are being disposed of through the supplying pharmacy and not a waste contractor. There was no evidence to support the legal basis of this route of disposal but the manager said medicines had recently been collected by the Pharmacy. No discrepancies were seen between the register, stock and entries on MAR charts for controlled medication. Three issues were identified: • • • Some liquid spillage in the base of cupboard had occurred wetting the outer carton of MST tablets. Three old entries, made in 2004 and 2007, for Temazepam and morphine solution where seen but there was no record of these being returned/disposed of. There was still a stock balance in the register. There was no evidence of regular checks being carried out on controlled medication being held in the home. We were told that some medicines update training had been delivered by Boots the Chemist but no records were seen. No medicine system audits had been done recently. We were told this was due to the absence of the manager who said that she proposed to reintroduce these checks three or four times a year. Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 18 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): Standards 12, 13, 14 and 15. People who use the service experience poor quality outcomes in this area. People are not always encouraged or helped to be as independent as they can and social opportunities are limited, providing little stimulation. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Some family members had recently been invited to complete a social/activity history form. Those seen gave good information and advice about what people had done, what they might like to still do, and an insight into their personality. A new activities co-ordinator has been appointed to the staff team and will work for 20 hours each week. On the last visit to the home the manager gave us a copy of the new activity programme. This includes programmed one to one time with residents; carer supervised activity time; one to one trips out; arts and crafts; exercise club; memory time; film club; afternoon teas; social evenings. Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 19 Details of trips/outings/events are going to be displayed in the home’s foyer so that resident’s relatives can be involved if they wish. When asked how the home could improve a relative said: “Provide more stimulation in the form of activities specifically for people with advanced dementia. Staff should be encouraged to initiate interaction with the less able residents and have a more inclusive rather than a reactive approach. Turn off televisions in the lounge and play music instead. Often the television is watched only by the carers. Television is the easy and lazy option”. Residents are given the chance meet their religions needs. A representative from the Catholic Church comes to the home each week so that people can take communion. Members of other churches also visit regularly. The manager told us that family and friends are welcome to visit regularly. She had also set a date for a relatives’ meeting. The files we saw had information in them about contact and visits from family and family involvement in review meetings. The kitchen is shared with an adjacent home. A chef and three kitchen assistants are on duty each day. We were told meal times go on for “as long as it takes”. We saw people having breakfast as late as 10:00, they were not being rushed and conversation was light and at times fun. Soft and pureed diets are provided. Pureed food was seen being served from potato scoops with each item being put on the plate separately. More thought could be given to the presentation of this type of meal. Advice and input from a dietician had been sought to support people with swallow problems. Dietary supplements are also available to make sure that people get proper nutrition. Staff were heard talking to each other across the dining room, over residents heads. Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 20 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): Standards 16 and 18. People who use the service experience adequate quality outcomes in this area. People are not confident that their concerns or complaints are taken seriously and properly investigated. Staff may not be properly trained in safeguarding adults that could place residents at risk. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Policies and procedures are in place to support the receipt, recording and investigation of complaints and concerns. We saw the complaint log where minor, verbal, complaints and concerns are recorded. All complaints should be clearly recorded to show when they were made, by whom, the nature of the concern, the outcome and whether the complainant was satisfied with the outcome. Several complaints had recently been received about care practice in the home. The investigation and tone of feedback to relatives was not encouraging or sympathetic. The manager had been absent on sick leave when the latter complaint had been dealt with and said she had already identified these issues for herself. One relative said: “Communication has always been a problem”. Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 21 Another person said: “I live a long way away and am only able to visit two days every month. Your questionnaire was left in my mother’s room and only discovered by my aunt who visited last week. She passed the form to me. If Hunter Hall had posted it to me I could have returned it on time”. The deputy manager and another manager in the organisation have been trained to provide safeguarding adults training to staff. Not all staff have had up to date training in safeguarding adults. Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 22 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): Standards 19 and 26. People who use the service experience adequate quality outcomes in this area. People live in a homely environment that keeps them safe and gives them the chance to spend time privately. All areas of the home are in need of refurbishment but were clean and tidy promoting the comfort of residents. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We were told on our first visit to the home that a thorough revamp of facilities in the home was to take place. On a later visit we were advised that there had been a reduction in the budget for refurbishment. The manager said the improvement programme would start with bedrooms and floor coverings to the first floor and further refurbishment would depend on what money was still available. Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 23 Blinds have been fitted to the glassed areas of the dining rooms to protect the privacy and dignity of residents whilst they are eating. During the tour of the premises the home was seen to be in a state of poor repair and decoration. There were no valances on beds in residents’ bedrooms and the bedding was of a poor quality. Pull cords in all areas were seen to be dirty and in need of replacement. There is limited storage available for equipment. We were told that the bedroom currently being used was to be re-commissioned as a bedroom. The laundry is shared with the adjacent home. Problems in the laundry continue. Washing machines have been upgraded but the water system cannot supply water to all four machines. Larger water tanks are to be fitted but until then only two washing machines are in use. On our last visit the laundry was seen to be disorganised and staff were having difficulty coping with the amount of laundry. Bags and piles of laundry were seen waiting to be done. This does not promote good hygiene and infection control. Domestic assistants were seen carrying out their duties during each of the visits and all areas were clean, tidy and odour free. Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 24 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): Standards 27, 28, 28 and 30. People who use the service experience poor quality outcomes in this area. Recruitment and selection procedures, staff training and supervision do not properly protect residents, their privacy and dignity and the chance to stay independent. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The deputy manager told us that there had been problems with staff not accepting change but that these had been addressed and new staff had been recruited. There had been two recent investigations involving staff behaviour which had been properly addressed. The company operates “zero tolerance” on the use of agency staff. Four Seasons has it’s own bank staff system but we were told this is through a booking system and does not work well when covering short notice staff absences. Staffing levels need to be based on the needs of people living in the home and not the number of people living there. Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 25 The manager said she taken over the organising of staff duty rotas so that she could ensure an equal level of staff and mix of skills and gender of carer over both floors. Two nurses and six carers are on duty from 08:00 to 14:00, two nurses and four carers cover from 14:00 to 20:00. At night there is one nurse and three carers on duty. A new member of staff told us that she had had a good induction and had been on training to use the assessment documentation. Staff have requested training in communicating with people with dementia, diabetes, first aid update and wound management. These are considered very relevant and necessary given the client group care is provided for. We saw evidence to show that the registration status of nurses is up to date. The records for five new members of staff were seen. Proper recruitment and selection procedures had not been followed. There was no application for one person, references were not available for three people and explanations for gaps in employment had not been properly explored or documented. A basic interview sheet was seen. It recorded that the manager had carried out the interview but was signed by her deputy. We were told that staff are able to request training as and when needed and that the company has it’s own in-house training service. Staff have requested training in palliative care and death, dying and bereavement. We were told that the home did not currently meet the National Training Organisation (NTO) recommended level of 50 of care staff having achieved a National Vocational Qualification at a minimum of level 2. Four staff were waiting to start this training. Seven staff sent back questionnaires. They gave differing responses to questions about support and the information provided about the residents they were caring for. These included always, usually or never getting enough information about residents needs. One person said: “Important information is always passed on. Especially if someone is ill or had a fall. If any changes to care plans occur it usually filters through the staff eventually. However, there is no care staff handover from the qualified at the beginning of every shift and I feel personally this would be an improvement to information transfer.” Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 26 They all said that they had received an induction and were given training that helped them understand peoples’ need and kept them up to date with new ways of working. One person said: “The company is very good at encouraging education.” “We have an appraisal process which is usually six monthly. However, you can usually approach senior staff for guidance and reassurance when required.” When asked what the service could do better staff said: “Improve the environment by updating the décor and furniture. Staff have more time to spend with clients other than just seeing to their care needs.” “Support staff.” Some staff are in need of refresher training in health and safety, first aid and moving and handling. Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 27 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): Standards 31, 33, 35 and 38. People who use the service experience poor quality outcomes in this area. Information about the home was not provided when we asked for it and this could mean that people may not be receiving a service that is organised and run in their best interests. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager is suitably qualified and experienced to run the home. We did not receive a copy of the Annual Quality Assurance Assessment (AQAA) when asked for it. It is a legal requirement for the home to complete the AQAA each year. Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 28 The company has policies and procedures in place to protect and manage monies on behalf of residents. There is a limit to how much money can be kept in the home. Numbered, carbonised receipt books are used and money held on behalf of residents is kept in a non-interest attracting account with the bank. Periodic unannounced audits are carried out by headquarters staff. The last was on the 4 March 2008. Staff are clear about the team of staff they are supervising. A nurse told us that she had started supervision with staff she is responsible for. The level of supervision and support that staff are currently getting does not meet the recommended levels in the National Minimum Standards. Maintenance and service contracts were seen and were up to date. We were told that staff had asked for training in the use of hoists and slings as they were not confident with all the equipment in the home. Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 29 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 3 Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 30 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 Requirement The quality and content of care plans must be improved so that staff are clear about the care and support a person needs. This will help keep people safe and well. Previous timescale of 31 July 2007, not met. 2. OP8 12 Care plans must include guidance for staff to help when managing people’s mental health needs and diffusing situations. This will mean that people living in the home are kept safe and well. Care plans must be kept under review and record the outcome of reviews. This will mean that people living in the home are getting the right care and support. Best practice guidance and the providers current procedures must be followed when medicines are received into the DS0000028817.V363889.R01.S.doc Timescale for action 08/10/08 08/10/08 3. OP7 14 08/10/08 4. OP9 13 06/05/08 Hunter Hall Version 5.2 Page 31 home and when giving and recording all medicines. This will help demonstrate that medicines are being given as prescribed thereby protecting the health of people living in the home. Medication must be stored securely/ safely and in line with any legal requirements. This will prevent any tampering with medicines and possible theft. A system for the safe handling of medication with a limited use once opened must be in place. A record of all medicines no longer required and disposed of must be maintained .This will ensure that there is an accurate record of medicines in the home. Disposal of all controlled drugs must be recorded in the controlled drug register. Stocks of medication must be checked regularly and ordered in a timely fashion. This will make sure that people receive their medication as prescribed and the treatment of their medical condition is not affected. 5. OP9 13 and 18 Additional training that reflects best practice guidelines must be provided to all staff involved in the handling and administration of medication. Having well trained staff helps to reduce the risk of medication errors and omissions. Residents must be given the chance to have their personal care provided in private. This will promote their privacy, dignity and self-respect. DS0000028817.V363889.R01.S.doc 08/10/08 6. OP10 12 08/07/08 Hunter Hall Version 5.2 Page 32 7. OP10 12 Staff must consider the residents they are supporting or who are around when they are speaking to each other. This will promote the privacy and dignity of everyone living in the home. 08/07/08 8. OP12 16 The planned programme of social 08/09/08 activities and opportunities for residents must be carried. This will mean that residents receive of stimulation and the chance to go out. Previous timescale of 16 April 2007, not met. 9. OP18 13 All staff must receive training in Safeguarding Adults. This will mean that people who live in the home and kept safe. Four Seasons Health Care must provide CSCI with a programme of refurbishment and redecoration for the premises. This will help to ensure that people live in a comfortable environment. The water supply to the laundry must be upgraded to ensure that all the washing machines can be used. This will promote infection control and the availability of clean clothing and linen in the home. Proper recruitment and selection procedures must be followed at all times, including checking the suitability of people to work with vulnerable people. This will mean that people are kept safe. Staff must have the opportunity to receive training in the areas they have identified, including DS0000028817.V363889.R01.S.doc 08/09/08 10. OP19 23 08/07/08 11. OP26 16 08/08/08 12. OP29 19 08/07/08 13. OP30 18 08/12/08 Hunter Hall Version 5.2 Page 33 communicating with people with a dementia, palliative care, death, dying and bereavement and wound management. This will mean that people living in the home can receive the care and support they need. 14. OP31 24 CSCI must be provided with a completed copy of the Annual Quality Assurance Document (AQAA). This will help to demonstrated that the provider and manager are continually assessing the quality of services they provide. Previous timescale of 14 February 2008, not met. 15. OP36 18 Staff must receive regular, documented supervision to help them do their job. 08/12/08 08/09/08 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 DART assessment should be properly and consistently used to identify the needs of people living in the home. This will make sure that they continue to receive the right care and support. Review the practice of keeping a range of documents in every residents file, whether they are needed or not. This will help staff to understand what a persons care needs are more easily. Staff should make clear recordings in care plans and other documents to that it is easy for everyone to read and DS0000028817.V363889.R01.S.doc Version 5.2 Page 34 2. OP3 3. OP7 Hunter Hall 4. OP9 understand. This will help reduce the chances of mistakes being made or additional care and support being provided. A system should be in place to record all medication received into the home, medication carried over from the previous month and medication sent for disposal. The record of medicines disposed of should include the name of the resident, medicine details, the quantity and the date. This makes sure that there is a complete record of medication in the home and helps confirm that medication has been given as prescribed. Handwritten entries and changes to MAR charts be accurately recorded and detailed. Staff should sign and date handwritten entries they make on the MAR charts and each entry should be checked and countersigned by a second person to reduce the risk of error when copying information. This makes sure that the correct information is recorded so that the person receives their medication as prescribed. The refrigerator should be locked and the key held with the other medicine keys when not in use. The refrigerator should be defrosted and the temperature regularly monitored, preferably using a maximum/minimum thermometer. This will demonstrate that medicines are stored within the appropriate temperature range and so are safe to use. Oral syringes should be used for measuring small liquid volumes. Syringes for the administration of injections should not be used to measure or administer oral liquid medicines. Regular audits of the medicine systems should be carried out together with regular checks on controlled drug stocks. This will help to ensure that staff are following all medicine policies and that medicines are safe and secure in the home. 5. OP15 Consideration should be given to alternative ways of presenting food that has to be pureed. This will mean that residents get the chance to eat food that looks appealing as well as meeting their nutritional needs. The complaints register should clearly record who has made a complaint/expressed a concern, the nature of the concern, the outcome and whether the complainant was DS0000028817.V363889.R01.S.doc Version 5.2 Page 35 6. OP16 Hunter Hall satisfied with the outcome. This will demonstrate that complaints, concerns and allegations are taken seriously and properly investigated. 7. 8. OP19 OP27 Consideration should be given to reviewing the facilities for storage within the home. Staffing levels should be established to meet the needs rather than the number of people living in the home. This will mean that staff have time to spend with people as a group and individually. Interview records should be completed and signed by the person or persons carrying out interviews. This will promote good employment and equality processes. At least 50 of care workers employed in the home should attain a National Vocational Qualification at a minimum of level 2. This will mean that people living in the home know that staff are properly trained to do their job. 9. OP29 10. OP30 Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Hunter Hall DS0000028817.V363889.R01.S.doc Version 5.2 Page 37 - 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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