Inspection on 23/07/07 for Huntercombe Hall Care Home

This inspection was carried out on 23rd July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Huntercombe Hall Care Home 30/05/06

Huntercombe Hall Care Home 07/02/06

Huntercombe Hall Care Home 04/08/05

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Huntercombe Hall Care Home Huntercombe Hall Huntercombe Place Nuffield Henley on Thames Oxfordshire RG9 5SE Lead Inspector Stephen Webb Unannounced Inspection 09:45 23rd July 2007 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 Huntercombe Hall Care Home DS0000063474.V344307.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. Huntercombe Hall Care Home DS0000063474.V344307.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Huntercombe Hall Care Home Address Huntercombe Hall Huntercombe Place Nuffield Henley on Thames Oxfordshire RG9 5SE 01491 641792 01491 641761 huntercombe@caringhomes.org www.caringhomes.org Huntercombe Hall Limited C/o Caring Homes Limited vacant Care Home 48 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) Category(ies) of Old age, not falling within any other category registration, with number (48) of places Huntercombe Hall Care Home DS0000063474.V344307.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To admit one named under age resident Date of last inspection 30th May 2006 Brief Description of the Service: Huntercombe Hall is registered to provide nursing care for up to 48 male and female service users aged 60 years and over. Registered nurses are on duty 24 hours a day. The home is in a rural part of Oxfordshire and public transport is limited. There is a country bus service, but the bus stop is some distance from the home. The public rooms are spacious and are on the ground floor. There are 40 single and 4 double rooms situated on the ground and first floors with each room having its own en-suite facilities of toilet and washbasin. Two single rooms have an en-suite shower suitable for infirm residents. There is a pleasant patio with garden tables and chairs accessible from the conservatory that overlooks the home’s extensive grounds. At the time of this inspection, the fees for this service ranged from £650 to £950 per week. Huntercombe Hall Care Home DS0000063474.V344307.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced site visit from 09.45 until 18.45 on 23rd July 2007. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from brief conversations with staff members on duty, and discussions with the manager and regional manager. The inspector spoke to a number of the residents during the inspection, and some time was also spent observing the interactions between residents and staff at various points during the inspection and over lunch with the residents. The inspector also toured the majority of the premises, including some of the bedrooms. The home had responded to the issues raised in the previous inspection report and the manager and regional manager demonstrated a positive approach to the inspection process. The home manager’s application for registration was being processed. What the service does well: The needs of prospective residents are identified through a thorough preadmission and post-admission assessment process, which leads to a detailed individual care plan. The detailed care plans record the needs and wishes of residents are supported by a range of other useful formats, and the healthcare needs of residents are also met. Though none of the current residents is able to manage their own medication, the home has an effective system for managing this on their behalf. Staff respect the privacy and dignity of residents. The home tries to establish the likes, dislikes, hobbies and interests of the residents and seeks to provide a range of activities, entertainment and outings to meet the diversity of social and cultural needs of residents. Huntercombe Hall Care Home DS0000063474.V344307.R01.S.doc Version 5.2 Page 6 Most residents have regular family contact and the home supports open visiting. Residents also have opportunities to access the local community, supported by staff. The residents are supported to make choices in their day-to-day lives, where they are able. The home provides residents with a varied and wholesome diet. Choices are available at every meal, and residents are consulted about the menu. The home has an appropriate complaints procedure, of which residents are aware, and complaints forms are readily available in the entrance hall. The complaints record indicates that complaints are taken seriously and appropriately acted upon. Systems are in place to protect residents from abuse, and the staff receive appropriate training on safeguarding vulnerable adults. Residents are provided with a safe, well-maintained and homely environment for the most part, with specialist equipment provided to meet individual needs. Standards of hygiene throughout the home were good, and the home has an appropriately equipped laundry. The staffing levels and skill mix of staff are sufficient to meet the current needs of residents, and ongoing progress is being made regarding NVQ attainment. Residents are protected by the home’s recruitment and vetting practice, and staff receive an appropriate core training programme. The home is well managed by a competent management team, and the management are accessible to residents and relatives. The home consults appropriately with residents, relatives and others about their views on the service provided, and has effective management monitoring and review systems in place. The health, safety and welfare of residents and staff are promoted. What has improved since the last inspection? The assessment process has been improved in the past year. The manager is seeking to further develop the range of activities and outings, and the role of the activities coordinator. Training is being sought to address the impact of the Mental Capacity Act. Huntercombe Hall Care Home DS0000063474.V344307.R01.S.doc Version 5.2 Page 7 Ongoing efforts are being made to maximise the quality of the dining environment and there have already been significant improvements in menus and choice. In general the home has benefited from having a consistent manager in post who maintains an overview of the home supported by effective management monitoring and support systems. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Huntercombe Hall Care Home DS0000063474.V344307.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 Huntercombe Hall Care Home DS0000063474.V344307.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): Standards 3 and 6: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of prospective residents are identified through a thorough preadmission and post-admission assessment process. Standard 6 is not applicable since an intermediate care service is not provided. EVIDENCE: A sample of three resident’s case record files was examined. Each contained a detailed preadmission assessment to a standard format, which included details of social, healthcare, spiritual and cultural needs. On admission, an admission and assessment format is completed, together with relevant risk assessments and other documents in order to develop the individual’s care plan. Copies of discharge summaries from previous placements were also on file where applicable. Huntercombe Hall Care Home DS0000063474.V344307.R01.S.doc Version 5.2 Page 10 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: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs and wishes of residents are recorded within detailed individual care plans, supported by a range of other useful formats, and their healthcare needs are also met. There is room for further development in terms of the systems for recording and evidencing the health and social care provided. None of the current residents is able to manage their own medication, but the home has an effective system for managing this on their behalf. Staff take appropriate steps to respect the privacy and dignity of residents, and treat the residents with respect. EVIDENCE: Each resident’s file has a care plan in place, subdivided into relevant sections, which is supported by a range of other documents. The supporting documents include relevant risk assessments on various aspects of care, information on communication, a biography giving information Huntercombe Hall Care Home DS0000063474.V344307.R01.S.doc Version 5.2 Page 11 on the individual’s life and employment, details of any individual likes, dislikes, preferences and preferred individual daily routines. There is also a format for the resident or their next of kin to agree review frequency and consent to various matters. The information supports the nursing and care staff in getting to know the resident as an individual, as well as meeting their identified needs. Issues relating to spiritual or cultural diversity needs are also identified. A comprehensive range of risk assessments is completed to identify needs in specific areas relating to health and nursing care. The manager monitors all accident forms and more than two accidents within a month, by an individual, triggers a review of their falls risk assessment. In response to a previous inspection recommendation the manager indicated that staff training on working with residents who are hearing impaired is being provided, though this did not appear on the training audit available. The training matrix was not available at the time as it was being updated. One of the nursing staff had also received training on syringing ears, to address this where necessary. The service manager indicated awareness of the possible implications of the new Mental Capacity Act in terms of consent and “mental capacity”, and had raised the need for training in this area within the provider organisation. No readily available record of the actual delivery of care to each resident was available, and information within daily notes was variable. The possible benefits of a system of individual personal care monitoring records, was discussed with management, and it was agreed this would be considered. Such a system provides individualised evidence of the actual care delivery, and if staff are required to initial the record when they complete elements of care, it also provides accountability. The manager indicated that none of the current residents had any pressure sores, and said that the home has few instances of these, mostly arising where a resident is admitted with one already in place. The home has a range of equipment in place to reduce the risk of pressure areas development, and has sought the advice of the tissue viability nurse. An appropriate wound assessment chart was available, which includes a system for review and monitoring, designed for use in monitoring the full range of wounds. However, in the case of one resident with a small leg ulcer, no measurements had been recorded and the one photograph taken was rather blurred. Huntercombe Hall Care Home DS0000063474.V344307.R01.S.doc Version 5.2 Page 12 In discussion with the home manager and service manager, it was agreed that a digital camera would be obtained to ensure better quality pictures, and that appropriate measurement systems would be explored to compliment and inform the existing recording format, in order to evidence and monitor the healing process. There was evidence with care plans of their regular internal review and updates are recorded within the relevant area of the plan. Periodic reviews with the appropriate care manager and/or next of kin are also undertaken. Case records also included records of medical appointments and outcomes, with various external healthcare professionals. In discussion the manager indicated that situations where individual resident’s complex needs have presented challenges, the home has responded appropriately, adopting different approaches where possible to address and manage the situation, and also recognising when an individual’s needs could no longer be met by the home, and supporting a move to a more appropriate alternative service. None of the current residents is felt able to manage their own medication but the home has an effective system in place to manage this on their behalf. The nursing staff administer all medication within a monitored dosage system, and the pharmacist has provided training in this area. Records provide the necessary audit trail for medication and include double signatories for controlled drugs. Storage is within appropriate cabinets and a medication fridge is also available. The medication policy/procedure is present within the medication administration record (MAR) sheet files as is a photo and details of any allergies regarding each resident. Homely remedies are only used where their use with existing medication has been authorised on an individual basis by the GP and any changes to prescriptions are only actioned following receipt of written GP confirmation. Where unused medication is destroyed, this is appropriately recorded. One resident’s emergency epilepsy medication is securely stored within their bedroom for ready access in emergency. The pharmacist last visited in May 2007, to inspect the medication management systems. Huntercombe Hall Care Home DS0000063474.V344307.R01.S.doc Version 5.2 Page 13 During the inspection residents’ dignity was observed to be respected by the staff in terms of knocking on doors, using appropriate terms of address and the provision of serviettes etc. and staff spoke respectfully to the residents. The bathrooms and toilets are also fitted with appropriate locks. Some of the residents confirmed that staff respected their dignity and privacy and that they were well looked after. Staff enabled residents to eat lunch in an unhurried way, whilst being attentive and avoiding unnecessary delays, and individual requests were met without delay. For example one resident’s request for additional gravy was immediately met, and another’s earlier request for a particular meal (not on the menu that day), had also been met. The manager indicated that appropriate screening was provided in shared bedrooms on request, when occupied by two residents. Residents reportedly only share a bedroom at their own request. One of the small lounge areas is also made available for residents to receive visitors in private, as an alternative to using their bedroom. At the time of inspection all of the residents apart from one were of white UK origin, but their individual spiritual and diversity needs were identified within the care plan and addressed by the home. In the case of one resident who is not of white UK origin, the home has a staff member who can speak the resident’s birth language, and she is asked to assist where communication becomes difficult. The needs of wheelchair users within the home, have been addressed through the provision of ramps where necessary and various doors have been made to open wider, which has presented some difficulties in one area. The doorways throughout the communal areas are held open on electromagnetic holdbacks during the daytime to enable wheelchair-using residents to mobilise freely. Huntercombe Hall Care Home DS0000063474.V344307.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15: Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home tries to establish the likes, dislikes, hobbies and interests of residents and provides a range of activities, entertainment and outings to meet the social and cultural needs of residents. The manager continues to seek further developments in this area. The home tries to meet the spiritual needs of residents, but needs to continue to pursue visits from a Church of England representative for residents of this faith. The vast majority of residents have regular family contact and/or visits, and the home supports open visiting. Residents also have opportunities to access the local community, supported by staff. Residents are enabled and supported to make choices in their day-to-day lives, where they are able. Training is being sought to address the impact of the Mental Capacity Act. The home provides residents with a varied and wholesome diet. Choices are available at every meal, and residents are consulted about the menu. Ongoing efforts are being made to maximise the quality of the dining environment. Huntercombe Hall Care Home DS0000063474.V344307.R01.S.doc Version 5.2 Page 15 EVIDENCE: Residents’ care plans and supporting documents include reference to previous activities, interests and hobbies, and identify their religious faith and whether they wish to pursue it, so aspects of spiritual and individual cultural diversity are addressed effectively, and biographical information is also available to facilitate engagement and conversation. The home has an activities coordinator who was off sick at the time of this inspection, but a carer has taken on the role in their absence and was providing a good range of activities for varied tastes. The activities included movie sessions, relaxation with classical music, reading, knitting, pampering sessions, ball games and a range of external visitors and entertainers, including singers, “pets as therapy” and a local birds of prey sanctuary, where the home has adopted a bird of prey. The home also organises outings for residents, which have included a boat trip on the Thames, a visit to a garden centre and shopping trips. Residents’ birthdays are celebrated and there are various social events throughout the year. Residents talked about the various events and trips out and there were framed photographs of residents enjoying a number of these displayed in the entrance hall. Resident feedback about the activities was positive and several also said they had enjoyed the outings and entertainers. They were also looking forward to the upcoming barbecue at the home. The colourful activities posters, which were available in a holder in the entrance hall, indicated planned activities on most mornings and afternoons, seven days per week. The manager indicated that she wanted to further expand the range of activities and develop the role of the activities coordinator so they facilitate the involvement of other staff in leading short activities, and looking creatively for opportunities within their daily work, to undertake these. She was also planning for individual activities assessments to be undertaken, to ensure that there was something provided for everybody, which met their needs. The activities coordinator keeps individual records of residents’ involvement in activities, which were held collectively for ready access. It is recommended Huntercombe Hall Care Home DS0000063474.V344307.R01.S.doc Version 5.2 Page 16 that as these sheets are completed, they are filed within the residents’ files as a record of their social and recreational life in the home. For those residents of the Roman Catholic faith a local priest will visit to support their spiritual needs, and the home used to have a Church of England vicar who visited, but the manager has been unable to secure such visits recently. The manager should continue to approach the church through appropriate channels in order to secure a visiting service to the home. Around three quarters of residents have regular family contact and visits, and only very few have no visits or contact. Some family visit and take residents out for lunch or for the day. As noted above, the care plans and associated documents contain records of residents’ individual choices, preferences, likes and dislikes where known, within the various formats. Residents also have opportunities to make choices in their day-to-day lives, and this was observed at various points during the inspection, such as in relation to drinks and meal options at lunch and whether or not to participate in the afternoon’s singing session. None of the residents is able to manage their own finances and the home currently manages them on residents’ behalf. Residents are able to bring in some of their own familiar items to individualise their bedroom. The manager indicated they could bring in anything that complied with health and safety requirements. The service manager was aware of the possible implications of the new Mental Capacity Act, in relation to residents’ capacity to make choices, and was seeking training on this for the staff team. Feedback from residents was complimentary regarding the food provided, and the ready availability of choices was confirmed, and witnessed on the day. One resident particularly liked the choice now available at breakfast and another had ordered a different meal, which was not on the menu that day, which had been provided. The manager had held a meeting with residents and their families and had also circulated questionnaires regarding the menus, and had made changes in response, including two meat choices at main meal as well as the vegetarian option and wider options at breakfast and teatime. More fish options had also been added and curry was also now on the menu. Huntercombe Hall Care Home DS0000063474.V344307.R01.S.doc Version 5.2 Page 17 The menu provides a varied and appropriate diet and the meals on the day of inspection were of good quality and well presented. The chef now meets with the residents to get direct feedback and provide opportunities for requests. At present there are few specialist dietary needs, but meals are blended for a small number of residents, keeping the meal elements separate to maintain variation in flavour and texture, and a small number require “peg” feeding, for which staff had reportedly been trained. It had been noted in a previous inspection that the dining room was rather crowded, and this had been addressed to some extent by moving a couple of tables into the conservatory, which was a pleasant dining environment. However, this does rather limit the use of the conservatory at other times of day, so the manager plans to try using one of the small lounge areas as an additional dining room instead. Huntercombe Hall Care Home DS0000063474.V344307.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): Standards 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 an appropriate complaints procedure in place of which residents are made aware, and complaints forms are readily available. However, the format of the complaints form could be made more user friendly. Residents confirmed their awareness of the procedure. The complaints record indicates that complaints are taken seriously and appropriately acted upon. Systems are in place to protect residents from abuse, and the staff receive appropriate training on safeguarding vulnerable adults. EVIDENCE: The home has a recently revised complaints policy/procedure in place, and the procedure and complaints forms were available in the entrance hall, without recourse to staff. However, whilst the complaints form may be suitable as a monitoring tool, it is not particularly user friendly. It is suggested that the format be changed to be more accessible to residents and others. The basic details of any complaints are logged in date order on typed sheets within a confidential file for management monitoring purposes. The file also contains a plastic wallet for each complaint, containing the completed Huntercombe Hall Care Home DS0000063474.V344307.R01.S.doc Version 5.2 Page 19 complaints form as a front-sheet, together with associated correspondence, statements etc. The manager demonstrated an open and positive attitude to complaints as a source of information to support continuous improvement of the service and this was reflected in the log, which indicated nineteen issues having been raised since the last inspection, (one of which was a staff issue which should have been raised via the grievance procedure). The majority of the issues were informal complaints of a relatively minor nature, and all had been appropriately addressed and resolved. The inspector spoke to several residents, who were all aware of the complaints procedure, which was posted in the entrance hall, and said they would report any concern to the manager. Two concerns were raised with the commission since the last inspection, both of which were monitored at this inspection and found to have been addressed appropriately via training. A copy of a further complaint, which had also been sent to the home, and appropriately addressed by them, was also received. Over eighty percent of the staff had received training on safeguarding vulnerable adults and the home had a policy on this. Remaining staff will be provided with this training as it is part of the provider’s core training. No POVA-reported issues have arisen since the last inspection. However, one or two concerns have been raised relating to resident care and welfare. Where such issues have arisen, the home has responded appropriately to change procedures, provide additional training or equipment. The home has appropriate systems and records in place for the management of residents’ money on their behalf. Huntercombe Hall Care Home DS0000063474.V344307.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): Standards 19 and 26: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a safe, well-maintained and homely environment for the most part, which is appropriately adapted to meet their needs, though there is a need to address the lack of storage and some other issues. Standards of hygiene throughout the home were good, and the home has an appropriately equipped laundry. EVIDENCE: The home is decorated to a good standard and furnished in a homely fashion, and the communal facilities in the original part of the building in particular are very attractive. The home provides a lounge, a quiet room/library, an additional smaller lounge room, a conservatory and a dining room. Previous problems with the fire alarm have been addressed by the installation of a new fire alarm control panel and the majority of fire doors in communal Huntercombe Hall Care Home DS0000063474.V344307.R01.S.doc Version 5.2 Page 21 areas are held open in the daytime, on electromagnetic hold-backs which release the door to close on sounding of the alarm. This enables residents who are able, to mobilise independently about the building. One fire door, which has had to be widened to allow wheelchair access, now opens slightly across the door to a resident’s bedroom, which presents a potential hazard. Whilst alternatives do not obviously present themselves, it is suggested that further explorations of any possible reconfiguration to avoid such an arrangement, are made. Some of the residents prefer their bedroom doors to be open during the day, but it was noted that this was not achieved via an approved device in some cases. Where a resident wishes for their door to remain open in this way, the provision of an approved holdback device should be risk assessed and tested in the particular location. Wedges and other impromptu devices must not be used, as they do not allow the door to close freely on its self closer in the event of fire. The advice of an occupational therapist had been sought regarding appropriate specialist provision to meet the needs of one resident, and a range of other adaptations and equipment is provided to address the diverse needs of other residents. These adaptations include two passenger lifts, baths with pillar-hoists, parker baths, wheelchair accessible showers, standing, and other mobile hoists, and the provision of ramps where necessary, though the latter has presented its own problems in two areas of the extension, where the ramps cross a small number of bedroom doorways on each floor, introducing a step up to the rooms. It does not seem possible to address this easily now, owing to the layout in these areas, but it should have been avoided at the design stage. It was evident from some of the inappropriate storage of stock pads, unused yellow waste bags and other stock supplies, that the home lacks sufficient storage for these items. The bulk storage of stocks of pads and yellow bags in the open, in toilets is neither hygienic nor desirable, though a small cupboard could be created in these locations to hold a working stock. It is suggested that management re-inspect the building to identify opportunities for the creation of additional storage facilities. The inspector brought one potential location, on landing at the top of one of the staircases, to the manager’s attention during the inspection. This offered the potential for quite a large cupboard with no loss of usable width on the corridor, and it may be possible to identify other such opportunities. Huntercombe Hall Care Home DS0000063474.V344307.R01.S.doc Version 5.2 Page 22 The bedrooms were individually decorated, of varied layout, and personalised to different degrees by their occupant(s). The home has four double rooms, and screening was said to be available on request where they are being shared. All of the bedrooms have an en suite toilet and five also have en suite bathing facilities. Verbal feedback from some of the residents was positive about the physical environment. One commented that it is a lovely building and another said the garden was especially lovely and confirmed that residents sat out on the terrace at the tables and chairs provided, when the weather was warm. The recent torrential rain in the period just before the inspection had revealed a problem with the roof in one area, which had been leaking. Contractors had already visited and were due to return to address the problem once the area dries out. The manager had obtained funding to refurbish the lounge and there were plans to provide new furniture, footstools and to replace the carpet, which had become stained, and to provide a large screen TV. The home’s laundry was appropriately equipped to meet the needs of residents, and standards of hygiene around the home, were good. The home was free of unpleasant odours, and this was commented upon by one of the residents who said that this had been a key factor in them deciding to come to live there. Huntercombe Hall Care Home DS0000063474.V344307.R01.S.doc Version 5.2 Page 23 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, 29 and 30: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staffing levels and skill mix of staff are sufficient to meet the current needs of residents, and ongoing progress is being made regarding NVQ attainment. Residents are protected by the home’s recruitment and vetting practice. The provider has an appropriate core training programme, but some additional training is required in identified areas. EVIDENCE: The staffing levels and skill-mix of the team appears appropriate to meet the current needs of residents. Where resident numbers are less than forty-four, the staffing is two nurses and six care staff throughout the day. Where there are forty-four or more residents, an additional carer is provided throughout the waking day. Night staffing is two nurses, and three carers. The home has its own bank staff who are used to cover shortfalls on the rota rather than use agency staff, wherever possible. The manager indicated that only five shifts in the three months leading up to completion of the AQAA preinspection questionnaire had included agency staff. Huntercombe Hall Care Home DS0000063474.V344307.R01.S.doc Version 5.2 Page 24 However, the home does experience difficulty in recruiting local staff owing to its isolated location, and chooses to recruit nursing staff from abroad, though it also maintains a standing recruitment advertisement in a local job centre. The provider has their own internal staffing agency, which undertakes recruitment locally in Poland on behalf of the service. The manager undertakes a telephone interview once applicants have completed writing and English language assessments, and later a face-to-face interview is undertaken at the home. New recruits from overseas commence work on a three-month trial period, the same as those recruited locally. Staff were said not to start work until the POVA check, CRB and mandatory training is completed, and to shadow existing staff during the early stages. In response to previous concerns regarding the ability of some overseas staff to communicate effectively with the residents all overseas staff are now provided with English lessons to support their communication with residents. Examination of a sample of the recruitment and vetting records indicated an appropriately rigorous vetting process, for the most part including the translation of references, where necessary. In one case a copy of the CRB was not available but the member of staff provided their own copy to confirm this was in place. In another no copies of photo ID were present though it was confirmed that examination of these was part of the vetting process. Good progress had been made on attainment of NVQ by the care staff, but with three staff leaving recently, the percentage of carers with NVQ level 2, had dropped to around 42 . However, the manager indicated that a further six staff recently enrolled to undertake NVQ level 2, and two of those who have completed level 2 are enrolled and working towards their level 3. Feedback from the residents spoken to indicated that they were happy that the staff are “very good” and look after them well. One said that you sometimes have to wait a bit when they are busy, and another commented that she could understand the staff better now, but that they sometimes didn’t understand the jokes and funny sayings people used. The provider has an in house training company, “Training In Care”, who are an approved City and Guilds assessment centre accredited to deliver much of the required core training. They produce a training programme and a regular newsletter, and courses are provided either by in house accredited trainers, or by external trainers. The core training covers the required areas and additional specialist courses are also made available where required. Huntercombe Hall Care Home DS0000063474.V344307.R01.S.doc Version 5.2 Page 25 The manager has a training matrix and a training audit tool, (though the former was unavailable on the day of inspection), which provide an overview of training to the whole team. The available training audit tool was, in most instances completed with ticks rather than dates, so was not completely transparent as regards the dates when the recorded training took place, though it is understood the dates are included within the matrix. Examination of the training audit tool indicated that most staff had received the majority of the core training, though significant gaps were evident, in fire safety training, where there was no record of this training having been received by about half of the staff team; and first aid, where there was no record of all of the care staff having received at least the basic one day first aid training, though some had received the “Appointed Person” first aid training. Specialist training in pressure area care should also be provided to at least some key staff, and ancillary staff would usually be expected to receive COSHH training. It is also suggested that additional staff receive training on dementia awareness to support their care of residents where this may become relevant. Huntercombe Hall Care Home DS0000063474.V344307.R01.S.doc Version 5.2 Page 26 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: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed by a competent management team, who are accessible to residents and relatives. The home consults appropriately with residents, relatives and other stakeholders about their views on the service provided, and has effective management monitoring and review systems in place. Appropriate systems are in place to protect residents’ finances, though full receipting of all expenditure is recommended. The health, safety and welfare of residents and staff are promoted. Huntercombe Hall Care Home DS0000063474.V344307.R01.S.doc Version 5.2 Page 27 EVIDENCE: The manager is appropriately experienced and qualified to manage the unit and was in the process of obtaining registration. She is an RGN and has also completed the Registered Manager’s Award, and attends ongoing training to maintain and update her knowledge. The manager had a relaxed relationship with residents, who feel able to approach her directly, and this was observed during the inspection. Staff and residents received a quality assurance survey in June, and the returned forms were analysed by an external consultant, who produced a summary report for management. The results of the survey were also fed back to residents via the residents meeting and recorded in the minutes thereof, which are sent to each resident. Quality assurance questionnaires were also sent to stakeholders and relatives at the same time, but the results are still awaited. Residents and relatives were also consulted separately about the new menus, and the chef now makes contact with residents directly to seek feedback. A comprehensive monthly management monitoring system is in place, including the completion by the manager of a detailed monthly report to head office, and other monthly audits also take place, such as a training audit, and these, together with the home’s business plan, address the requirements for annual development planning. The service manager undertakes monthly Regulation 26 monitoring visits and provides the reports to the manager. The reports include evidence of proper consultation with residents. The home is working towards Investors In People accreditation. None of the residents is able to manage their own finances, but the home has an appropriate system in place to do this on their behalf, which is run by the home’s administrator. Individual records of expenditure are maintained, as are separate wallets for each resident’s money. Receipts are retained for most expenditure, and it is recommended that receipts are also obtained for hairdressing payments to provide a fully auditable record. Examination of a sample of health and safety related service certification indicated that servicing had taken place with the appropriate frequency, with the exception of the gas safety check, where an up-to-date certificate could Huntercombe Hall Care Home DS0000063474.V344307.R01.S.doc Version 5.2 Page 28 not be located. This safety check should be arranged if evidence of a recent check cannot be located. The home had an up to date fire risk assessment, which had been reviewed in November 2006, and daytime and night-time fire drills had recently taken place, which had identified some issues, for which new staff training was being provided. The home has a range of specialist equipment provided to support the staff in meeting the needs of residents. Examination of the home’s accident recording system indicated that both the required collective record and individual records of accidents were present. The collective records are separated by month and monitored by the manager for trends and patterns. Huntercombe Hall Care Home DS0000063474.V344307.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 4 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 3 Huntercombe Hall Care Home DS0000063474.V344307.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO 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 OP19 Regulation 23(4) Requirement The manager must ensure that where any fire door is to be held open, this is only by means of an approved hold-open device, which enables the door to close freely on it’s self-closer in the event that the fire alarm sounds. The provider/manager must ensure that all staff receive the full range of core training, updated with appropriate frequency. Timescale for action 23/08/07 2 OP30 18(1) 23/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP8 OP12 Good Practice Recommendations The manager should consider how to improve the records of the care and treatment given by the staff, as discussed, so as to provide effective evidence of this. The manager should continue to pursue visits from Church of England clergy via appropriate channels, in order to support the spiritual needs of residents of this faith. DS0000063474.V344307.R01.S.doc Version 5.2 Page 31 Huntercombe Hall Care Home 3 4 5 6 7 8 OP16 OP19 OP19 OP30 OP35 OP38 The provider/manager should consider providing a more user-friendly complaints form. The provider/manager should consider any possible resolutions to the identified fire door issue in order to avoid the possibility of accident. The provider/manager should explore any possibilities for the creation of additional storage cupboards, to address the inappropriate open storage of various items. Consideration should be given to providing specialist training in the identified areas to additional staff. It is recommended that receipts are also provided to cover the expenditure of residents’ money on hairdressing, to provide a fully auditable record. It is recommended that a gas safety check be arranged if certification of such a check within the last twelve months cannot be located. Huntercombe Hall Care Home DS0000063474.V344307.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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. 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