CARE HOMES FOR OLDER PEOPLE
Hunters Care Centre Cherry Tree Lane Cirencester Glos GL7 5DT Lead Inspector
Mrs Kate Silvey Key Unannounced Inspection 18th & 24th January 2008 10:15 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 Hunters Care Centre DS0000016479.V350085.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. Hunters Care Centre DS0000016479.V350085.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Hunters Care Centre Address Cherry Tree Lane Cirencester Glos GL7 5DT 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) 01285 653707 01285 655529 hunters@barchester.com www.barchester.com/oulton Barchester Healthcare Homes Limited Mrs Susan June Stannard Care Home 89 Category(ies) of Dementia (33), Old age, not falling within any registration, with number other category (56) of places Hunters Care Centre DS0000016479.V350085.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 providing nursing or personal care- Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category- Code OP- maximum 56 places 2. Dementia- Code DE- maximum 33 places The maximum number of service users who can be accommodated is 89. 28th July 2006 Date of last inspection Brief Description of the Service: Hunters Care is a purpose built care home with nursing for older people, which accommodate older people with both general nursing and dementia care needs. The general nursing accommodation is situated on two floors and comprises of both single and double bedrooms with en-suite facilities. There is a large lounge area and dining room on the ground floor with several smaller lounges on both the ground and first floor. The recent additional nineteen-bedded general nursing care unit on the first floor has two spacious lounges and a dining room. Many of the lounges give a view across the surrounding landscape and some smaller ones provide privacy to people and their relatives if they wish to use them. The dementia care Unit provides nursing care and is situated on two floors. It is divided into three separate units with the more able people are accommodated in the ground floor units with access to a large circular ‘wandering corridor’ with seats and a lounge area. An enclosed garden area can be accessed from this corridor, which people can freely use. The accommodation on the first floor has an open lounge area and separate dining room/lounge. A new enclosed garden area has been developed at the side of the unit for people to use with staff support. There are assisted bathrooms and toilets situated in all of the areas used by
Hunters Care Centre DS0000016479.V350085.R01.S.doc Version 5.2 Page 5 people living in the home. The kitchen and laundry area is situated on the ground floor. There is a recent new addition of a large activities room providing excellent facilities. The current fees range for £850.00 to £1200.00 dependent upon care needs, the room available and whether nursing care is required. The fee may be less if a companion room is taken. Additional costs include: Chiropody, hairdressing, newspapers and visitors meals. Hunters Care Centre DS0000016479.V350085.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes
The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The home was inspected by us (the Commission) on two days, the first day was unannounced and there were two inspectors and the second day was announced with one inspector. All areas of the home were seen and people were spoken to, which included visitors, people that live in the home and staff. Eighty-two people were accommodated on the first day of the inspection. We looked at care records and some policies and procedures, including medication administration, quality assurance information and fire safety procedures. The registered manager returned the Commissions Annual Quality Assurance Assessment, this is a self-assessment about the home and is a legal requirement, it was well completed with a lot of information. We sent surveys to the staff, relatives and people living in the home and received completed surveys from twelve relatives, thirteen people living in the home and three staff. What the service does well:
The experienced staff complete a comprehensive pre-admission form to help ensure that peoples needs are identified and can be met before they move into the home. The home has a lot of information to give to people about the facilities and procedures in the home in the Service User Guide and the Welcome Pack, with additional information in the reception area in the homes Statement of Purpose. People are well cared for and are treated with respect in a dignified manner and their individual wishes are recorded and met. People said to us during the inspection that ‘all the staff are very kind and patient’, ‘staff are always the same nothing is too difficult for them’, ‘all you have to do is ask and staff help you’, and ‘this is a beautiful place’
Hunters Care Centre DS0000016479.V350085.R01.S.doc Version 5.2 Page 7 People’s surveys stated; ‘very good care, staff are sympathetic and kindly’, ‘staff are always very helpful, pleasant and cheerful’ Relatives’ surveys stated; ‘The staff are well organised, friendly and competent’, ‘the dementia care is first class for mother, and father’s care is outstanding as he has very high care needs’, ‘excellent care they do everything well’, ‘standard of care excellent and very little staff turnover’. Healthcare needs are identified and people are well supported by additional healthcare professionals when required. Our observations were that people who could not respond well in the dementia unit looked alert, relaxed and responded positively in other ways, for example by smiling. The home has dedicated staff for activities and people are able to choose from a range of things to do and the weekly programme is altered to ensure the changing needs of the people are met. The home has a newsletter and this advises everyone of the programme for the forthcoming week. There are also bus trips to visit places of interest in the local community. People living in the home are involved in the organisation of some activities, which includes ‘music appreciation’ The home provides good quality food with options for all meals and each course, where people enjoy their food in pleasant dining rooms or in their own room. All of the people who were spoken to by us were complimentary about the food saying that it was pleasantly presented and of good quality. In the dementia unit staff helped people eat their meals in an unhurried manner, highlighting the importance of this social activity and maintaining peoples dignity. Complaints are taken seriously and the two looked at by us were dealt with promptly and in courteous manner. People are safeguarded from abuse by the home’s robust recruitment procedures, and staff spoke to were clear what was abuse and how they would respond. People live in a well-maintained and pleasant environment, which is safe and clean and in very good decorative order. Additional benefits are provided to help ensure that the dementia care environment is attractive and supportive for vulnerable people. People have individual ‘memory boxes’ outside their bedroom doors in the dementia unit to aid orientation. The staff are well trained and have the right skills to meet people needs. The new training officer was making good progress ensuring their knowledge is updated and the training is well planned. The home is well organised and run by a good competent manager and staff team who in turn are well supported by Barchester, which helps to ensure that people are listened to, and improvements are made to prolong independence
Hunters Care Centre DS0000016479.V350085.R01.S.doc Version 5.2 Page 8 and keep them safe. The home has a number of quality assurance checks and the results are shared with people in the home and their relatives. We felt that after speaking to staff and people living in the home that there was an open and inclusive environment, where concerns raised would be acted upon by attentive staff and wherever possible resolved without formality. Staff commented in the surveys that: ‘I have received all the training I need’, I like what I am doing and I feel competent,’ I enjoy caring for the residents’, and, ‘senior staff are helpful and supportive’. We looked at Barchester’s complete annual clinical audit of the home, which indicates how well it is run. This is an extensive piece of work by clinicians and Hunters Care Centre’s percentages for the many areas looked at were all in the nineties. Improvements were made after this audit indicating that it helps to improve outcomes for people living in the home. The information provided in the AQAA indicates that all the home’s equipment is serviced regularly, and that there are policies and procedures that have been reviewed in the last twelve months to protect people from health and safety risks. We looked at fire safety and the training officer had completed a lot of work on training people to use the new evacuation equipment if required, and updating the fire procedures. What has improved since the last inspection?
The home has a new care planning system, which clearly identifies all the care needs for people and includes good detailed information and risk assessments to help ensure that peoples needs are well met. The improved dedicated activities room offers more space where people can join in with the varied and stimulating activities programme. Considerable refurbishment throughout the home has taken place since the last inspection. This includes, new carpets in many hallways in the general and Memory Lane units, new colour schemes, which appeared bright and cheerful, and the refurbishment of a number of lounges and bathrooms. People spoken to also see the new hairdressing salon as a valuable addition. A large screen television has been installed, which will be used as a ‘cinema’ for people to enjoy together. The walls in the home have additional paintings, which reflect the interests of the generations that are accommodated. Memory Lane has a wide collection of wartime memorabilia and items in various comers where people can spend time. The home complete bi-annual assessments of peoples needs to help ensure that sufficient staff are available to meet peoples needs and had made some
Hunters Care Centre DS0000016479.V350085.R01.S.doc Version 5.2 Page 9 improvements in the staffing levels. Care staff, maintenance staff and reception staff hours have increased to help keep people safe and well cared for, and to ensure that visitors are welcomed to the home later in the day and at weekends. The dementia unit now has a fulltime hostess to help enable care staff to complete their care duties. New ‘ski-pads’ have been provided on each floor to help evacuate people in the event of a fire and procedures have been updated with advice from the fire safety officer. 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. Hunters Care Centre DS0000016479.V350085.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 Hunters Care Centre DS0000016479.V350085.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): 1 & 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a lot of good information available for people to look at when deciding to move in, however, the Service User Guide was not given to everyone on admission. Experienced nursing staff assess people before they are admitted to the home to help ensure their needs can be met there. EVIDENCE: Two pre-admission assessments were seen for new people admitted and contained all the relevant information. The registered manager was asked to update the Service User Guide with the most recent fee information in line with the Fees and Frequency regulations. This was completed by the second visit and a copy was seen and given to us.
Hunters Care Centre DS0000016479.V350085.R01.S.doc Version 5.2 Page 12 People have the home’s Welcome Pack on admission, which contains the complaints procedure, but the Service User Guide is not given to people but is available to read in the reception area of the home, or a copy given on request. All people or their relatives or supporters should have a copy of the Service User Guide before admission, as the information is different to the welcome pack and more detailed about care provision and the home aims and objectives. There was some discussion with the registered manager as to whether the two documents could be put together as one, to ensure people had all the information about the home. The home’s Statement of Purpose is a larger document that is available in reception and contains additional information, for example the qualifications of staff employed in the home. Hunters Care Centre DS0000016479.V350085.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): 7,8,9 &10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are well cared for and their healthcare needs are met with the help of good clear care plans, which identify problems and provide staff with clear actions to follow. Medication is well managed; some minor improvements for additional information will help guide staff to make good decisions in people’s best interest. EVIDENCE: We looked at eight care plans in detail in three different units and spoke to the people living in the home as well. The home had started a new care planning format since the last inspection with fourteen generic care areas covered, each area was completed individually with information and actions in a story form. The care plans were added to whenever there were changes, and the monthly reviews were dated and signed and did not have a record of whether the plan was working or not.
Hunters Care Centre DS0000016479.V350085.R01.S.doc Version 5.2 Page 14 There was some very good information in the care plans, but as this was a new system people were getting used to where they should record information in the fourteen areas. There was some discussion with the staff about having to read the whole story in the care plan actions to know what was the latest action required. It was decided that as this detailed and improved system progresses the staff would be able to see clearly what is happening. Risk assessments were well recorded and reviewed. The daily records recorded by the nursing staff contained good numbered information relating to the care plans. A six monthly review is held when people and their relatives can be involved and they sign their acceptance of the care plan, this is in addition to the monthly reviews. We looked at two wound care records, and one had sufficient information recorded to describe the wound and to enable staff to follow clear instructions. The other wound record was not clear what dressing was required but there were good descriptions of the wound, which had recently deteriorated. The nurse spoken to stated that wound photographs would be taken soon. Social histories seen were well recorded and have become an important part of the individual care plan to help know peoples values and care for them well. This is important information when considering the implications of the new Mental Capacity Act when decisions are made to help people without capacity. Excellent healthcare records were seen, for example the psychiatrist instructions were recorded and the staff had completed the regular observations required to help ensure the person was safe. A continence adviser’s plan had been followed to help ensure the person with dementia was cared for to help prevent pressure sores and promote their dignity. We spoke to most of the people who were part of the detailed care plan review, all of them had dementia at different stages and some were unable to offer a verbal response. However, observations made by us were that most people were relaxed, alert and responded positively to questions about their care. Medication was looked at in more detail in one unit, as medication records were seen in all units while case tracking individual care plans. An annual clinical audit is completed by Barchester, which includes medication. The results of the homes last audit said that the home achieved 97 rating, and there was a recommendation to update the homely remedy policy, the room for storage needed a thermometer and that separate storage was
Hunters Care Centre DS0000016479.V350085.R01.S.doc Version 5.2 Page 15 required for medication. One unit also required a weekly Controlled Drugs audit. The supplying pharmacist checks the homes administration procedures every six months. The registered manager said the home was planning to do a weekly audit of all medication. Medication storage was secure but very cramped, however both the trolley and the cupboard were well organised. A new medication trolley was already on order for this unit. A spot check was correct in the Monitored Dosage System used, which indicates that the system is working. There was no recorded temperature for medication storage; however, all medication areas will be having air conditioning installed this year to help ensure storage is kept at the correct temperature. We audited the Controlled Drugs, which were correct. One person was able to self-medicate an asthma spray and had safe storage to ensure that no other person could access the medication from the bedroom. The medication administration records were generally well recorded we looked at the last months as a new month had just started. Not all hand written transcribed entries on the records had been signed, this should be completed to ensure an audit trail can be done and that nurses can be identified, as they are accountable for their practice. Two medications prescribed as ‘as required’ did not have a protocol for their administration. Care plans must reflect what choices people who live in the home are given about how their medicines are handled and their consent to the way in which staff administer their medicines. Where consent is not possible, because of lacking capacity, records must be made of the agreement that the way in which medicines are administered is in the best interests of that particular person in accordance with the provisions of the Mental Capacity Act 2005. There was no clear written information to help make sure medicines that the doctor has prescribed ‘as required’ are administered correctly for the benefit of that person. This is needed so that staff have clear direction how to make a decision to use such medication for each person. Hunters Care Centre DS0000016479.V350085.R01.S.doc Version 5.2 Page 16 There must be clear written guidance to staff on how to reach decisions for all those medicines prescribed to be administered “as required”. A record must also be made of how staff have reached the decision to administer in accordance with the provisions of the Mental Capacity Act 2005. This will help to make sure that there is some consistency for residents to receive medication when necessary and in line with planned actions. The unit looked at did not have a medication procedure for reference; there should be a copy on each unit. Hunters Care Centre DS0000016479.V350085.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The people in the home are able to lead the lifestyle they choose when possible and are encouraged to maintain their personal interests and experience new and varied activities. Staff support people well and there is flexibility to help accommodate people’s wishes. Meals are a highlight of the day and people have good quality food, which they can choose, and alternatives are always available. EVIDENCE: The daily routines of the home are flexible and on the morning of the inspection one person told us that they had just finished breakfast at 10:15, a time that was convenient due to a hospital appointment. People told us that they are able to get up and go to bed at times they choose. Where support is required from staff there is still flexibility about the time this is provided. The routines of the home are based on the needs and wishes of the people living in the home. Hunters Care Centre DS0000016479.V350085.R01.S.doc Version 5.2 Page 18 The home has dedicated staff and space for activities and there are plans for a new service to include new staff structures to manage the activities. The people are able to choose from a range of things to do and the weekly programme is altered to ensure the changing needs of the people are met. The home has a newsletter and this advises everyone of the programme for the forthcoming week. Many of the activities are undertaken in the activities room but some events e.g. quizzes are held in the lounges. There are also bus trips to visit places of interest in the local community. Every effort is made to include everyone irrespective of any disability. We felt that considerable thought was given by the staff to ensure there is a varied and stimulating range of things to do. It is anticipated that the new mini bus will have greater use this year with the appointment of an additional driver. People are involved in the organisation of some activities, to include the ‘musical appreciation group’ where a person living in the home entertains everyone, as he was a classical pianist. Friends and relatives are welcome and during the inspection a number of visitors were seen and spoken to. They said they felt welcome at the home, and said that the staff were good listeners. They also confirmed that they were consulted where appropriate about the care of their relatives/friends. The chef and second chef were seen and the provision of meals was discussed. There are options for each course and meal. This extends to further options where the original options were not seen as appropriate. There is a formal way for people to choose meals, and this is recorded by staff the day before. Meals can be taken in the dining room or bedroom. The main dining room provides a pleasant social environment and is popular with people. All of the people who were seen were complimentary about the food saying that it was pleasantly presented and of good quality. We also observed meal times in the frail elderly care unit and the dementia unit where lunch was presented attractively, and staff helped people in an unhurried manner highlighting the importance of this social activity and maintaining peoples dignity. The dementia unit now has a fulltime hostess, which helps to ensure that care staff do not have to complete all mealtime duties with regard to serving food and can spend more time with people. Two relatives commented that people missed their drinks sometimes and were unable to inform the staff due to their dementia. However, one relative had raised the concerns with the manager who dealt with it immediately, and sent a memo to all staff as a reminder. Hunters Care Centre DS0000016479.V350085.R01.S.doc Version 5.2 Page 19 Some people have a nutritional assessment tool completed in their care plan, including a regular weight record, which highlights anyone at risk nutritionally and indicates what additional care they may require. Hunters Care Centre DS0000016479.V350085.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): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a robust complaints procedure and people are protected by the staff who have been trained in the protection of vulnerable people and the homes policies and procedures which support good practice. EVIDENCE: The complaints procedure is included in the homes Welcome Pack and Service User Guide, all of which are available in the reception area of the home. The new address for the Commission has been included. People spoken to were aware of what to do in the event of any concerns, and the complaints records in the home showed that there had been two complaints. The correspondence in respect of the complaints was seen and it was evident that the complaints had been dealt with in a prompt and courteous manner, ensuring that each issue raised had been investigated and a response given to the complainant. Staff seen during the inspection were clear about what to do in the event of any allegations of abuse, and informed the inspector that the home provides internal training in respect of the protection of vulnerable adults. They were clear about what would be seen as abuse and how they should respond. All staff will be completing specific Protection Of Vulnerable Adults training in September 2008.
Hunters Care Centre DS0000016479.V350085.R01.S.doc Version 5.2 Page 21 We spoke to several people and observed many interactions between staff and people accommodated. We felt that people were cared for in a dignified manner, and one in which ensured their rights were safeguarded. People saw the registered manager and all staff as approachable. The relaxed atmosphere in the home results in concerns that are raised are, wherever possible, dealt with in an informal manner and without delay. People gave examples to us of matters brought to the attention of staff and how they were dealt with in a satisfactory manner. The home has now made available to people the services of an independent advocacy scheme, and was aware of the introduction of the Mental Capacity Act 2005, which came into force during 2007 and the implications for people living in the home. Hunters Care Centre DS0000016479.V350085.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): 19 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People live in a well-maintained and pleasant environment, which is safe and clean and in very good decorative order. Additional benefits are provided to help ensure that the dementia care environment is attractive and supportive for vulnerable people. EVIDENCE: The home was found to be clean, organised and odour free. All of the communal accommodation and a random sample of the bedrooms were seen. The accommodation was in good decorative order and furnished with appropriate and comfortable furniture and fittings. Hunters Care Centre DS0000016479.V350085.R01.S.doc Version 5.2 Page 23 The environment in Memory Lane were seen as enabling for the vulnerable people there, and the addition of the ‘memory boxes’ outside the bedrooms has clearly helped to aid orientation for people with dementia. The outside area had been further developed to include a safe and pleasant area with decking, which offers a further option in the warmer weather. Memory Lane now has a potting shed in the grounds as people have shown considerable interest in the preparation of plants for the home. Other walkways in the grounds have been improved and people can continue to enjoy them in comfort and safety. Considerable refurbishment throughout the home has taken place since the last inspection. This includes, new carpets in many hallways in the general and Memory Lane units, new colour schemes, which appeared bright and cheerful, and the refurbishment of a number of lounges and bathrooms. In this financial year it is proposed to refurbish a number of bedrooms and the five-year plan of expenditure clearly indicated the areas that will receive attention. People see the new hairdressing salon as a valuable addition. The home has plans for a ‘cinema’ to be provided in a Memory Lane lounge, and the staff are in discussion with the local university about artwork for an appropriate environment there. A large screen has already been installed. The walls in the home have additional paintings, which reflected the interests of the generation that are accommodated. Memory Lane has a wide collection of wartime memorabilia and items in various comers where people can spend time. One double room had now been created and replaced the originally registered room (20a). The room was seen as meeting the requirements and at the time of the inspection had only one occupant. The home has a no smoking policy, however, if people are admitted who wish to continue smoking it would be advisable to ensure they can smoke in an area that does not affect the policy of the home, but somewhere which provides a safe and comfortable environment. Hunters Care Centre DS0000016479.V350085.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): 27,28,29 & 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The staff are well trained and have the right skills to meet people needs and the training officer ensures their knowledge is updated and the training is well planned. Bi-annual assessments of the staffing levels are completed and extra hours have been provided as a result. Recruitment procedures are good and the records are well maintained. EVIDENCE: Total care assessments for all people living in the home are completed twice a year by the registered manager and the staff to help ensure that there are sufficient staff on duty. As a result the care hours and trained nurse hours have increased this year. We saw evidence of the record of percentage hour increases during the inspection. The maintenance person hours have also increased to ensure all facilities are well maintained. The reception staff have also extended their hours until 19:00 hours and to include weekends, to help people who visit the home. The staffing in Memory Lane appeared to be based on a minimum number, usually one nurse and several carers, in some lounges two carers, in others three. Staff informed us that there have been times when a lounge would be
Hunters Care Centre DS0000016479.V350085.R01.S.doc Version 5.2 Page 25 effectively left in the control of one carer due to a variety of reasons. e.g. sickness. This was discussed with the manager and to ensure a safe and therapeutic environment at all times the nurse in charge should be regularly checking each unit. It seems, however, that the nurses are often busy and do not always leave the nurse’ stations to assist the one member of staff on duty. We recommend that given the peoples disabilities it would be essential for there to be at least two staff on duty in the communal areas at all times. There may of course be emergencies, as an exception, but the general rule should be at least two with the vulnerable people accommodated. Barchester provide a specialist environment for people with dementia with skilled staff. It is recommended that the deployment of staff be looked at to ensure that there are sufficient staff available at all times in the dementia care units. The dementia unit now has a fulltime hostess to help enable care staff to complete their care duties. We observed that people were being cared for in a personalised and dignified manner, within a comfortable environment where their needs were paramount, and staff were seen as caring and competent. The recruitment records for two new staff were well completed. Barchester complete an internal audit of the business services, and one was due soon to make sure that all records are maintained to correct standards. The administration staff showed us all the Criminal Records Bureaux checks since the last inspection and information regarding how many staff had left the home and the reasons why, the total number of staff employed was 138. Generally staff are not allowed to start until they have a CRB check, however, if this takes some time and a Protection Of Vulnerable Adults check has been received then there is a form completed within Barchester, to ensure that the new staff member is shadowed by a senior carer at all times. We spoke to the fulltime training officer who informed us that there are sixtyfour care staff, ten have completed NVQ level 2 and twenty-seven have completed NVQ level 3 and overall 58 having obtained an NVQ qualification to level 2 or above. The training officer is planning to complete a dementia training course and attend a Dementia Care conference. The home has new induction packs, which includes the Skills for Care standards. Barchester inductions are transferred into a progress log with Skills for Care, as care staff require induction certificates to enable them to register with the General Social Care Council. The home has an extra dementia care induction standard, which includes the Alzheimer’s society booklet about the modern approach to person centred dementia care. Hunters Care Centre DS0000016479.V350085.R01.S.doc Version 5.2 Page 26 The training officer completes one nursing shift per week, this enables her to see the methods used by the staff and identify areas where improvements can be made. The training officer supplied us with the Barchester Learning and Development Academy Training Grid, which covers all staff training needs, who delivers it and how it is delivered and the frequency. To support this the home have produced their own comprehensive training plan for 2008, which includes leadership skills in dementia and person centred dementia care for the new Registered General Nurse who is head of dementia care. All aspects of mandatory training have been scheduled for all staff including the protection of vulnerable adults, and many update training courses for the nurses, for example; tissue viability and wound care, challenging behaviours, venapuncture (taking blood samples), malnutrition and dehydration, the Mental Capacity Act, syringe driver/pain management, Gastrostomy (enteral feeds), and drug assessments/medication management. The trainer was completing personal training files for all the staff; we saw one file and certificates were included. Hunters Care Centre DS0000016479.V350085.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): 31,33,35 & 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is well organised and run by a good competent manager and staff team who in turn are well supported by Barchester, which helps to ensure that people are listened to, and improvements are made to prolong independence and keep them safe. EVIDENCE: The registered manager is well qualified, experienced and competent and has a senior team to include a deputy manager and senior sister in Memory Lane for support and they are accountable to her. Hunters Care Centre DS0000016479.V350085.R01.S.doc Version 5.2 Page 28 Barchester’s Regional Operations Director, Property Services Manager and Clinical Development Nurse support the registered manager who is the General Manager for the home. The quality of the information in the AQAA was excellent, which included plans for further improvements in the home. The staff make great efforts to ensure that people who have dementia enjoy the services of the home and are not disadvantaged by their disabilities. This was evidenced by the ability of people to join in the activities with other people from the general nursing unit, or where necessary other more appropriate activities were provided with additional support. The home has a number of quality assurance checks and they include a) the culture survey for staff, and b) the customer service satisfaction questionnaire to residents and relative’s. The results of the latest surveys are yet to be collated and published but it was clear that the views of all stakeholders are taken seriously. The quality assurance results are shared with the people in the home and their relatives. The registered manager also meets people living in the home regularly and people told us this provided a useful forum, and that it was conducted in an open and friendly manner where they felt happy to raise issues. The dining room had a comments book and this was seen and included lots of positive comments, together with observations, where the service was not seen as satisfactory. We felt that after speaking to staff and people living in the home that there was an open and inclusive environment, where concerns raised would be acted upon by attentive staff and wherever possible resolved without formality. Barchester complete an annual Clinical Audit in each region, which indicates how well the home is performing in several areas. Each unit in the home was given a percentage on how well they were doing; the percentages were all in the nineties and included recommendations for areas that required some improvement. This was an extensive piece of work by clinicians in the company, which helps the manager to see where improvements are required and implement them. The areas covered were; Medication, Infection control, Continence, Tissue Viability, Risk assessments, Accidents, Complaints, Documentation, Person Centred Care. An example of how this works was that wound care required consistency, so the head nurse had completed a wound care update training and is the lead in the home for advice and information. The administrator informed us of the improvements in recording the hairdressing personal monies, and the record seen included two signatures.
Hunters Care Centre DS0000016479.V350085.R01.S.doc Version 5.2 Page 29 Accidents in the home are audited monthly and actions are raised at the health and safety committee’s quarterly meeting when required. Twelve bedrooms in the dementia care unit have sensors to help alert staff to people moving, who may require staff help. The home also benefits from the support of the Care Home Support Team with regard to advice on falls prevention. Currently the manager is sourcing the purchase of alarm pendants for vulnerable people to wear in the garden or in their bedroom to help maintain their independence. The information provided in the AQAA indicates that all the homes equipment is serviced regularly, and that there are policies and procedures that have been reviewed in the last twelve months to protect people from health and safety risks. The trainer has completed a lot of work on fire safety training and the provision of ‘ski-pads’ evacuation equipment and training to ensure that all staff can use them and they are available on each floor. The new evacuation procedure includes the latest guidance and a fire drill was planned for one evening soon. Hunters Care Centre DS0000016479.V350085.R01.S.doc Version 5.2 Page 30 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 4 X X 4 Hunters Care Centre DS0000016479.V350085.R01.S.doc Version 5.2 Page 31 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 OP9 Regulation 13 (2) Requirement The registered person must ensure that all medication prescribed as ‘as required’ have detailed protocols to ensure they are administered consistently in people’s best interests. And all nurses must sign their hand written transcribed medication records. Timescale for action 21/03/08 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 OP27 Good Practice Recommendations It is recommended that the deployment of staff be looked at to ensure that there are sufficient staff available at all times in the dementia care units. Hunters Care Centre DS0000016479.V350085.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Hunters Care Centre DS0000016479.V350085.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
