Inspection on 28/09/05 for Hunters Care Centre

This inspection was carried out on 28th September 2005.

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

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

Other inspections for this house

Hunters Care Centre 18/01/08

Hunters Care Centre 28/07/06

Hunters Care Centre 01/02/06

Hunters Care Centre 21/03/05

Hunters Care Centre 10/11/04

Hunters Care Centre 17/03/04

Hunters Care Centre 03/09/03

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Manor Lodge

The Garden House

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

CARE HOMES FOR OLDER PEOPLE Hunters Care Centre Cherry Tree Lane Cirencester Glos GL7 1AF Lead Inspector Mrs Kate Silvey Unannounced Inspection 28th September 2005 09:30 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.V254573.R01.S.doc Version 5.0 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.V254573.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hunters Care Centre Address Cherry Tree Lane Cirencester Glos GL7 1AF 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 Barchester Healthcare Homes Limited Mrs Anne Millan Care Home 89 Category(ies) of Dementia - over 65 years of age (52), Old age, registration, with number not falling within any other category (37) of places Hunters Care Centre DS0000016479.V254573.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st March 2005 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 accommodation with en-suite facilities. There is a large lounge area and dining room on the ground floor with several small lounges on both the ground and first floor. The small lounges offer views across the surrounding landscape and provide privacy to service users and their relatives if they wish to use them. The Dementia Care units offers both nursing and residential care and are situated on two floors. It is divided into four separate units with the more able service users at present accommodated on the first floor. The ground floor units have access to a large ‘wandering corridor’ with seats and a lounge area for service users to sit in. An enclosed garden area can be accessed from this corridor, which service users can freely access. The accommodation on the first floor is divided into two units with an open lounge area and separate dining room offered in one of the units. The other unit has recently been altered to provide two lounge areas and one dining area for service users to access. A new enclosed garden area has been developed at the side of the unit for service users to use with staff support. There are assisted bathrooms and toilets situated in all of the areas used by service users. The kitchen and laundry area is situated on the ground floor. Hunters Care Centre DS0000016479.V254573.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place over 6.5hours with two inspectors. All the units were seen and many service users were spoken to including some of their relatives. The head of care on the general unit was spoken to and many of the staff on the units. A sample of care records were inspected and most of the environment was seen. What the service does well: What has improved since the last inspection? What they could do better: Update the Service User Guide regarding the no smoking policy of the home to ensure service users are aware before they are admitted. Provide more detailed care plans and adequate reviews to ensure that complete care is provided at all times. All service users and their representatives must have a copy of the complaints procedure available to them. Hunters Care Centre DS0000016479.V254573.R01.S.doc Version 5.0 Page 6 There must be training provided for care staff to manage challenging behaviours in the dementia units to ensure good practice. The registered manager must ensure that the staff skill mix sufficiently supports the care staff at all times and provides a good care model for the service users with dementia. 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. Hunters Care Centre DS0000016479.V254573.R01.S.doc Version 5.0 Page 7 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.V254573.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 The homes Statement of Purpose/Service Users Guide is comprehensive, however, details regarding the homes smoking policy must be included and kept under review. All service users or their representatives’ must have an updated copy if they wish. EVIDENCE: The issue of a service user being able to smoke in the home was discussed and the inspectors were informed that there was a no smoking policy throughout the home, and that prospective service users were informed of this. The policy of the home regarding smoking must be contained in the homes Statement of Purpose/Service User’s Guide. A service user spoken to, who had been living at the home for some time in the general nursing unit, had no recollection of having received a Service User Guide. It is recommended that all service users or their representatives are asked if they would like another copy of the guide as the registered manager had previously ensured that everyone had one. Hunters Care Centre DS0000016479.V254573.R01.S.doc Version 5.0 Page 9 Hunters Care Centre DS0000016479.V254573.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,10 The care plans seen were not always specific and more attention to recording sufficient detail and adequate reviews must be achieved to ensure the service users needs are well met. The care staff were seen as respectful towards the service users and it was evident privacy was respected which is provided in a caring and inclusive environment. EVIDENCE: One inspector visited the residential unit for older people with dementia. Two care plans were seen. Each plan is based on the model “person centred care”. The plans explained the reasons for this model of care but lacked detail as to how some objectives could be achieved. e.g. respect the values of the individual, without expressing what specific values were the subject of the plan. One plan of care had comments about the management of inappropriate behaviours, there was evidence that other professionals had been consulted and that a strategy was in place. In both plans there was evidence of monthly review and daily recordings, which referred to specifics plans. One relative Hunters Care Centre DS0000016479.V254573.R01.S.doc Version 5.0 Page 11 said that they were consulted about and involved in care planning for their relative. Another inspector looked at care plans and visited the service users in the nursing dementia unit and the general nursing unit. Service users here are less ambulant and can be highly physically dependent and also have mental health needs. The quality of the care plans seen varied. One plan had good action plans, but poor reviews, which continually stated ‘continue’ and manual handling had not been reviewed since 2002. The service users weight was measured every four months, which may not be enough to identify any deterioration and implement the required action. Several service users were spoken to in the general unit and they stated that they were happy with the care staff who treated them with respect and very comfortable in the home. A letter was seen, written to all the staff by a service user, thanking them for ensuring that she was able to watch all the cricket test matches on the television this summer. A care plan in the dementia unit had a detailed personal history, which can be helpful with dementia care. However, the actions for dementia care were not specific to the service user. The care plan was lengthy and for catheter care did not record that the catheter had been ‘pulled out’ by the service user. The plan for management of weight loss did not have any food supplements recorded although the inspector was informed that regular ‘smoothy’ drinks were given. One service user had two pressure sore wounds, there was no regular clear description or photo to measure and monitor the wound and the records were confusing as to which sore was being described. The daily records were generally well recorded in the dementia unit in relationship to the care plan ‘needs identified’. The doctors visits to the service users were well recorded. Most of the service users were seen and some were spoken to in the dementia unit, they appeared to be well cared for and were able to communicate that they were content on the day. Care staff were seen engaging service users appropriately. Hunters Care Centre DS0000016479.V254573.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 The care staff make every effort to understand service users wishes and help implement them in a dignified manner to preserve their autonomy. EVIDENCE: Staff on duty were aware of the philosophy of the home and the need to ensure the values of dignity and privacy are assured particularly when personal care is being provided. e.g. bath times. In spite of the high dependencies and the inability of the majority of service to give clear verbal choices about how they wish to spend their day staff manage to communicate in a variety of ways and make great efforts to ensure their implicit wishes are met. Evidence of this was seen where a service user who requested a lock on their bedroom door was provided with one. Service users are able to lie in bed in the morning or go to bed when they wish and where they are not able to communicate such wishes staff consider previous lifestyles to ensure they have some choice and control over their daily lives. Hunters Care Centre DS0000016479.V254573.R01.S.doc Version 5.0 Page 13 The care centre has a number of staff who are exclusively involved in activities with service users. This takes the form of group and one to one activities. The inspector spent some time in the residential Unit for dementia. The programme for this Unit was varied and the activities were appropriate in view of the abilities and dependencies of the service users. There was an activity each day and wherever possible service users were integrated with other groups and went out for short trips. The inspector saw an activity and it was evident that service users are engaged by staff and that activities are meaningful. There is no doubt that considerable thought has gone into the planning. Hunters Care Centre DS0000016479.V254573.R01.S.doc Version 5.0 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The home has a robust complaints procedure, which should be given to all the service users or their representatives to ensure that any issues are dealt with and adequately resolved. Managing challenging behaviour by care staff was not adequately addressed, which could leave both the service user and the carers at risk. EVIDENCE: The majority of the service users seen were not be able to understand/use the formal complaints procedure. In the circumstances it is essential (and a requirement) that relatives/advocates/friends have a copy of the Service Users Guide, which will have the complaints procedure enclosed. One relative was seen and they were not aware of the written complaints procedure but felt comfortable about approaching staff if they had concerns. One service who was content with concerns raised in the home, felt that the registered manager always gave an answer, which was appreciated. Staff seen had undertaken training in the identification of abuse and after speaking to them it was evident that they had a good knowledge of the causes of abuse in respect of the older person. Staff were also seen to deal with service users request in a sensitive and dignified manner. Hunters Care Centre DS0000016479.V254573.R01.S.doc Version 5.0 Page 15 Some staff in the units had not received any training in managing challenging behaviours and felt this would be helpful. The view of the inspectors is that such training is essential. Hunters Care Centre DS0000016479.V254573.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 The accommodation seen was clean, providing a good standard of décor and furnishings with additional items enhancing the environment for service users with dementia care needs. The access to the garden was not easy for service users with dementia who were accommodated upstairs. EVIDENCE: The Units for dementia (nursing and residential) were found to be clean odour free, and organised. Not all of the accommodation was seen, however, the communal areas were in good decorative order and with appropriate furnishings to include special chairs for those who were immobile. The corridor on the ground floor now has a number of domestic areas which reproduced Victorian/Edwardian life with related furniture and personal items. Hunters Care Centre DS0000016479.V254573.R01.S.doc Version 5.0 Page 17 The staff informed the inspectors that service users enjoy looking at and touching the items/furniture and it was evident that this was providing appropriate stimulation. There is a pleasant garden and walking area outside the ground floor area of the dementia Units however staff felt that the service users on the first floor might not be able to take full use due to their location. Hunters Care Centre DS0000016479.V254573.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 The number of care staff appeared to be sufficient to meet the care needs of the service users but without a recorded review this was difficult to ascertain. There were deficiencies in the skill mix in the dementia Units. EVIDENCE: Dementia Unit (residential). Three care staff were on duty and one activities person. At the time of the inspection they were all involved with the service users and were seen to respond to needs in a sensitive and competent manner. Dementia Unit (Nursing) The inspectors were advised that there had been an increase in staff since the last inspection and that they now felt they were able to meet the high needs of the service users. The skill mix on this unit must be addressed as there was no Registered Mental Nurse or Registered General Nurse with ENB N. 11 equivalent qualification on duty. A recorded review of staffing levels/skill mix must be completed. General nursing unit The head of care stated that currently there was sufficient staff to meet the service users needs. However, the need to records staffing level/skill mix reviews was discussed. Hunters Care Centre DS0000016479.V254573.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 The welfare of the service users may be compromised through hearing the call bells constantly from other units. Support for service users with difficult behaviour may not always be adequate, as staff responsible have not always had appropriate training. EVIDENCE: The call system in the residential Unit (dementia) is activated even though the need is elsewhere. The bell was ringing constantly and arguably infringes on the need for a quiet and relaxed atmosphere. The question appears to be is there a need for staff in this Unit to be aware of the needs in other Units. At the time of the inspection a team leader managed the residential Unit. The inspector was informed that her reference point if difficulties with behaviours Hunters Care Centre DS0000016479.V254573.R01.S.doc Version 5.0 Page 20 should occur was the “nurse” in the nursing wing, which is adjacent to her Unit. During the morning of the inspection the “nurse “ in question was a Registered General Nurse and the inspector understood this was often the case. It is essential that the home provides an appropriate and suitably trained staff group to ensure needs can be met at all times. If Registered General Nurses are to provide support and guidance they must be suitably trained to carry out such duties. Hunters Care Centre DS0000016479.V254573.R01.S.doc Version 5.0 Page 21 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 2 x X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 X X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 X 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X X x Hunters Care Centre DS0000016479.V254573.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP27 Regulation 18.1 Requirement The registered manager must plan for and provide suitably qualified care staff/managers in the dementia unit at all times. (This was a requirement from 31 July 2005). The registered person must keep the Service User Guide up to date and under review. The register manager must ensure that all care plans are adequate and reviewed appropriately. The registered manager must ensure that all service users and their representatives have a copy of the complaints procedure. The registered manager must ensure care staff are suitably qualified with regard to managing challenging behaviours. The registered manager must ensure that the service users welfare is considered with regard to the call bell system. Timescale for action 31/01/06 2 3 OP1 OP7 6 15 31/12/05 31/12/05 4 OP16 5 (e) 31/12/05 5 OP18 18 31/01/06 6 OP33 12.4 31/12/05 Hunters Care Centre DS0000016479.V254573.R01.S.doc Version 5.0 Page 23 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 5 Good Practice Recommendations The registered manager should ensure all service users or their representatives have an updated copy of the Service User Guide if they wish. Hunters Care Centre DS0000016479.V254573.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 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.V254573.R01.S.doc Version 5.0 Page 25 - 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. 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