Inspection on 27/09/06 for Hurst Manor Nursing and Residential Home

This inspection was carried out on 27th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Hurst Manor Nursing and... 24/04/08

Hurst Manor Nursing and... 13/12/05

Hurst Manor Nursing and... 06/07/05

Hurst Manor Nursing and... 08/02/05

Hurst Manor Nursing and... 06/07/04

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

CARE HOMES FOR OLDER PEOPLE Hurst Manor Nursing & Residential Home Hurst Martock Somerset TA12 6JU Lead Inspector Stephen Humphreys Key Unannounced Inspection 27th September 2006 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 Hurst Manor Nursing & Residential Home DS0000003267.V305342.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. Hurst Manor Nursing & Residential Home DS0000003267.V305342.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hurst Manor Nursing & Residential Home Address Hurst Martock Somerset TA12 6JU 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) 01935 823467 01935 825728 www.hurstmanor.co.uk Hurst Manor Limited Mrs Ada Susan Aldworth Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Hurst Manor Nursing & Residential Home DS0000003267.V305342.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Elderly persons of either sex, not less than 60 years, who require general nursing care Up to fifteen places for personal care. Date of last inspection 13th December 2005 Brief Description of the Service: Hurst Manor is a three storey Grade II listed Georgian House situated in the centre of the village of Hurst. The home is set in its own landscaped ground with lawn and flowerbeds. Hurst Manor is a care home providing nursing for up to 36 elderly persons of either sex, not less than 60 years, who require general nursing care. Day care is provided for service users requiring nursing care within the registered numbers. The accommodation is mainly in the large Georgian House and the garden wing that has en-suite bedrooms with patio doors onto the gardens. There is a large car park to the side of the care home. Hurst Manor Nursing & Residential Home DS0000003267.V305342.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first key inspection of Hurst Manor using the Inspecting for Better Lives methodology. The inspection of Hurst Manor includes the survey of health professionals and a site visit that included talking to residents, relatives and staff. A tour of the care home was made during the visit and also the inspector spent time observing care practices. The site visit carried out on the 27th September 2006 from 09:30 until 17:00 by the inspector. A further site visit was carried out on 29th September 2006 with the purpose of finalising the investigation into a concern brought to the attention of the Commission for Social Care Inspection. The inspector was able to have one to one discussions with the provider, the administrator, deputy matron, carers and housekeeping staff. One to one discussions were also held with four residents and three relatives. The inspector observed the serving of lunch to residents in the dining room and also the transportation of meals to residents who choose to eat in their room. Prior to the serving of lunch the inspector spoke to one group of residents sitting at table and after lunch whilst residents were having a cup of tea a group of seven residents. The residents discussed their feelings about being in the home and the service delivered. All of the residents and relatives spoke very highly of all the staff including the matron and owner. The surveys returned from visiting health professionals contained very positive comments. During this inspection two incidents regarding medication administration were investigated. An action plan has been agreed with the deputy matron. What the service does well: The care home is run for the benefit of the residents. The internal and external environment is well maintained and safe. The new garden wing is finished to a very high standard. The main building offers warmth and comfortable lounge and dining room. The staff are very caring and respectful and deliver a high standard of personal and nursing care. The administration function is also of a high standard. Hurst Manor Nursing & Residential Home DS0000003267.V305342.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Hurst Manor Nursing & Residential Home DS0000003267.V305342.R01.S.doc Version 5.2 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 Hurst Manor Nursing & Residential Home DS0000003267.V305342.R01.S.doc Version 5.2 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): 1,2,3,4,5, The quality in this outcome group is excellent. Residents can be assured that they will be provided with sufficient information to make an informed choice to enter the home. Residents can be assured that they will be offered a place once the matron is sure their care needs can be met. EVIDENCE: Information about the care home and the services available is contained in the statement of purpose and service user guide which are available in the home, on display near the front entrance along with the last inspection report and other related information. On this occasion all the residents spoken to said they were not able to visit the home prior to admission due to them being in hospital. Relatives made the choice following visits to the home. Two residents said they had local knowledge of the home that enabled them to choose. Relatives confirmed they had received adequate information about the home and also at the time of their visits. Hurst Manor Nursing & Residential Home DS0000003267.V305342.R01.S.doc Version 5.2 Page 9 Three residents contracts were reviewed. The terms and conditions were set out clearly and the contract meets this standard. The contract sets out clearly the fees, liabilities and responsibilities of each party. The matron / deputy matron visits all prospective residents to carryout a needs based assessment using the activities of daily living model of care. The matron then discusses the assessment with her staff to clearly determine that care needs can be met. Residents and relatives confirmed that the staff spend time with them making them feel welcomed and treat them with respect and dignity. The matron also receives a detailed assessment of need from social workers and evidence of discharge reports were seen in the residents care plans. Staff are very experienced in caring for older persons and their complex needs. Hurst Manor Nursing & Residential Home DS0000003267.V305342.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The quality in this outcome group is good. Residents can be assured their health care needs will be met through robust clinical procedures and experienced staff however a requirement for a policy on syringe drivers has been identified. EVIDENCE: The registered person has developed a strong ethos in the home that involves residents with a robust care plan. The care planning system is based on the SHARPS model using the activities of daily living model of care for assessing the care needs. The care plans were discussed with the deputy matron and were found to be working records however the risk assessment detail could be stronger. The care plans are regularly reviewed. All staff understand the care plan and the registered nurse countersigns the carers daily entries. Staff are provided with opportunities to attend clinical training courses. A need for nurses to receive update training to use syringe drivers has been identified following the outcome of the investigation carried out during this inspection. Hurst Manor Nursing & Residential Home DS0000003267.V305342.R01.S.doc Version 5.2 Page 11 Residents confirmed that they have access to outside health professionals and GP’s visit regularly to see residents. Arrangements for residents to attend appointments outside the home are in place. Residents are encouraged to be independent and are involved in their personal care. The medication system and procedure was checked and found to be satisfactory however two incidents relating to medicine administration have been reported to the Commission for Social Care Inspection. The inspector investigated both incidents. The registered manager has also investigated the incidents and provided a report for the Commission for Social Care Inspection. The inspector has made two requirements following the investigation. A community pharmacist from Somerset Health Authority carried out an inspection of the medication procedures on the 12/06/06. A number of requirements were made. The receipt, storage, administration and disposal of drugs were inspected and found to be satisfactory. Controlled drugs were checked with the deputy matron and found to be correct. All the requirements made by the community pharmacist have been implemented. The fridge temperatures were within the accepted range and variable doses were recorded. Only one resident is self medicating. The risk assessment is correct and up to date. Risk assessments have been completed on creams kept in resident’s rooms. The deputy matron agreed that inhalers would be kept in a lockable facility if left in the resident’s room. The residents and relatives spoken to confirmed that they are treated with privacy and respect at all times. The service user guide advises visitors that they could stay over night by arrangement if they need to be with relatives. Comments received from relatives include “the staff are always friendly and courteous helpful to residents and visitors”. Care plans included end of life care needs and information. To promote end of life care the registered person is encouraged to consider introducing the gold framework standards. Hurst Manor Nursing & Residential Home DS0000003267.V305342.R01.S.doc Version 5.2 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): 12, 13,14 15 The quality in this outcome group is excellent. Residents can be assured that they are encouraged to have a flexible lifestyle in the home. EVIDENCE: Residents are able to enjoy a varied lifestyle with a number of options to choose. Some residents said they joined in the activities and entertainment others said they preferred their own company. All residents spoken to were aware of the activities programme and entertainment planned. The registered provider sends out an annual resident satisfaction survey and includes the comments and suggestions from residents to improve the life style in the home. Relatives were observed to visit through out the day. Relatives spoken to were very complementary towards staff and said they were made welcome and offered drinks and snacks. Information about advocacy groups is available and displayed in the home. Residents can handle their finances if they wish, support is offered by the administrator. Hurst Manor Nursing & Residential Home DS0000003267.V305342.R01.S.doc Version 5.2 Page 13 The administrator keeps accurate records of any financial transactions with residents. Food is considered to be highly important and meal times are definitely a social occasion. The inspector observed the serving of lunch in the dining room. The dining room is large with round tables fully laid with cutlery and condiments. Hot and cold drinks were available along with wine. Residents were observed to enjoy their meals and spoke highly of the quality of the meals. The inspector discussed the meals with a group of residents, all comments were positive. One relative commented whenever they visited the food was plentiful and well prepared. The staff were observed to ask residents their choices. One relative said, “ My relative is well fed” The catering manager informed the inspector that the menu cycle was being changed shortly and that more hot meals in the evening were being introduced. The meals are well balanced and residents requiring soft or special diets are provided for. The dietician is consulted if any culturally special diets are required. Hurst Manor Nursing & Residential Home DS0000003267.V305342.R01.S.doc Version 5.2 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 quality in this outcome group is good. Residents are protected by up to date policies and procedures and staff are aware of their responsibilities towards safe guarding vulnerable adults. EVIDENCE: The Commission for Social Care Inspection has received one concern regarding an issue of clinical practice in the home that was investigated during this inspection. The matron will also hold an internal enquiry. The deputy matron has agreed an action plan following the outcome of the investigation by the inspector. The Commission for Social Care Inspection will monitor the actions at each visit. The deputy matron has identified that staff need up date training to ensure they are fully conversant with all medical equipment used in the home. The complaints procedure is robust, residents and relatives are aware of who they can make any concerns known. The recruitment procedure and processes are robust. Three recently employed staff files were checked to ensure the process is carried out. The homes quality assurance system also ensures safe practices in the home. None of the relatives or residents spoken to had any concerns. Hurst Manor Nursing & Residential Home DS0000003267.V305342.R01.S.doc Version 5.2 Page 15 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): 19,26 The quality in this outcome group is excellent, however the main Georgian house in parts is showing signs of tiredness. EVIDENCE: HRH Princess Anne opened the new garden wing recently. The environment has been built to a high standard. The furnishings throughout the home are in very good condition. Maintenance is planned and carried out regularly. The home is warm as confirmed by the residents, and homely. A tour of the home was made during the inspection. The fire alarm system was tested during the day. Every room and corridor was clean and tidy. A couple of the bathrooms were being used as storerooms. The communal areas are comfortable with adequate easy chairs for all residents. Hurst Manor Nursing & Residential Home DS0000003267.V305342.R01.S.doc Version 5.2 Page 16 There is adequate equipment for moving and handling, pressure relieve mattresses and cushions. Fixtures and fittings and any adaptations are to a high standard. Hurst Manor Nursing & Residential Home DS0000003267.V305342.R01.S.doc Version 5.2 Page 17 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): 27,28,29,30 The quality in this outcome group is adequate. Residents can be assured the staffing level is maintained to ensure the needs of the residents are met however a requirement for nursing staff to update their knowledge and vigilance in carrying out medication procedures has been agreed. EVIDENCE: The staffing levels at the home are sufficient to meet the needs of current residents. There is a high proportion of care staff holding the NVQ qualification in care. Staff employment practices are sufficiently robust to protect residents. Staff statutory training is organised annually and takes due consideration of individual staffs training needs so that there is a competent staff team at the home. The registered person submitted details of staff training in the preinspection questionnaire. A good range of clinical, supervisory, managerial and statutory training has taken place at the home for all grades of staff. The clinical procedures followed are based on the Royal Marsden procedures, (universally accepted by the Nursing & Midwifery Council). The findings of two incidents involving registered nurse’s has identified a need for the registered manager to develop robust procedures that nurses must follow when using equipment to administer pain relief drugs. Hurst Manor Nursing & Residential Home DS0000003267.V305342.R01.S.doc Version 5.2 Page 18 There is at least one registered nurse on duty at all times in the home. The number of ancillary staff in addition to care and nursing staff are sufficient to ensure that the home is managed well. Staffing levels have increased beyond the minimum staffing notice where there has been a fluctuating higher dependency level of residents in the home There is a strong commitment to continuing staff training in the home. Most care staff hold the NVQ qualification in care at level 2 or 3. Several others are training to level 3. Team leader care staff are employed to supervise junior care staff. Staff recruitment records were inspected and found to contain all necessary security and employment checks. The administrator was able to demonstrate both verbally and by documentary evidence a good understanding of adult protection vetting procedures for the employment of new staff. Nursing staff have received wound care and medication training. The care and nursing team have also attended training events in managing challenging behaviour, effectively communicating with people with a degree of hearing loss, disability awareness, palliative/terminal care and infection control. The matron has identified update training in the use of delivering medication via syringe driver for all nurses in the home. Hurst Manor Nursing & Residential Home DS0000003267.V305342.R01.S.doc Version 5.2 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): 31,33,35,36,38 The quality in this outcome group is good. The management of the home is competent and has many years of experience in caring for older persons. The management team use a quality assurance system to monitor service delivery. EVIDENCE: Management at the home is competent and fosters an open and professional ethos at the home. The registered person has introduced formal quality assurance processes in annual quality questionnaires to regular staff and resident meetings and staff supervision sessions. The results of questionnaire surveys are published in the home. All comments whether positive or negative are published and include acknowledgement and an action plan to address any negative feedback. Quality assurance processes are formal as well as informal. The registered person is able to demonstrate that it seeks the views of people both using the Hurst Manor Nursing & Residential Home DS0000003267.V305342.R01.S.doc Version 5.2 Page 20 services at the home and working in the home. These views are responded to in order to improve upon services. The latest survey was carried out in July 2006. The quality system also involves the matron / deputy matron in carrying out audits. Accident, falls, care plan and food audits are recorded. Resident monies handed in for safekeeping is managed robustly and safely. The administrator keeps efficient records. The inspector checked three records with her. Health and safety issues are managed competently. Residents live in a safe environment. The Matron informs the CSCI of accidents in the home. Appropriate records are maintained for accidents in the home and reporting to RIDDOR, if appropriate. The inspector observed staff assisting residents to move position. Staff followed best practice handling techniques. Details of equipment servicing records were checked and found to be up to date Hurst Manor Nursing & Residential Home DS0000003267.V305342.R01.S.doc Version 5.2 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 4 4 4 4 4 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 X 3 3 X 3 Hurst Manor Nursing & Residential Home DS0000003267.V305342.R01.S.doc Version 5.2 Page 22 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 Timescale for action 30/11/06 2 OP9 13(4) The registered manager must arrange suitable and appropriate training for all nursing staff to ensure the nurse is familiar with equipment used to administer medication via syringe driver and that they can safely and competently set up the equipment. The registered manager must 30/10/06 develop and introduce a suitable policy and procedure for all nursing staff to follow when setting up and monitoring the administration of medicines via a syringe driver. 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 OP9 Good Practice Recommendations The registered manager should consider developing a champion amongst nurses to be the lead in pain DS0000003267.V305342.R01.S.doc Version 5.2 Page 23 Hurst Manor Nursing & Residential Home 2 OP11 management. The registered person is encouraged to introduce the gold Framework standards into care plans for persons needing palliative / end of life care. Hurst Manor Nursing & Residential Home DS0000003267.V305342.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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. 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