Inspection on 23/11/05 for Hurstead House Nursing Home

This inspection was carried out on 23rd November 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

Hurstead House Nursing Home 28/06/06

Hurstead House Nursing Home 17/02/06

Hurstead House Nursing Home 08/02/05

Hurstead House Nursing Home 03/09/04

Hurstead House Nursing Home 23/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Hurstead House Nursing Home Hurstead House 631 Halifax Road Rochdale Lancashire OL12 9QU Lead Inspector Tracey Devine Unannounced Inspection 23rd November 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 Hurstead House Nursing Home DS0000017330.V268146.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. Hurstead House Nursing Home DS0000017330.V268146.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hurstead House Nursing Home Address Hurstead House 631 Halifax Road Rochdale Lancashire OL12 9QU 01706 379511 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) Mr Nicholas John Frost Linda Eastwood Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (28), Terminally ill (2) of places Hurstead House Nursing Home DS0000017330.V268146.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. That the service should at all times employ a suitably qualified and experienced Manager who is registered with the National Care Standards Commission Within the total number of 30 places there can be up to a maximum of:- 30 General Nursing including 2 Pallative Care, Male and Female 60 years of age and over. 8th February 2005 Date of last inspection Brief Description of the Service: Hurstead House is a large stone property, which has been adapted and extended to accommodate 30 older people, providing personal care for all and nursing care for up to 24 service users. Hurstead House is situated in a residential area off Halifax Road, Rochdale, approximately two miles from Rochdale town centre. Local amenities include a Post Office, newsagents and pub all of which are within short walking distance. A regular bus service passes the home to/from Rochdale and Littleborough. Parking is provided to the front and rear of the home. Ramped access is available to the front door and a passenger lift and stair lift enables service users access to the first floor accommodation. Hurstead House Nursing Home DS0000017330.V268146.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 23rd November 2005 by 1 Inspector. The inspection started at 9.30am and finished at 3pm, a period of 5.30 hours. 2 residents were spoken with during the inspection, along with the Registered Manager, 1 nurse and other staff on an informal basis. The particular areas looked at on this inspection were: what information is received about residents at the home prior to them arriving, what information the home writes down about how they intend to care for people, and what information they write about how they are actually caring for people, how they share this information with residents and/or their relatives, how a person’s health needs are met, what activities are provided to keep residents occupied and entertained, what the food is like, what information is shared with residents in helping them to make a complaint if they so wish, and how the manager does her job. Areas not looked at on this inspection will be covered on the next inspection. The owner of the home also spends time working at the home. What the service does well: The home is homely in design. Assessments are done prior to residents arriving so the home always knows that they are able to care for someone. All the residents know the Manager and the owner, and residents said they felt comfortable in approaching them. Residents spoken with said they would “speak to Nick” (the owner) if they had any complaints. A nurse is always on duty. Staff and residents get on well with each other. The staff are knowledgeable about the needs of the residents. Hurstead House Nursing Home DS0000017330.V268146.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: The Manager needs to make sure that when she or any other member of staff complete an assessment, or add any additional information to records held for residents they date and sign the record. This ensures that everyone is clear as to who provided the information and when. The records kept in respect of residents (known as care plans) need to be in more detail, they are too brief and do not provide the full picture of the care needed or given. The Manager may wish to consider a different format than the current “tick” box kind in use at the moment. The Manager also needs to make sure that any concerns she has about the health of residents are communicated to the doctor and that all visits by the doctor are recorded. Residents who are not eating well, besides being monitored by staff at the home need additional input from the dietician. The Manager must make sure this is done. Care Plans should be shared with residents and/or their relatives. This allows them to understand the care, which will be provided, and to be sure that all their needs are being met. Some activities are provided, but not enough. The Manager needs to take on board that some residents are “bored” and consult with them as to what they want to do. The menu is repetitious running only a 2 weekly cycle. The Manager needs to extend this cycle to 4 or 6 weeks and make sure the meals served are varied. A choice of 2 hot meals should be served at lunchtime. This allows residents to have some control over what they want to eat, and allows them to have a meal they enjoy. The Manager of the home is also a nurse, and spends a great deal of her time being the only nurse on duty, and thus undertaking nursing tasks. As she is also the Manager she must have time away from nursing duties to develop her role as the Manager and ensure that all management task such as monitoring and developing staff are undertaken. The Owner needs to make sure that his Manager has a copy of her job description on site at the home, and he must issue a Contract of Employment to the Manager in respect of her current position. Hurstead House Nursing Home DS0000017330.V268146.R01.S.doc Version 5.0 Page 7 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. Hurstead House Nursing Home DS0000017330.V268146.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hurstead House Nursing Home DS0000017330.V268146.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable. The arrangements in place for ensuring that assessments are undertaken and received at the home prior to a new resident being admitted, ensure that the staff have the knowledge and skills to meet the needs identified. EVIDENCE: Most people admitted to the home are through care management arrangements with a local authority. Prior to admitting anyone to the home, the manager always makes sure that she has received an assessment of a person’s needs either from the person’s (funding) care manager. On some occasions, in addition to the care manager’s assessment the provider and/or the manager may also undertake an assessment. A selection of the assessments were looked at. The assessments which had been undertaken by the (funding) care manager were fully completed, and signed and dated and contained sufficient information on which to base a decision regarding being able to meet someone’s needs. This cannot be said with any consistency in respect of the assessments undertaken by the staff at the home. These assessments were not dated, nor signed, and at times brief. Hurstead House Nursing Home DS0000017330.V268146.R01.S.doc Version 5.0 Page 10 It was raised at the last inspection that assessments completed by staff at the home, should be signed and dated. Hurstead House Nursing Home DS0000017330.V268146.R01.S.doc Version 5.0 Page 11 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 The care planning system in place does not fully demonstrate the care to be provided, or the care actually provided. This potentially leaves residents at risk of having their needs only partially met. EVIDENCE: Each resident has a care plan in place. A selection of the care plans were looked at and in the main found to be brief. The care plan format in use by the home involves staff “ticking” a box, which best describes the care to be provided. On talking with staff, it was evident that staff were knowledgeable about the residents and their health, and their continuing care, but the care plans did not fully reflect the some of the residents. It was identified that a number of residents are poorly, and staff are concerned about them in terms of their food/fluid intake, and general health. The care plans looked at did not detail the poorly condition the residents were in, nor did they particularly detail what care was being offered. For instance, nutritional assessments had been undertaken which for 2 people showed a high reading which according to the assessment required a referral to the dietician for advice. On looking at the care plan and discussing it with the Manager, it was evident that no referral had been made. Likewise staff were concerned about the weight loss of Hurstead House Nursing Home DS0000017330.V268146.R01.S.doc Version 5.0 Page 12 another resident, but no additional monitoring of weight had been undertaken to establish the exact weight loss. This was discussed with the Manager who provided a satisfactory explanation for this, but her reasons for not doing so had not been documented. Very little progress has been made in sharing the content of the care plans with the resident and/or their representative, and none of the residents spoken with had any awareness of what a care plan was. The care plans looked at did evidence the promotion of self care, personal care, and pressure sore care. Care plans also evidenced visits from GP’s and/or other professionals, although these were not seen to be consistently recorded on the files looked at. The systems in place for the storage, and handling of medication have been inspected recently by the Pharmacist Inspector. Some issues were raised and the Manager said she has done everything the Pharmacist Inspector has asked her to do. The Pharmacist Inspector will revisit the home to check on this. Hurstead House Nursing Home DS0000017330.V268146.R01.S.doc Version 5.0 Page 13 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, 15 The activities within the home are limited, leaving some residents unfulfilled in their life at the home. The meals served at this home lack choice and variety, leaving residents unable to exercise choice and control over their diet and what they eat. EVIDENCE: No formal activities programme is in place with activities arranged more on an ad hoc type basis. A number of regular activities take place once a month such as: a “film show”, and staff run a “memory box” activity. A church service is also usually performed by local clergy once a month. Other than these activities, nothing else is particularly arranged and no formal activities programme is arranged. A record of the activities undertaken is generally kept in the diary. The manager said they used to have singers in but residents were not keen, and happy for them not to come anymore. An aroma therapist also used to visit and do hand massages for individual residents, but she no longer comes in. Residents spoken with said they were often “bored” and 1 said, “all the days are the same”. None of the residents spoken with felt sufficient activities were provided for them. Hurstead House Nursing Home DS0000017330.V268146.R01.S.doc Version 5.0 Page 14 The menu runs over a 2 weekly cycle. It is unusual to find a 2 weekly cycle with most care homes operating a 4 or 6 weekly cycle. It was noted that in 1 week, pie was served 3 times in the 7-day period. Overall the menu contained a variety of food such as fish, offal, potato, red and white meat, and milk puddings, although the type of meal was repetitive. No choice of hot meal was detailed for lunchtime, although a choice of food was detailed for teatime. The manager confirmed that the residents could have something different if they did not like what was on the menu, but what the “something different” was could not be established. Residents spoken with said they did not get a choice of food at lunchtime (but they did at tea time), and that you either “ate it or left it” and that “if you left it, nothing else was offered”. One resident was observed to leave a large part of her lunch, which was cleared away with nothing additional, offered by the carer. The menu was discussed with the manager, who said that the cook does lots of home cooking and does make additional things which are not necessarily always detailed on the menu, in particular numerous desserts are made, and cake is always available. It was also noted that the meal served on the day of the inspection did not fully correspond with the menu, therefore making it difficult for the inspector to ascertain the accuracy of the menu, and therefore the food served. Hurstead House Nursing Home DS0000017330.V268146.R01.S.doc Version 5.0 Page 15 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 Training provided has ensured that staff have knowledge and understanding about Adult Protection issues, which protects residents from abuse. EVIDENCE: The home has in place a complaints policy, which is known to residents. Those spoken to said if they had a complaint they would speak “to Nick” (the owner), and they had every confidence he would resolve their complaint. The manager demonstrated that she has the Interagency Guidelines on the Protection of Vulnerable Adults, and she has arranged for most staff to access the Protection Of Vulnerable Adult (POVA) training provided by the Council. 3 staff are due to attend the next course. The home has not had any allegations of abuse made. The manager talked through the process she would take if such an allegation was made, which was in line with the Interagency Guidelines. Hurstead House Nursing Home DS0000017330.V268146.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): EVIDENCE: None of these standards were inspected on this occasion. will be inspected at the next inspection. The key standards Hurstead House Nursing Home DS0000017330.V268146.R01.S.doc Version 5.0 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): EVIDENCE: None of these standards were inspected on this occasion. will be inspected at the next inspection. The key standards Hurstead House Nursing Home DS0000017330.V268146.R01.S.doc Version 5.0 Page 18 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, 36 The management arrangements in place need to be strengthened to ensure that the management tasks such as supervision of the staff are undertaken thereby ensuring that staff fully understand their roles and responsibilities in meeting the needs of residents. EVIDENCE: The manager of the home is a qualified nurse and she has recently completed her Registered Manager’s Award. At the last inspection, the Commission required the manager’s supernumery hours to be more clearly shown on the rota. This has not been done as it was not evident which of the manager’s hours spent at the home were supernumery, and on discussion the Manager was unable to identify which hours were specific to her management role, as opposed to her nursing role. Hurstead House Nursing Home DS0000017330.V268146.R01.S.doc Version 5.0 Page 19 As the home provides nursing care, a qualified nurse must be on duty at all times. On looking at the rota, the Manager shares the nursing duties with 2 other RGN’s, and at any one time there is only 1 RGN on duty. Whilst the Inspector is mindful that the owner of the home is also a qualified nurse and does undertake work for the home, he is not always on the premises owing to the nature of other work he undertakes for Hurstead House i.e. assessments, shopping etc. So although according to the rota he may be working he may not be in the home for instance on the day of this inspection, his hours were detailed as 9/4. However, it was not until 10.30am did he arrive at the home, having had other matters to attend to on behalf of Hurstead House. To ensure that the manager is able to undertake management task as opposed to nursing tasks, the management supernumerary hours need to be detailed on the rota. At the last inspection, it was required that the manager has in place a job description. No copy of a job description could be found on the Manager’s personnel file (held at the home), nor could an up to date copy of a Contract of Employment in relation to her position as the manager be found. A formal supervision programme has started, but as yet, is not fully operational. This was discussed with the manager, including ideas on how to progress this. Hurstead House Nursing Home DS0000017330.V268146.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X 1 X X Hurstead House Nursing Home DS0000017330.V268146.R01.S.doc Version 5.0 Page 21 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 OP9 Regulation 13(2) Requirement The provider must ensure that the ordering and stock control procedures are such that required medication is available for administration (Extended from 19/09/05) The provider must ensure that all medication records including those for receipt, administration and of medication for disposal are complete, clear, accurate and up-to-date. (Extended from 24/10/05) The care plan must set out in detail the action which needs to be taken by staff to ensure that all aspects of health, personal and social care needs are met. (Previous timescale of 30/04/05 not met) The care plan must be drawn up with the involvement of the service user and/or their representative. (Previous timescale of 30/04/05 not met) The manager must have designated supernumery hours, DS0000017330.V268146.R01.S.doc Timescale for action 28/11/05 2. OP9 13(2) 28/11/05 3 OP7 15 31/12/05 4 OP7 15 31/12/05 5 OP31 18 31/12/05 Hurstead House Nursing Home Version 5.0 Page 22 6 OP36 18 7 OP8 12 8 9 10 OP12 OP15 OP29 16 17 12 11 OP29 12 which are identified for management and clearly shown as such on the rota. (Previous timescale of 31/03/05 not met) Each member of staff must have formal supervision at a minimum of 6 times per year and a programme must be devised demonstrating how this is to be met. Residents with a poor dietary intake must be monitored formally, and referred to their GP for referral to the dietician should their food/fluid intake not improve. An activities programme must be drawn up after consultation with the residents. The menu must be adhered to all times. A copy of the job description for the position of Registered Manager must be forwarded to the Commission, and a copy held on file at the home. The Registered Manager must have a contract of employment in respect of this position, which is held at the home. 30/01/05 15/12/05 31/12/05 15/12/05 15/12/05 15/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP9 Good Practice Recommendations The medication refrigerator temperature should be recorded. Oxygen cylinders should be chained or in a trolley; appropriate warning signs should be displayed. Hurstead House Nursing Home DS0000017330.V268146.R01.S.doc Version 5.0 Page 23 3 4 OP7 OP15 5 OP15 Assessments (and all other information) completed by staff should be signed and dated. The 2 weekly menu should be increased to 4 or 6 weekly thereby increasing the choice of food as well as the variety. Changes made to the menu should be recorded for inspection purposes. A choice of 2 hot meals should be menu’d for the lunchtime meal. Hurstead House Nursing Home DS0000017330.V268146.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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 Hurstead House Nursing Home DS0000017330.V268146.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. 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!