CARE HOMES FOR OLDER PEOPLE
Hutton Village Nursing Home Hutton Village Brentwood Essex CM13 1RX Lead Inspector
Christine Bennett Unannounced 8 August 2005 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 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. Hutton Village Nursing Home I56 I06 S15539 Hutton Village NH V243278 080805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Hutton Village Nursing Home Address Hutton Village, Brentwood, Essex CM13 1RX Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01277 261929 01277 233955 BUPA Care Homes Limited Mrs Mary Watts CRH N 48 Category(ies) of DE Dementia 10, TI Terminally ill 2, OP Old Age registration, with number 46, PD Physical disability 1. of places Hutton Village Nursing Home I56 I06 S15539 Hutton Village NH V243278 080805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Care Home with nursing, not to exceed 48 places. Dementia 10 places Old age not falling into any other catagory 46 places Physical disability 1 place Terminally ill 2 places Date of last inspection 17th March 2005 Brief Description of the Service: BUPA Hutton Village Nursing Home provides care with nursing for 48 older people incorporating some catagories of dementia and terminal illness. The home is situated in a semi rural location, approximately four miles from the centre of Brentwood. It is easily reached from junction 28 of the M25 and from the A12. Shenfield main line railway station is one mile from the home. Some local shops are within easy walking distance. Shenfield shopping centre offers a wide variety of facilities including the post office, several banks, library and many specialised shops. Apart from the main dining room, which is housed in a converted Victorian schoolroom, the home is purpose built. It is surrounded by its own well maintained gardens. There is ample parking both at the front and at the rear of the building. The home has thirty single bedrooms and nine double bedrooms, all with en suite facilities. All the downstairs rooms have floor to ceiling windows overlooking the gardens or fields. Public areas of the home include three residents lounges and two dining rooms. Hutton Village Nursing Home I56 I06 S15539 Hutton Village NH V243278 080805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on 8th August 2005 over 8 hours. The inspection process included discussion with the manager, 15 residents, 4 relatives, and 8 members of staff. A tour of the premises was undertaken and an inspection of sample records and policies. What the service does well: What has improved since the last inspection?
The home has recently recruited an activities organiser, which has been welcomed by both residents and relatives and they spoke positively about some of the things they had been doing. One relative said, “I like the nails, hair and feet, things that make them feel looked after” and a resident said, “I join in the activities, it’s fun”. There have been a number of staff recruited from overseas, especially Poland, which has meant that the home does not have to use agency staff very often. Staff were very positive about this and said the staff morale is good and the staff team is very friendly. There has been an improvement in the laundry service with the use of individual net bags and the quality of the ironing was seen to have improved. The retained GP has changed and he visits the home each week to carry out regular reviews of treatment for residents, and visits at other times if requested. The home has also bought more specialised equipment including pressure mattresses and plans to replace all existing hospital beds with beds that are more adaptable to each person’s needs. Training for staff has taken place on specialised medical conditions to help them look after the residents. Hutton Village Nursing Home I56 I06 S15539 Hutton Village NH V243278 080805 Stage 4.doc Version 1.40 Page 6 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. Hutton Village Nursing Home I56 I06 S15539 Hutton Village NH V243278 080805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Hutton Village Nursing Home I56 I06 S15539 Hutton Village NH V243278 080805 Stage 4.doc Version 1.40 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 standard(s) 1,3,6 The home operates a thorough pre admission assessment ensuring appropriate admissions. EVIDENCE: The manager described a thorough pre admission process to ensure that a resident’s needs would be met. Visitors said that they viewed the home before the resident moved in and the manager visited the person in hospital to assess whether their needs could be met. A resident confirmed that she moved in to the home on a one month trial after which a review was held to ensure that all parties were happy with the placement. The home does not admit people for intermediate care. The Statement of Purpose and the Service User’s Guide have been amended to meet regulations. Hutton Village Nursing Home I56 I06 S15539 Hutton Village NH V243278 080805 Stage 4.doc Version 1.40 Page 9 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 standard(s) 7,8,9 Omissions of detail in care plans detract from the quality of care witnessed and substantiated by residents and relatives. The health needs of residents are met with good multi disciplinary teamwork taking place, and medication is well managed. EVIDENCE: Residents spoken with and observed looked well cared for and staff were seen to be gentle and caring in their dealings with residents. Relatives were very complimentary about the care being given and one said, “ I have never heard them speak an unkind word”. Residents said the staff were kind and comments made were, “they are very good, they look after us” and “staff are excellent”. However, care documentation did not fully reflect the care being provided. Two care plans were reviewed in detail and both lacked information relating to particular needs, one example being a resident who had been identified as at risk of weight loss but had not been weighed. There was little evidence of monthly reviews and no evidence to indicate that the resident or their relatives had been involved in the care plan or reviews. This was discussed with the manager who said that action would be taken to review care planning.
Hutton Village Nursing Home I56 I06 S15539 Hutton Village NH V243278 080805 Stage 4.doc Version 1.40 Page 10 Evidence was available to confirm appointments with outside professionals. The GP was visiting the home and comes weekly to review medication, one lady was at the local hospital for an appointment relating to her eyes, and another resident was awaiting a hospital admission to remove cataracts from her eyes. Staff confirmed that a physiotherapist, aromatherapist and a chiropodist visit the home on a regular basis. The home has appropriate storage facilities for medicines held on behalf of residents. Medication administration records were well completed and staff confirmed that they have a good relationship with the local GP and pharmacist. Five members of staff have received training in July 2005 for medication administration. Hutton Village Nursing Home I56 I06 S15539 Hutton Village NH V243278 080805 Stage 4.doc Version 1.40 Page 11 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 standard(s) 12,13,15 Residents experience a stimulating and varied life in the home with visitors encouraged. Meals are well managed and varied and meet the nutritional needs of the residents. EVIDENCE: The home has recently employed an activities organiser and residents, relatives and staff were very positive about this appointment. Individual sessions are arranged in the mornings and communal sessions in the afternoon to ensure individual needs are met. The range of activities is varied and includes poetry sessions, cooking, arts and crafts, picnics and a garden party. Entertainers also come into the home and a scone tea was arranged recently, to which 18 residents and 30 visitors attended. One resident confirmed that she has enough to keep her occupied in the home, and another spoke of her pleasure regarding the activities, stating, “it’s fun”. A relative was complimentary about the activities, especially “ the things that make them looked after such as nails, hair and feet”, and confirmed that she could visit the home whenever she wanted and was always made to feel welcome. Hutton Village Nursing Home I56 I06 S15539 Hutton Village NH V243278 080805 Stage 4.doc Version 1.40 Page 12 The home has recently revised its procedures and protocols relating to meal times. It identified a need for more supervision in the dining room and a qualified member of staff now ensures that residents are given an appropriate meal for their needs, and any help they require. The serving of the meals is staggered to ensure that the meal is hot and the dining area has been re arranged to allow more room for the residents. Lunch was observed and the dining tables had been laid attractively with cloth napkins, wine glasses and plastic spoons were no longer used. The meal looked appetising and nutritious and residents were seen to chat with the radio in the background providing a pleasant atmosphere. One relative said, “the food is very, very good” and one resident said, “the food is out of this world, super food”. Hutton Village Nursing Home I56 I06 S15539 Hutton Village NH V243278 080805 Stage 4.doc Version 1.40 Page 13 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 standard(s) 18 Staff are aware of issues relating to the protection of vulnerable adults ensuring that the residents are not put at unnecessary risk. EVIDENCE: Residents confirmed that they felt safe in the home and had not experienced any unkindness or rough treatment from staff. The home has policies and practices that act to protect residents and there have been no POVA issues since the last inspection. Twelve staff has recently received training on Challenging Behaviour and six staff has had POVA training in July 2005. Hutton Village Nursing Home I56 I06 S15539 Hutton Village NH V243278 080805 Stage 4.doc Version 1.40 Page 14 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 standard(s) 19 A clean and comfortable environment is provided to make the home a pleasant place to live. Building work must be addressed to comply with fire regulations and ensure the safety of residents. EVIDENCE: The home is well maintained, clean and free of unpleasant odours. The housekeeper confirmed that the home has recently purchased a new quieter hoover and a carpet washer. The gardens are landscaped and provide attractive views from residents’ rooms. A recent fire risk assessment by the estates department of BUPA highlighted some areas of concern in an area of the home. Building work to rectify this problem is due to commence in September 2005 and will last for approximately 6 weeks. The home has employed an extra member of staff at night to assist with evacuation in the event of a fire, and has a special evacuation procedure in place until work has been completed. Hutton Village Nursing Home I56 I06 S15539 Hutton Village NH V243278 080805 Stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 Staff at the home are employed in sufficient numbers to meet the needs of the residents. The home operates a safe recruitment practice, with appropriate checks being carried out to protect residents. Staff training provides staff with the core skills to do their jobs and to promote safe practice. EVIDENCE: The staff rota was seen and evidenced that the home is maintaining staffing levels and no member is working excessive hours. The manager outlined a recruitment programme from overseas, mainly Poland which has meant a great reduction in the use of agency staff. Residents and existing staff were very positive about this, and said there is a good team spirit, and high staff morale. Staff files were examined for 3 new members of staff and appropriate checks had been made in accordance with regulation prior to commencement of employment. A new member of staff described a thorough induction process and staff training records were seen which highlighted a variety of training that had been undertaken by staff including wound care, care planning, eating and drinking, diabetes and dementia. One member of staff confirmed that there was a good training programme in place and that the management were open to suggestions in this respect. 3 care workers have achieved NVQ level 2 and 2 care workers have achieved NVQ level 3. The manager explained that as the care staff recruited from Poland are on a one-year contract, it is not possible for them to undertake NVQ training. Hutton Village Nursing Home I56 I06 S15539 Hutton Village NH V243278 080805 Stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 The manager provides leadership, guidance and direction to the staff to ensure residents receive consistent quality care. EVIDENCE: The manager is an RGN and has worked at the home for many years. Residents, relatives and staff made positive comments about the manager and felt that she is approachable and any concerns would be addressed. Hutton Village Nursing Home I56 I06 S15539 Hutton Village NH V243278 080805 Stage 4.doc Version 1.40 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 2 x x x x x x x STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 3 x x x x x x x Hutton Village Nursing Home I56 I06 S15539 Hutton Village NH V243278 080805 Stage 4.doc Version 1.40 Page 18 YES Are there any outstanding requirements from the last inspection? 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 7 Regulation 15 Requirement Timescale for action 1/12/05 2. 19 23(4)(a) The registered person must prepare a written plan as to how the residents needs are to be met involving the resident/relatives and review monthly The registered person must take 1/12/05 adequate precautions against the risk of fire. 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 22 8 Good Practice Recommendations The registered person ensures call bells are left within reach of residents. Residents should be weighed on a periodic basis. Hutton Village Nursing Home I56 I06 S15539 Hutton Village NH V243278 080805 Stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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