Inspection on 16/05/06 for Hygrove House Nursing Home

This inspection was carried out on 16th May 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hygrove House Nursing Home 20/02/07

Hygrove House Nursing Home 04/01/06

Hygrove House Nursing Home 17/05/05

Hygrove House Nursing Home 19/11/04

Hygrove House Nursing Home 09/06/04

Hygrove House Nursing Home 12/01/04

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

CARE HOMES FOR OLDER PEOPLE Hygrove House Nursing Home Minsterworth Gloucester Glos GL2 8JG Lead Inspector Sharon Hayward-Wright Unannounced Inspection 1:00 16 & 17th May 2006 th 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 Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 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. Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hygrove House Nursing Home Address Minsterworth Gloucester Glos GL2 8JG 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) 01452 750716 01452 750331 hygrovehouse@highfield-care.com Southern Cross Care Homes No 2 Limited Mrs Rita Harris Care Home 48 Category(ies) of Dementia - over 65 years of age (48) registration, with number of places Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th January 2006 Brief Description of the Service: Hygrove House is part of the Southern Cross Group. Hygrove House sits back off the main A48 Gloucester to Chepstow road in Minsterworth. The house itself is a large extended period building surrounded by extensive gardens, with views over the surrounding countryside and Gloucester City. The Home cares for elderly people who suffer from a dementing illness. The building is on three levels and has a passenger lift including stair lifts where required. Many of the Service Users are prone to wander and can do so freely within safe areas to include part of the garden; the areas inside the home are secured with keypads on the doors. Fee ranges are from £460.75 to £710. This information was given to the inspector following the inspection and the fees do not include extras for example chiropody and hairdressing. If a service user is in receipt of the Registered Nurse Care contribution Scheme (RNCC), this is added on to the fees. A copy of the homes Service Users Guide is available in the main reception area. Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this inspection over one day in May 2006 and one of these inspectors is a pharmacist. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes in to account the views and experiences of people using the service. The Registered Manager was available during the inspection as were other members of the home team. A total of 27 standards were inspected. Service users were observed and spoken with, where able, to ascertain their views on the care and services provided. Feedback cards were left at the home for relatives and two have been returned. Six relatives were spoken with to gauge their views on the home. The comments received from relatives both at the inspection and on the feedback cards say they are happy with the overall care received and some felt there had been an improvement in the home, however several concerns were highlighted. These include the lack of planned activities, not being kept up to date with important matters affecting their relative and their relatives not wearing their own clothes and clothes going missing. The Registered Manager and care staff were spoken with throughout the inspection and were helpful and co-operative. Feedback on the inspection findings was given on completion and was received in a constructive and positive way by the Registered Manager. Ten requirements had not been complied with since the last inspection. On this occasion the timescales have been extended as indicated in the requirements made. Unmet requirements impact upon the welfare and safety of service users. Failure to comply by the revised timescale may lead the Commission for Social Care Inspection to consider enforcement action to secure compliance. What the service does well: The home has systems in place to ensure prospective service users have a full assessment completed prior to admission and to ensure their needs can be Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 Page 6 met. Where able service users and their families’ can visit the home to check on its suitability. The staff have a good understanding of service users needs and this was evident from the positive relationships, which have been formed between the staff and service users. The inspector observed staff spending time with service users in a relaxed atmosphere. Service users are able to wander in a secure environment and this includes part of the garden so they can go outside. The Registered Manager has a supportive, open approach to running the home, which benefits the service users, staff and relatives. Feedback received at the inspection confirmed this. Visitors to the home confirmed that they are always made to feel welcome when visiting. What has improved since the last inspection? What they could do better: The home needs to update their Statement of Purpose as listed in this report to ensure all statements made about the service they offer are accurate. A copy of the homes terms and conditions needs to be added to their Service Users Guide and issued to families/representatives. Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 Page 7 Further improvements are needed with care planning to ensure each problem identified has a plan of care. Inconsistencies were found with the reviewing of care plans as some were reviewed monthly and in the case of one service user they had not had one of their care plans reviewed since November 2004. One of the service user’s whose care was examined in detail had very in-depth care plans, but this was not the case for the other service users whose care was examined. A concern highlighted by all relatives spoken with was the lack of planned activities. The home is trying to recruit an activities coordinator. The staff are allocated on a daily basis to provide activities. The home was liquidising service users main course all together, resulting in an unappetising meal, consideration should be given to liquidising all courses of the meal separately to enhance presentation. Some concerns were expressed again at this inspection from service users relatives about the problems they are experiencing with the laundry system; these include clothes going missing and service users wearing other service users clothes. Since the last inspection the standard of vetting and recruitment practices has declined with appropriate checks not being carried out and potentially leaving service users at risk. 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. Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 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 Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 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): 1, 2, 3, 5 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The home’s Statement of Purpose and Service Users Guide provides details of the services the home provides enabling an informed decision about admission to the home. Improvements must be made to the Statement of Purpose and Service Users Guide to ensure these documents are comprehensive. The home’s admission procedure ensures that all service users are admitted on the basis of a full assessment of their needs, ensuring the home is able to meet their needs. Prospective service users and their family/representatives have the opportunity to visit the home and assess it for its suitability prior to the service user moving in. EVIDENCE: Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 Page 10 Following the last inspection the home needed to make several amendments to their Statement of Purpose as they had detailed services that the inspectors could not confirm were taking place. Of the five areas identified only two remain. These are: • That the home writes to new service users to confirm that they can meet their needs. • Service users meetings are held monthly and minutes are displayed. The home has obtained a copy of the letter used by Southern Cross to write to service users or their family to confirm their needs can be met and this will start to happen for new service users. The Registered Manager said due to the medical conditions of the service users they are unable to participate in meetings. Therefore the wording of this sentence needs reviewing to ensure it is pertinent to the service users in Hygrove House. Southern Cross has now revised their terms and conditions following a merger last year with Highfield Care. However the home did not have copies of these new terms and conditions, therefore the requirements issued in previous inspections have not been addressed. Southern Cross has added to their Statement of Purpose that all service users will receive a copy of their terms and conditions. A pre admission assessment of a recently admitted service user was examined. A full assessment of their needs had been undertaken and a copy of their multi-disciplinary assessment was included. From this the home had devised draft care plans. Where able, service users and their family/representatives are encouraged to visit the home prior to the service user moving in. The home has yet to write to service users or their family/representative to confirm they can meet their needs as described in their Statement of Purpose. Intermediate care is not offered in this home. Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 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, & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The care planning system provides staff with the majority of the information they need to satisfactorily meet service users’ health and personal needs; fuller recording in some cases would further improve this, as well as consistency with reviewing of care plans and risk assessments. Service users health care needs are met. Improvements are evident in the management of medicines in the home and most service users receive their medicines safely. There are still issues for attention and some mistakes so the home’s quality audit system of medicines must be more effective in order to protect the safety and wellbeing of service users. Personal support in this home is offered in such a way as to promote the service users’ privacy and dignity. Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 Page 12 EVIDENCE: The care of three service users’ was examined in detail. One service user was recently admitted to the home and the other two service users had been at the home for a period of time. The service user who was recently admitted to the home had detailed individual care plans; the remaining service users’ care plans were not as detailed. One service user is a diabetic, however their care plans did not indicate how often they have their blood glucose level checked. One of the other service user’s is an epileptic, again it did not indicate in their care plan the course of action to take if a fit occurred. This service user had care plans that in one case had not been reviewed since November 2004 and another since November 2005. There were inconsistencies with the reviewing of service users care plans as some were done monthly and others were not. No evidence was seen in these three care plans of the service users family involvement, however the Registered Manager said that other service users families have signed their care plans. One service user had recently had a multi-disciplinary review, but there were no detailed records of what happened at the review. Consideration should be given to recording these reviews to assist the staff with care plans reviews. One service user did not have a care plan for personal care despite needing assistance from the staff. All three-service users had recently had a review of their assessment of need. Records were seen of health professionals input into service users care and communication with relatives. Risk assessments were in place for moving and handling, pressure sores, dependency score, nutrition, falls and continence. A separate written risk assessment was seen for falls. None of the continence assessments had been signed or dated for when they took place. Consideration should be given to completing this to assist staff with reviews. Since the last inspection there are improvements in the Medication Administration Record (MAR) charts but some mistakes were noted. The allergy section needs filling in. Dosage details must be checked as up to date directions for some medicines were to ‘give regularly’ but records indicated they are given ‘as required’. There were two examples where one tablet is prescribed ‘twice daily’ but signed as given ‘once daily’. This may be because two tablets are given once daily. The dose given must be noted when the doctor has prescribed a choice (one or two tablets for example). One medicine for emergency rectal use was in stock but not included on the resident’s MAR chart and there was no information about the dose to use or information in the care plan. For another resident the dose of a tablet had recently changed Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 Page 13 (after a hospital visit) from ‘one tablet every other night’ to ‘one tablet each night’ but the MAR chart had not been changed. For the same person use of a cream was described in the care plan but not on the MAR chart. The use of some prescribed medicines applied externally such as creams and ointments is not always recorded so it is not known if the correct treatment has been used. Creams and ointments were found in two bedrooms. This may put service users at risk. The date of opening is not written on containers of creams and ointments. An ointment in one bedroom was labelled for a service user no longer in the home. There are recommended expiry dates for many medicines when in use but these cannot be followed if the date of opening is not known. The opening date was written on eye drops and another medicine where the expiry date is more critical. Sample care plans were looked at to see how medicine use is included. There is one good example of a plan for medicines but other plans are not so good. Information is needed to describe how any medicine is used that is prescribed ‘as required’ so that all staff understand how to use the medicine consistently according to the needs of each person. The inspector could not find records for blood glucose measurements for other service users where this is supposed to be checked. A fan unit is in place in the ground floor clinic room but this is not effective in keeping the temperature below 25°C – the maximum temperature to keep medicines safely. The Registered Manager said the Company are considering installing a proper cooling unit. The clinic room on the top floor was secure and at a suitable temperature. Some tubs of creams and ointments in here were not labelled or were labelled for service users no longer in the home. A new maximum / minimum thermometer is needed to check temperatures in the medicine fridge. Records showed temperatures outside of the safe range of 2-8°C. The inspector checked the temperature with a thermometer probe and this showed 7.7°C, which is safe. The thermometers in the fridge are probably faulty. The controlled drug cupboard is now securely fixed. Some controlled drugs need to be disposed of using a proper inactivation kit. The controlled drug record book was inspected and an error noted in the recorded stock balance on page 61. Staff record checks of the record book now but the identified error had not been reported and investigated. The medicine trolley for the ground floor is not large enough to hold all the medicines safely so some rearrangement of stock or additional space is needed. Some audit checks, by counting medicines and comparing with the record charts, were accurate but there were some examples where records and counts did not agree. This indicates service users may not have had their medicines correctly or staff are not recording accurately. More checks would be possible if the date of opening is written on the labels of all medicines. The Registered Manager carries out a monthly audit of medicines. This would be more effective if there is a written action plan to improve what is found by the audit and this is followed up. Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 Page 14 Staff take blood samples from some service users to measure blood glucose levels. Lancing devices used need to comply with Medical Device Alert MDA/2005/063 to reduce the risk of infection for service users and staff. There is a medicine policy and procedures but Southern Cross has not revised these. This was a requirement at the last inspection. A new member of staff had not seen the Hygrove House procedures but has worked in other homes within the Company. So that all staff understand how the home expects medicines to be managed the procedures should be readily available in the clinic room. Staff were seen treating service users with care, dignity and respect and no relatives spoken with expressed any concerns about this. Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 Page 15 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. There was some evidence that activities are taking place, however this is compromised without a designated person to organise them and it is difficult to assess their suitability for the service users. Service users are helped to make choices over their lives within the limitations of their ability and visitors to the home can visit when it is convenient for them. Dietary needs of the service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. EVIDENCE: The home does not have a designated activities coordinator at present, therefore there are no planned activities taking place and no records maintained. Staff are allocated each day to undertake activities with service users. A number of relatives expressed concern about this and the Registered Manager said they are in the process of trying to recruit an activities coordinator. On one day of the inspection communion was taking place and the hairdresser visited the following day. The inspector observed the staff Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 Page 16 sitting and talking to service users and undertaking activities that included ball throwing and taking them outside for a walk around the grounds. During both days the inspector noticed how relaxed the atmosphere was and how well the staff interacted with the service users. Service users are free to wander securely around the home and since last year the home has a secure area in the garden. Relatives confirmed that visiting to the home is not restricted and two relatives commented that the staff always make them feel welcome and bring them a drink. One service user was going out with their family on one of the days of the inspection and another relative said they often take their relative out. Where able, staff were seen assisting service users to make decisions about their lives, this included service users being able to choose what they have for each meal from the choice. Due to the medical condition of the service users in the home they would not be able to manage their own finances. Following a complaint received regarding the nutritional content of the food, the home has reviewed their menus. A choice is offered at every meal and in between meals snacks are available. Milky drinks are offered in between mealtimes as well as milk shakes. Staff reported that the service users really enjoy the milk shakes. Mealtimes were observed on both days and found to be a social event with staff offering assistance discreetly. The inspector tasted a meal on the second day and found the food to be delicious. A small number of service user require a liquidised meal, and it was noticed that the main course was all liquidised together making the meal look unappetising. Consideration should be given to liquidising each part of the meal separately to enhance presentation. The kitchen records were inspected and found to be in order except for food records, see Standard 37. Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 Page 17 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. There is a complaints system in place that provided evidence that views expressed by service users relatives/representatives are listened to and acted upon. Arrangements are in place for protecting service users from the possible risk of harm and abuse. EVIDENCE: The home has received one complaint since the last inspection. An action plan has been put in place and issues addressed. The Commission for Social Care Inspection received a concern that was not upheld. The home has a copy of their complaints procedure displayed in the main entrance and is included in their Statement of Purpose and Service Users Guide. Relatives and staff said they would approach the Registered Manager or Deputy Manager if they had any concerns. Records are maintained if a complaint is received. The home has policies and procedures in place for the protection of vulnerable adults. Staff are aware of the whistle blowing policy as an incident occurred prior to the inspection where the home dealt with an incident in the correct manner. Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 Page 18 At the last inspection staff were asked questions about adult protection and answered the questions correctly. A new member of care staff was asked how they would deal with a certain incident and they were also able to give the correct answers. There are plans in place to provide training in this subject. Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 Page 19 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. There has been a vast improvement in the cleanliness of the home ensuring service users live a in a pleasant environment. Laundry arrangements have been improved, however further improvement is needed to meet the needs of the service users. EVIDENCE: A tour of the home took place and a number of service users rooms were inspected. A redecoration programme is taking place on the top floor as a service user has removed the wallpaper. A number of doors to service users rooms have been painted in the colour of their front door from their own homes and door furniture has been provided. Two doors on the top floor were seen to be propped open, this could be a fire risk and consideration must be given to fitting the appropriate self-closing devices, as both of these rooms are communal areas. Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 Page 20 Another visitor to the home expressed a concern that a curtain in their relative’s room had been taken down for repair but had not been returned for some time. This was relayed to one of the Operations Directors for Southern Cross as this was identified as an issue with an outside company. Consideration must be given to providing alternative window covering until the curtain is returned to ensure the privacy of this service user is maintained. There was a vast improvement in the cleanliness of the home and one relative thought new carpets had been provided downstairs. No odours were found on entering the home, which was the case at the last inspection. Two service users rooms inspected had slight odours but the home is working hard to combat these. The domestic staff are working very hard to maintain these high standards. Staff were seen wearing protective clothing when required. The training plan for this year contains training on infection control. At the last inspection concerns were raised about the safety of the laundry room. Refurbishment has nearly been completed except for a small number of minor jobs. There were no bags of soiled linen and clothing waiting to be washed and the room was very organised. One visitor to the home expressed concerns that their relative was not wearing their own clothes and number of items of clothing had gone missing. A comment card returned after the inspection also mentions missing clothes. At the last inspection a large number of relatives expressed concerns but at this inspection some felt it had got better. The Registered Manager is going to look into the issue of the laundry. Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 Page 21 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The staff have a good understanding of service users support needs and this was evident from the positive relationships, which have been formed between the staff and service users. Training opportunities have been provided for staff to improve their skills but there are inconsistencies with not all staff receiving training. Since the last inspection the standard of vetting and recruitment practices has declined with appropriate checks not being carried out and potentially leaving service users at risk. EVIDENCE: At the time of the inspection the home was under their registered number of service users. The home is staffed as if it was full. Between the hours of 8am to 8pm there are two qualified nurses and seven care staff on an early shift and five care staff on an afternoon shift. The night staffing levels consist of one qualified nurse and three care staff. The Registered Manager is supernumerary to these numbers. Ancillary staff undertake other tasks to include, administration, domestic duties, cooking, gardening and maintenance. Comments received from visitors to the home were all very complimentary about the staff saying how friendly they are and they work hard. The inspector observed the staff interacting with service users and found it was a relaxed atmosphere with staff encouraging the service users to join in activities or they would sit and talk to service users. Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 Page 22 The home is working towards the 50 of care staff trained in NVQ 2 or equivalent. Five care staff are planning to start their NVQ 2 training and three are due to complete by the end of the year. Four of the care staff are nurses from overseas working as carers. Personnel files of four recently appointed staff were examined. One of these had been appointed by the home the other three had been appointed by another department from Southern Cross. The one person appointed by the home had all the required information, except there was no evidence of a POVA/CRB (criminal records bureau) check. The Registered Manager said one had been undertaken but could not find any records to confirm this. No interviews records were found. The Registered Manager said normally these are maintained. The remaining three files did not have copies of their application form so the home is not able to examine their employment history in detail and explore any gaps. In these files there were several documents, however it was difficult to determine if these were references due to the handwriting. Interview records were seen for two of these staff members. These three files had either evidence of a POVA and CRB. The home has a training matrix in place to identify when training is needed for staff. One member of staff did not have moving and handling training in 2005 and none to date. This must be rectified. Whilst discussing the procedures for managing service users finances the administrator said she had not been shown how to use the system, again this must be rectified. Training was taking place during the inspection. Training is planned to include dementia care and the home is able to link in with other homes that are part of the Southern Cross group. Southern Cross has devised an induction programme booklet that is held by the staff member. This booklet was not examined at this inspection, however a new member of staff confirmed she had an induction booklet and who their supervisor was. Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 Page 23 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, 32, 33, 35, 36, 37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The Registered Manager has a supportive, open approach to running the home, which benefits the service users, staff and relatives. However there are areas that need improvement to meet the standards. The home regularly reviews aspects of its performance through a programme of self-review and consultations, which include seeking the views of relatives, staff and where able service users. Systems are in place to manage service users monies, however training is required to ensure staff can administer these competently. As far as is reasonably practicable the health, welfare and safety of service users are promoted and protected. Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 Page 24 EVIDENCE: There have been no changes to the Management of the home. The Registered Manager has completed the Registered Manager Award. A condition of registration was for the Registered Manager to undertake a course in dementia care; to date she completed a course about Alzheimer’s and is looking to access a more in depth course about dementia. From discussions with relatives and staff the Registered Manager is approachable and friendly and will listen to any concerns they have. The Registered Manager operates an open door policy and staff and relatives can go to her at any time. The Registered Manager also operates a late evening ‘surgery’ for relatives if needed. The inspector observed the Registered Manager interacting with service users in a friendly and calm manner and has the ability to calm distressed service users. At this inspection a number of requirements remain outstanding and these must be addressed as they can impact on the welfare of the service users. The home has sent out questionnaires to relatives in January 2006, and the results are on the notice board in the main entrance. The Registered Manager or the Operations Manager undertakes monthly audits on the home. Audits are also in place for pressure sores, medications and accidents. Policies and procedures are provided by Southern Cross and updated when any new legislation is passed. The home has systems in place to manage service users monies, however the new administrator has not had any training in how to use the system. This must be addressed (see standard 30). A secure facility is provided. The Registered Manager has a plan in place to meet the recommended six times per year supervision of care staff. Records were seen of these sessions. A requirement issued at the last inspection in relation to maintaining detailed food records has not been addressed since the introduction of the new menus. This requirement has been repeated. Records were seen of servicing of equipment and checks carried out by the maintenance person. A fire risk assessment is in place. Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 Page 25 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 2 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 2 3 2 3 Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 Page 26 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 OP1 Regulation 4&6 Requirement The Registered Person must amend their Statement of Purpose and ensure that the statements listed in this standard are taking place in the home. This requirement has been repeated from the last inspection The Registered Person must add to their Service Users Guide a copy of their terms and conditions and contract. This requirement has been repeated from the last inspection. Service users, irrespective of how their care is paid for, must receive a copy of the homes terms and conditions. Timescale of the 1/8/04 was not met, however due to the merger with Southern Cross this has been put on hold. This will be completed once the company has reviewed their documentation. This requirement has been repeated from the last three inspections. DS0000038272.V293912.R01.S.doc Timescale for action 30/07/06 2. OP1 5&6 30/07/06 3. OP2 5(1b & c) 30/07/06 Hygrove House Nursing Home Version 5.1 Page 27 4. OP7 15 5. OP7 15 6. OP9 13 & 17 7. 8. OP9 OP9 13 13 9. OP9 13 10. OP9 13 The Registered Person must ensure that all service users have care plans for all identified problems. (This relates to specific care plans mentioned in the report). This requirement has been repeated from the last inspection The Registered Person must ensure that there is consistency with reviews of care plans for service users and provide evidence that care plans are reviewed. (This relates to a service user not having their care plans reviewed in one case since November 2004). Administer medicines to service users according to the doctors’ instructions and keep all records of medicines given to service users completely and accurately. Keep written plans for the use of medicines prescribed for use ‘as required’. Put in place effective arrangements to always store medicines below 25°C. Keep accurate records in the controlled drug record book. Investigate and resolve any errors Use lancing devices complying with the information contained in Medical Device Alert MDA/2005/063 to obtain blood samples from residents. This requirement has been repeated from the last inspection Revise the medicine policy and procedures to include the issues raised at inspections and reflect the new ownership and procedures specific to this home. This requirement has been repeated from the last DS0000038272.V293912.R01.S.doc 30/07/06 30/07/06 15/06/06 30/06/06 15/06/06 30/06/06 30/06/06 Hygrove House Nursing Home Version 5.1 Page 28 11. OP12 16(n) 12. OP19 12(4a) 13. OP19 23(4ci) 14. OP26 12 4(a) & 23 15. OP29 19 & Sch 2 inspection The Registered Person must provide activities suitable for the needs and interests of the service users. This requirement has been repeated from the last inspection The Registered Person must ensure that an alternative window covering is provided in room 1 until the curtain is returned from being repaired. The Registered Person must provide self closing devices on the top floor dining room and lounge to reduce the risks to service users, as these were propped open. The Registered Person must review the laundry arrangements to ensure they are meeting the needs of the service users. (This relates to a concern raised by a relative at this inspection). This requirement has been repeated from the last inspection The Registered Person must obtain the following for all staff prior to starting work at the home. Criminal Records Bureau disclosure (including a POVA check where applicable). Two written references, including, where applicable a reference relating to the person’s last period of employment, which involved work with vulnerable adults, of not less than 3 months duration. Where a person has previously worked in a position which involved contact with children or vulnerable adults, written 30/08/06 30/06/06 30/06/06 30/07/06 01/08/06 Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 Page 29 verification of the reason why the person ceased to work in their last position unless it is not reasonably practicable to obtain such verification. Full employment history with satisfactory written explanation of reasons for gaps in employment The Registered Person must ensure that all staff receive training appropriate to the work they are to perform. (This relates to a staff member not having received moving and handling training and the administrator not being able to use the systems for managing service users monies.) This requirement has been repeated from the last inspection The Registered Person must keep records of the food provided for service users in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and of any special diets prepared for individual service users. This requirement has been repeated from the last inspection 16. OP30 18(1c)(i) 30/07/06 17. OP37 17 & Schedule 4(13) 01/07/06 Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 Page 30 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 OP1 Good Practice Recommendations Where the home has mentioned in their Statement of Purpose and Service Users Guide that the staff have dementia training, they should be more descriptive about what this training contains. Care plans should not have ambiguous statements in them, as these statements can be confusing to staff and there is no way to measure against these to see if they are happening when reviewing care plans. Care plans should document service users interests to assist with devising an activities programme. The home should find out if any service users are subject to the Care Programme Arrangements and if they are, obtain a copy of the plan. The staff completing assessments for the first time should date and sign them. The staff should maintain records of multi-disciplinary reviews or store them in the service users care file to assist them in the reviewing of care plans and assessment of need. Write the date on the label when medicines are first opened to use. Use a new maximum and minimum thermometer to record temperatures in the medicine fridge. Review storage of medicines in the trolley on the ground floor to make more space. The staff should ensure that each course of the meal is liquidised separately to enhance presentation. 2. OP7 3. 4. 5. 6. OP7 OP8 OP8 OP8 7. 8. 9. 10. OP9 OP9 OP9 OP15 Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 Page 31 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 Hygrove House Nursing Home DS0000038272.V293912.R01.S.doc Version 5.1 Page 32 - 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. 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