Inspection on 20/02/07 for Hygrove House Nursing Home

This inspection was carried out on 20th February 2007.

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 16/05/06

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 Key Unannounced Inspection 10:00 20 & 21st February 2007 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.V320644.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 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 None Southern Cross Care Homes No 2 Limited To apply to the Commission to be considered for registration. Care Home 48 Category(ies) of Dementia - over 65 years of age (48) registration, with number of places Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd August 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 £529.70 to £720. This information was given to the inspector prior to the site visit 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 Statement of Purpose and Service Users Guide is available in the main reception area. Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two Inspectors carried out the site visit, which took two days in February 2007. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The Manager was available for both days of the site visit. A total of 26 standards were inspected. Several service users where able were spoken with to ascertain their views on the care and services provided. An observation tool was used for two hours and this focused on the interactions and engagements of three service users. The majority of interactions between staff and service users were good. A number of surveys were sent to the home prior to the site visit for staff and visitors. A number of these were returned to the Commission. On the whole they were positive stating improvements have taken place. Comments from these surveys are included throughout the report. The Manager and care staff were spoken with throughout the inspection and were helpful and co-operative. Since the last inspection the home has made improvements in a number of areas and these are mentioned below. Two 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: Visitors to the home are made to feel welcome and are offered drinks and can stay for a meal with their relative if they request to. Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 Page 6 Service users are able to wander in a secure environment and this includes part of the garden so they can go outside. The manager carries out audits of medication systems as a check that service users are receiving their medicines correctly. Medicines are in stock to give to service users according to the doctors’ directions. What has improved since the last inspection? The home has updated their Statement of Purpose and Service Users Guide and these are available in the main reception of the home. Care plans have been improved to provide staff with information needed to care for each service user. Reviews are taking place and the service users family is also included. The appointment of an activities coordinator has improved the activities provided. When the coordinator is not working the staff are now encouraged to undertake activities. Storage arrangements for medicines have been improved. Safer lancets for taking blood glucose samples are used. Medicine records have improved and audit counts confirmed this. Laundry arrangements have improved and with this the storage of service users belongings in their wardrobe. Feedback from visitors indicates that the meals provided have improved. ‘Finger food’ is now readily available for service users in between meals. A new manager has started at the home and the feedback received from staff is that she has made a number of improvements. Improvements with the homes recruitment procedures were found but the home needs to ensure all the required checks are taking place. Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 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.V320644.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The information provided by the home offers service users and their family details about the services supplied by the home enabling an informed choice about whether admission to the home is right for them. Service users are not admitted to the home without first having an assessment of needs undertaken to ensure the home can meet their needs. EVIDENCE: The home has reviewed their Statement of Purpose and Service Users Guide since the change in management of the home. Both guides contained detailed information about the services provided by the home and copies of these guides are displayed in the main entrance to the home. The Manager said that all service users are given a copy of the Service Users Guide and these were seen in several service users rooms. However whilst service users have access to these guides the inspector was not able to gauge service users Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 Page 10 understanding of them as when asked service users did not acknowledge them. These guides are available on audiocassette. The home is in the process of issuing new terms and conditions to all service users in the home. Southern Cross has different terms and conditions depending on who is paying for the fees but they all contained the same information. Their terms and conditions have been reviewed following the implementation of additional Regulations that came into force in October 2006. The care records for a recently admitted service user were examined. This service user had an assessment of their needs and draft care plans devised. A list of their medical history and medications was also available. Discharge information from the hospital was available in the service users care records. No evidence was seen that the home had written to this service user or their family to say they can meet their needs. The Manager is aware that this needs to be done in line with the homes Statement of Purpose and the Care Home Regulations 2001. Intermediate Care is not provided at Hygrove House. Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 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. 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 this service. Since the last inspection the home has improved their care planning systems to ensure staff have the information available to meet the assessed needs of the service users. There are continued improvements in the way this home manages medicines safely for the benefit of service users but some further action is identified to store medicines correctly and make sure safe procedures are always followed. Service users are treated with respect but to ensure their dignity is maintained further vigilance is needed with personal care. EVIDENCE: The care of three service users was examined in detail. This included examining care records, speaking to staff and the service users and using an observational tool. One service user had recently been admitted to the home Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 Page 12 and the other two service users had been at the home for at least a year. All three had an assessment of needs completed. From this care plans had been devised. Care plans examined were individual to each service user and had evidence of monthly reviews. One service user had only recently been admitted therefore was still having their care plans finalised. One service user had a care plan in place for wound care but this had not been dated or signed by the staff member devising it. Two service users relatives had signed their care plans as evidence of agreement. Two service users had personal profiles completed and the other service user as mentioned previously is new to the home and this is due to be completed. Two service users had recently had reviews of their care that had included a member of their family being present. All but the recently admitted service user had photographs on their care records and this is due to be done. Daily records are maintained and the home now uses handover sheets for staff to record details they need to be aware of and to ensure these are handed over to the next shift. Risk assessments were in place for each service user both in a hand written format based on individual needs and a set format. Evidence was seen that these are reviewed monthly. However one service users risk assessment for pressure sores said they were using an alternating mattress but on visiting their room they were in fact on a static mattress. This needs to be updated. Two continence assessments were not dated or signed when they were undertaken thus making it difficult for the home to provide evidence they are reviewed. The set formats used for risk assessments include, falls, nutrition, pressure areas, moving and handling, dependency and continence. Evidence was seen of service users having their weights taken as the home has now purchased a new set of scales. At the last random inspection concerns were highlighted about the nutritional condition of several service users, since then the home has introduced a new protocol to monitor service users most at risk and this includes completing records sheets for diet and fluid intake in line with frequent checking of their weight. Body mapping charts are in place and updated as required. Evidence was seen of input by health professionals and this includes GP, continence assessments completed by the Primary Care Trust, Occupational Therapist, Community Psychiatric Nurses and Registered Nurse Care Contributions Scheme (RNCC). One service user had input from the palliative care team from the local hospital. The majority of service users are now registered with the local GP practice. The new manager has introduced some changes and is monitoring the way medicines are handled. Sample audit checks of medicines and records were satisfactory and indicate service users are receiving their medicines correctly. Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 Page 13 The administration of medication policy was displayed with the medicine records. This referred to other more detailed policies about specific topics, for example controlled drugs and crushing / disguising medication. The operations manager said this detailed guidance was on the company intranet. A paper copy should be readily available for staff to easily refer to. The manager carries out regular audits of medication systems including stock balance checks. It is important that if discrepancies are found these are followed up and it was not clear if this was the case. Registered nurses administer the medicines. The manager said the pharmacy have recently provided some training and she is making arrangements with a local college to provide Safe Handling of Medicines training. There are suitable arrangements in place for keeping records of medicines received, administered to service users and returned to the pharmacy. Since the last inspection for each person a cover sheet with basic information, a record with details of any medicine changes and a protocol of how to use medicines prescribed ‘as required’ has been introduced. Where variable doses (one or two tablets) are prescribed the actual dose given is often recorded but there were examples where this was not done. It is important always to know the exact dose the service users receive. The following specific issues were noted. For a service user admitted for respite care on 11/2/07 the medicine chart agreed with the information on the container labels but a cover sheet with basic information or plans for using ‘as required’ medicines was not in place. There were some eye drops in the trolley labelled ‘as directed’ for this person together with an unlabelled bottle of some different drops. These had not yet been used and it was not clear how they should be used. The same person was prescribed a sleeping tablet to take each night as well as another sedative medicine ‘as required’. There was no plan how to use this but doses were signed as given each night as well as the sleeping tablet. Staff were making contact with the doctor about these points during the inspection. For another person admitted 12/2/07 the medicine chart and labels of medicines were in agreement and the medicines received were recorded. Nothing was found in the care plan about checking medicines on admission. This is needed as a check that the medicines service users bring to the home with them are the right ones for them to take. The manager said she does pre-admission assessments, which includes full details of medication and would check with the GP. Some protocols for ‘as required’ medicines would benefit from containing more information about the dose where a variable dose is prescribed (one or two sachets for example). Another plan for an emergency medicine given rectally Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 Page 14 did not contain sufficient information about the actual dose and the specific time intervals. A plan for using an emergency injection must contain information about the dose to use. For one service user there is a care plan to give some of the medicines in food or drink. The doctor has been involved and the manager said she tries to always discuss care plans with relatives. A full ‘best interests protocol’ must be drawn up and to involve all persons with an interest in this service user’s care so that it is quite clear that the medicines are given in this way in their best interests. There are recognised professional guidelines to follow about this and the company have their own policy. There are health and safety considerations in preparing some of the medicines in this way. It is strongly recommend that the doctors’ prescriptions are always checked in the home before being sent to the pharmacy for dispensing. The manager agreed to introduce this. The pharmacist inspector watched how medicines were given to some service users at lunchtime in the downstairs lounge. Safe procedures were carried out except for one person who was not in the lounge at the time. The medicines were prepared in here then carried down the corridor and around the corner to the bedroom. This practice can lead to mistakes and service users having the wrong medicines. It is important to take the medicine trolley as close as possible to the person taking the medicine so that the safe practice of checking the labelled medicine container and records in the presence of the service user is followed. Since the last inspection extra space has been provided to store medicines with another medicine trolley, safer arrangements for keeping medicines applied externally and most medicines moved to a cooler room. The controlled medicines cupboard must also be moved, as the downstairs room is too hot (29°C on the day of the inspection which is above the safe storage temperature for most medication). The temperature in the upstairs room was however 27°C on the day of the inspection and records showed the temperature range since 1/1/07 was 21 – 27°C. It is acknowledged that the home have taken some action on this issue raised at previous inspections but this has not always been effective so further action is needed to keep medicines below 25°C. There is a medicine fridge for which a new thermometer has been installed but records still indicate temperatures outside of the safe range of 2 – 8°C so more action is necessary. Two tubes of cream needed moving from the main medicine cupboard. This is to prevent medicines applied externally coming into contact with medicines that are swallowed. Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 Page 15 Checks of controlled medicine stocks with the record book were correct. Signed daily checks of these medicines are carried out. When liquid medicines are recorded consideration should be given to keeping a new page for each new bottle rather than adding on to existing pages. This allows for the stock to be checked when each bottle is used up and prevents measurement discrepancies accumulating. Action has been taken to use safer lancet devices when taking blood glucose measurements from service users. Records are kept of the measurements taken. Where these were outside the ‘normal’ range a note was made ‘treatment given’ but not specifying what this was. An observational tool was used as part of the inspection and on the whole the interactions between staff and service users observed were good, however on one occasion a member of staff removed a service users tabard from behind them whilst they were asleep causing them to become agitated as they were woken up. Good interactions observed included staff sitting with service users and talking to them and dancing to the music. Staff were observed speaking to service users with respect and service users were well dressed with their hair brushed and male service users had all been shaved. Two service users were noted to need their hair washing and a member of staff said the hairdresser takes care of service users hair. To ensure service users dignity is maintained the staff need to offer assistance to service users with their hair care when the hairdresser is not at the home. Staff said service users have one planned bath a week but can have more if required. Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements with the activities provided by the home enable service users to receive stimulation and to meet their recreational needs. Visitors to the home are encouraged and made welcome to help in enriching the lives of service users. The staff in the home need to continue to encourage service users to make choices and ensure these are listened to. Improvements have been made to the provision of food ensuring the needs of the service users are being met. EVIDENCE: The home has a designated activities person for set hours each week and when they are not on duty the care staff undertake them. The activities coordinator has completed ‘life histories’ on each service user, which helps her to plan activities. Records are maintained on each service user detailing their Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 Page 17 activities. Activities were seen taking place on both days of the inspection and the activities coordinator and staff undertook these. A plan is in place and details activities planned. The home has a secure garden where service users can wander in warmer weather. Two comments about activities were made on the relatives/visitors surveys, one said ‘they would like their relative taken out more’ and ‘the activities lady is excellent and very competent’. Service users were observed joining in activities or they were able to make the decision not to. Several service users appeared happy to sit and watch whilst other joined in. Staff were see encouraging service users to take part whilst acknowledging the service users may not want to. One service user was sat in a chair and appeared happy just to cuddle the soft toy they were holding. Visiting to the home is not restricted and visitors were seen at the home during the inspection. All responses on the relatives/visitors survey said the staff in the home makes them feel welcome at any time. Visitors were seen being offered drinks and food. Where able service users are able to make decisions in their daily lives. This includes staff offering service users a choice for their meals and this was observed. An observational tool was used and part of this was to observe interaction between service users and staff. An incident was observed where a member of staff offered a service user their meal and they said no. The member of staff continued to press the service user who at this point was becoming agitated. The manager then came into the lounge and proceeded to attempt to offer this service user their meal, again they refused and in the end they became very agitated and upset and tried to throw their drink at the manager. The inspector is mindful of the good intentions of the staff, however this service user had indicated several times they did not want their meal. This was discussed with the manager at the feedback session who agreed that best course of action would have been to go back to the service user at later point and offer them their meal. A number of service users rooms were seen and contained their personal belongings. Since the last inspection the home has had a change in the kitchen staff and a new cook has been appointed. The home follows a three-week rotational menu that is provided by Southern Cross. Alternatives are provided, and one service user is a vegetarian. The meals for the day are written on the notice board in the dining room. All the appropriate health and safety checks are carried out and recorded. The cook is planning to attend the training on the updates for food standards. Two mealtimes were observed and were found to be unhurried with service users being offered a choice were they want to eat their meal. The inspector tasted a meal on one of the days of the inspection and found it to be very tasty. Service users were observed enjoying their meals. Comments received from relatives/visitors surveys said that the ‘cook is very very good but the Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 Page 18 food needs to be cut up more’ and ‘there has been a vast improvement in the food as they stayed for lunch’. Since the last inspection ‘finger food’ for service users is now readily available. Bowls of fruit were seen in communal areas and one service user was seen helping themselves to the bananas. Drinks were given out at mealtimes and in between with the finger foods. Another comment on the relatives/visitors surveys said that ‘jugs of water are not supplied in service users rooms and plate guards are not provided’. Plate guards were seen in use during the inspection for several service users. Records relating to food were examined see Standard 37. Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 Page 19 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. 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 this service. The home has a complaints procedure in place with evidence that the views of service users and relatives are listened to and acted upon. Arrangements are in place to ensure service users are protected from possible abuse or harm. EVIDENCE: In the last twelve months the home has received eight complaints and Southern Cross has investigated all of these. Outcomes to these investigations have been provided to the complainants and the CSCI. The home has copies of their complaints procedure in their Service Users Guide and Statement of Purpose, which are both, displayed in the main entrance to the home. The relatives/visitors surveys all said they were aware of how to make a complaint. Southern Cross has polices and procedures in place for the protection of vulnerable adults and these include ‘whistle blowing’, ‘no secrets’ and the ‘alerters guide’ which is information about local procedures. The manager and training records confirmed staff have received training in abuse. The inspector was not able to determine if this training provides information about local procedures and if this is not the case consideration should be given to the home providing training in local procedures. Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 Page 20 One service user was referred to the adult protection unit at the local council, however following several visits to the home by a social worker they were happy with the care provided and this service user’s referral was closed. Two members of staff have been referred to the POVA list and they no longer work at the home. Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 Page 21 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. 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 this service. Improvements are needed to the environment to ensure service users live in a pleasant and safe home. EVIDENCE: A tour of the environment took place with nearly all service users room seen. Comments received via relatives/visitors comment cards said that there is an ‘odour at the entrance to the home and inner lounge’, however prior to the inspection the home has replaced the carpet to part of the main lounge and this how now improved. Another comment is that the ‘temperature in some rooms needs monitoring as they are cold in the winter and hot in the summer’. This was relayed to the manager. A number of rooms were found to be odorous and the numbers were given to the manager during the inspection. A room on the ground floor had the Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 Page 22 window propped open using a ‘coaster’ as the window would not stay open on its own. This needs to be addressed. By one room on the middle floor there was wallpaper peeling above the door and this was seen by the Area Manager, as he was party to the tour of the home. On this floor a door handle was missing to a fire door and another service user’s room had a cracked windowpane. On the top floor one service user’s room had an electric cable running across the floor, which could potentially become a risk, as this service user needs to be hoisted. On the top floor there are areas where the wallpaper has been ‘picked off’ by a service user, which looks unsightly. The self-closing device on door to the lounge appears not to be working as the staff are propping the door open with a footstool. The self-closing device on the dining room on this floor was not working and the door was also being propped open, and this fire door does not close properly. These need to be addressed as a matter of urgency as it can potentially place service users at risk. This was relayed to the manager at the end of the inspection. Service users are able to have their own personal items in their rooms and these were seen. The manager said they have a programme in place for redecoration. Several service users room have their door painted in a colour chosen by their family to help them recognise their rooms. The toilet doors are painted in yellow and service users were observed being able to recognise this and where able use the toilets independently. The laundry area was inspected and was found to be well organised and the washing machines have been repaired following the last inspection where they were found not be washing the clothes with the correct amount of detergent. A comment received on a survey from a visitor/relative said ‘the laundry is very clean and smells lovely, a bit slow sometimes’. Wardrobes in a number of service users rooms were seen and found to be very tidy and well organised. Clothes were seen being taken back to rooms with care attention. Staff were seen wearing protective clothing when required and several members of staff have completed an infection control course. A comment received on relatives/visitors survey said their ‘relative’s room is always spotless’. Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 Page 23 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. 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 this service. The home is confident that the numbers of staff on duty meet the needs of the service users. Improvements have been made with the majority of the required recruitment checks being completed but the home needs to ensure that all of these checks are undertaken prior to the staff member starting at the home. Training opportunities have been provided for staff to improve their skills and further progress can be made by including recognised training for care staff. EVIDENCE: Duty rotas were seen for the home and the manager confirmed the staffing numbers on each shift and she is confident that the needs of the service users are being met. Ancillary staff are extra to these number and this includes domestic staff, maintenance and kitchen. The manager is not included in these numbers. Six of the seven relatives/visitors surveys returned said they felt in their opinion there is sufficient staff on duty. Staff spoken with during the inspection all said they enjoyed working at the home and there is a good team spirit. Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 Page 24 Since the last key inspection the home has had a period of instability in their staffing but this has now improved with a good match of qualified staff that offer consistency to the service users. The pre inspection questionnaire states that no staff in the home has NVQ 2 training. Six staff are in the process of undertaking this training. Four personnel files were examined for recently appointed staff. All the required recruitment checks had been undertaken except for one who did not have a full employment history. A ‘pin’ check had been undertaken for a qualified nurse. The home has an ongoing training programme to include moving and handling, abuse, fire, and first aid. Other subjects are included for example dementia awareness and infection control. Staff confirmed that since the new manager has started at the home they have received a lot of training. Southern Cross has a format for induction training based on the national specifications. As staff members hold their induction books none were examined. The manager said that they are not documenting the name of mentors for new staff on their induction booklet but this will be addressed as the new manager is working towards ensuring all new staff completes the induction programme. Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager has a supportive, open approach to running the home, which benefits the service users, staff and relatives. 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. As far as is reasonably practicable the health, welfare and safety of service users are promoted and protected. Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 Page 26 EVIDENCE: Since the last ‘key’ inspection the home has a new manager in place. She is a qualified nurse with both a general and mental health qualification. She has completed the Registered Managers Award and is an NVQ assessor. This manager has managed care homes and has undertaken various courses in nursing. She is still to apply to the Commission to be considered for registration. Staff surveys and staff spoken with all praised the new manager saying she has improved the home and introduced a lot of new systems The home follows Southern Cross’s quality assurance procedures to include monthly audits on all aspects of the home. Relatives meetings take place on a monthly basis and a relatives association has been started and this has included devising a newsletter. Copies of the first edition were seen in the main entrance to the home. Staff meeting take place on a frequent basis. The Manager said she operates an ‘open door policy’ for staff and visitors. The home looks after monies for a number of service users. Records, receipts and audit procedures are in place. The home has plans to review the account they use at the present time. The manager has a plan in place to ensure staff are supervised. Several records were seen of sessions that have all ready taken place and the manager is looking to undertaken appraisals with all staff. Records relating to the documentation of food require further detail, as they are not recording for example types of sandwich fillings used or the type of soup. As there has been a change of cook since the last inspection she was not aware of the details required. The cook said this would be rectified immediately. The home has a new maintenance since the last inspection and is in the process of being inducted. Some of the records that relate to fire checks were not up to date, however the Operations Manager said they have been undertaken as a maintenance man from another home had done them. He said he would make sure they were updated. The homes fire risk assessment is dated April 2006 and needs to be reviewed in line with new requirements issued by the Fire Service. Evidence was seen regarding monthly checks to include water temperatures and window restrictors. The pre- inspection questionnaire listed details of checks that include boilers and gas installation. The home is in the process of obtaining a copy of their electrical wiring certificate. A health and safety poster is displayed in the home. Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 Page 27 Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 Page 28 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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 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 X 3 X 3 3 2 3 Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 Page 29 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 Put in place effective arrangements to always store medicines below 25°C. This requirement has been repeated from the last inspection as it is only partly met and further action is needed. The medicine fridge must be kept within the range of 2-8°C so that medicines are kept at the right temperature to maintain their potency. The procedure for administering medicines to people who use the service must make sure the medicines are conveyed safely around the home and are prepared adjacent to the person so that direct checks are made with the labelled medicine container and record chart and so reduce the risk of the wrong medicine being given. The Registered Person must ensure the self-closing devices on the top floor dining room and lounge are in good working order and that the dining room door shut properly. This is to reduce DS0000038272.V320644.R01.S.doc Timescale for action 30/04/07 2. OP9 13(2) 30/04/07 3. OP9 13(2) 30/04/07 4. OP19 23(4ci) 30/04/07 Hygrove House Nursing Home Version 5.2 Page 30 the risks to service users, as these were propped open. 5. OP19 16(k) The Registered Person must keep the care home free from offensive odours to ensure service users live in pleasant environment. The Registered Person must obtain the following for all staff prior to them starting work at the home. • Full employment history with satisfactory written explanation of reasons for gaps in employment. This requirement has been repeated from the last inspection. The manager must apply to the Commission to be considered for registration to ensure a qualified and competent person manages the home. 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 two inspections. 30/04/07 6. OP29 19 & Sch 2 30/04/07 7. OP31 8 01/06/07 8. OP37 17 & Schedule 4(13) 10/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 Page 31 No. 1. 2. 3. 4. 5. 7. 8. Refer to Standard OP8 OP8 OP9 OP9 Good Practice Recommendations 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. Arrange to see and check all prescriptions before they are sent to pharmacy for dispensing. When any person needs medicines given in food or drink write a full ‘best interests’ plan. Include all those involved with that particular person and follow NMC guidelines. Include more detailed dose information in some of the written plans for ‘as required’ medicines. The home should provide training for staff in the local procedure to follow if an allegation of abuse is suspected if their training does not cover this. The home should review their fire risk assessment in line with the Fire Service Requirements. OP9 OP18 OP38 Hygrove House Nursing Home DS0000038272.V320644.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V320644.R01.S.doc Version 5.2 Page 33 - 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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