Inspection on 10/11/08 for Lewis W Hammerson Memorial Home

This inspection was carried out on 10th November 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lewis W Hammerson Memorial Home 30/11/06

Lewis W Hammerson Memorial Home 12/01/06

Lewis W Hammerson Memorial Home 06/07/05

Lewis W Hammerson Memorial Home 01/02/05

Lewis W Hammerson Memorial Home 21/09/04

Lewis W Hammerson Memorial Home 11/12/03

Lewis W Hammerson Memorial Home 21/07/03

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lewis W Hammerson Memorial Home 50a The Bishops Avenue East Finchley London N2 0BE     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ffion Simmons     Date: 1 1 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Lewis W Hammerson Memorial Home 50a The Bishops Avenue East Finchley London N2 0BE 02084584523 02084582537 info@hammersonhouse.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Celia Collier-Bawden Type of registration: Number of places registered: Lewis W Hammerson Memorial Home care home 68 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Limited to 68 adults of either gender over the age of 65 years, 15 of whom have nursing needs. Date of last inspection Brief description of the care home Hammerson House Memorial Home is registered to care for up to sixty eight people over the age of sixty five who are Jewish. The home is owned and operated by a charitable trust on behalf of the Hammerson family and has been registered since 1985. The home is situated in a residential area of North London and is served by public transport. The home is decorated to a high standard and well maintained. There are three floors, with the nursing unit on the ground floor. There is a lift to all floors. There are twenty- two sheltered housing units within the home and these are integrated within the residential home. The home has its own physiotherapy facilities and is run by qualified staff. The kitchen facilities have been contracted to a company Care Homes for Older People Page 4 of 31 Over 65 68 0 Brief description of the care home who also provide serving staff in the dining room. The aims of the home are That all service users shall live in a safe and clean environment and be treated with respect and sensitivity to their individual needs and abilities. Staff are responsive to the individual needs of service users and will provide the appropriate degree of care to ensure the highest possible quality of life within the home. The current cost of a weekly nursing and residential placements are between £890 - £1050 Following Inspecting for Better Lives the provider must make information available about the service, including inspection reports, to service users and other stakeholders. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The unannounced key inspection took place over two days on the 10th and 11th November 2008 and lasted a total of 16 hrs. This was the homes first key inspection for this year. During the inspection, we spoke with residents and staff and observed care practises. We tracked the care of four residents, and in doing so we checked their personal records. A number of other records and documentation were checked during the inspection, including care plans and risk assessments, staff files, health and safety documentation, the homes complaint records and incident records and quality assurance documentation. Care Homes for Older People Page 6 of 31 Questionnaires were sent to residents, professionals and staff to comment on the service. We have used the information within these questionnaires to contribute to the content of the report. The Chief Executive took time to complete the Annual Quality Assurance Assessment (AQAA), which has also been used as evidence to inform this report. What the care home does well: What has improved since the last inspection? What they could do better: Immediate action is necessary to improve on the safe administration, recording and cold storage of medication in the home. Action must be taken to ensure that accurate records are kept in respect of all medicines administered in the home. When not administered the correct endorsement must be used so that the records are accurate and up-to-date and reflect that medication is given as prescribed. Immediate action must be taken to ensure that medication is given as perscribed so that residents receive the correct dosage. This is necessary so that residents receive their medication as prescribed, and to ensure that their health and well-being is not put at risk. Action must be taken to ensure that all mediation is kept at safe temperatures and are not used pased their shelf-life. The Manager must ensure that staff who are responsible for the administration of medication receive training and must be assessed as competent to administer medication to residents. Improvement are also needed in the homes recording of wound management so that wounds can be better monitored. Care Homes for Older People Page 8 of 31 Care plans would benefit from being more person centred to better reflect residents wishes and choices and to identify their strengths and abilities as well as areas of need. Consideration should be given to improving the recording of complaints and the action taken to investigate complaints. The complaints records should be regularly audited to ensure the records are clear and are of good quality. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are comprehensively assessed by a skilled person prior to admission. The assessment and admission processes focus on achieving positive outcomes for the individual. Prospective residents are given the opportunity to spend time in the home prior to moving in and are given a high level of support to ensure they are well supported in their decision making. Evidence: The home has a service users guide, which is written in plain English and is currently under review. The Chief Executive confirmed during the inspection and within the Annual Quality Assurance Assessment that the home plans to introduce a website for the home within the next 12 months to enable those interested in the service to access information at any time. The homes admission procedure is user friendly and is undertaken by members of the Care Homes for Older People Page 11 of 31 Evidence: Management Committee who have many years of experience. It was explained within the AQAA that the Matron (or a Deputy Matron) would then assess care needs of the individual, and that this would be undertaken in a flexible way, either in hospital or in the prospective residents home. During the inspection, we tracked the care of four residents, and in doing so, we checked their personal files. We noted that there was a completed needs assessment on the files of each resident outlining residents needs and abilities. Staff at the home appreciate that deciding to move into a care home requires careful consideration. To assist prospective residents and relatives in making the right choice for them, Hammerson House has compiled a list of questions for them to consider asking when visiting the home. This list is comprehensive and covers a number of aspects including accommodation, facilities, activities, catering and daily living. The Chief Executive explained within the AQAA that all prospective residents stay for 2 weeks trial with an option for a further 2-4 weeks extension. During this period there are meetings with the family and resident to check we are meeting the residents needs. The home has also recently re-introduced a buddy system for new residents, which is where a new residents is paired with another resident in the home who can provide them with support and guidance. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each resident has a plan of care in place, which could be more person-centred. People have access to health care services both within the home and in their local community. Medication was not always given as prescribed, and records were not up to date with gaps in recording, which potentially could be putting residents health and well-being at risk. Issues were also identified with regards to the safe storage of medication. Evidence: During the inspection, we tracked the care of four residents, and in doing so, we checked their personal files. Each resident had care plans on their files, which were reviewed regularly. The quality of the care plans varied, with some being quite basic. Care plans could be more person centred and could be improved to better reflect residents wishes and choices and to identify their strengths and abilities as well as areas of need. During our discussions with the Matron, it was noted that this has been identified as an area for improvement. It was noted that each resident had a completed nutritional risk assessment on their Care Homes for Older People Page 13 of 31 Evidence: files. The Matron, Deputy Matrons and the staff team have worked hard to ensure that where possible, residents weights are monitored and recorded. Records showed that residents weights were being monitored on a monthly basis or on a weekly basis where there were concerns about weight loss. The home assesses the risk to residents of developing pressure ulcers using the Waterlow tool. One of the residents case tracked had developed a pressure sore. A clear plan was in place for managing the wound. More work is needed however in ensuring that there is a clear audit trail, through the use for example of a wound chart to record the appearance of the wound including size, depth and level of exudate. This was not available on the file checked. This would provide clearer records so that the wound could be better monitored and the plan of care be assessed to see if effective. When checking the individual files, we noted that each resident had a multi-disciplinary sheet on their files to record various appointments. During the inspection, we noted that residents, where possible are driven to their health care appointments in the homes mini bus which promotes and retains their independence. Where residents are unable to visit local health care services, visits are arranged to the home, for example by the GP and Chiropodist. Hammerson House also has an in-house physiotherapy service. During the inspection we audited a sample of medication administration records (MAR) and checked the standards for storing, administering and recording medication. The home uses the nomad system, and medication is received into the home on a weekly basis. Nursing staff are responsible for the administration of medication, with residents being given the opportunity to self-medicate where it has been deemed appropriate and safe for them to do so. We checked the MAR charts, and found that there were some gaps in recording which demonstrated that Nursing staff were not maintaining accurate records. It was also difficult to evidence if residents were receiving all their medication as prescribed. We also noted that the code x had been inserted for when regual medication such as salbutamol and paracetamol medication had not been administered, but this code x had not been defined. During the inspection, we checked the records of two residents who were receiving warfarin. For one of the residents, we found evidence that the resident was being supported to receive regular blood tests and the dose being administered was as prescribed, with blood results being kept with the MAR chart, which is evidence of good practice. For the another resident however we were extremely concerned to note that staff had been administering a different dose of Warfarin to that prescribed by the anticoagulant clinic since mid August. It was very concerning to note that the prescription on the MAR chart remained unchanged despite a change in dosage being Care Homes for Older People Page 14 of 31 Evidence: prescribed by the anticoagulant clinic. This error was discussed with the Matron and staff during the inspection. Steps were taken to immediately amend the dosage to ensure that from then on the resident would be administered the correct dose as per the instructions of the anticoagulant clinic. The Matron also set about to immediately put a local policy and guidance in place to ensure the safe administration of warfarin. Immediate steps must be taken to ensure that staff are briefed on this local policy, receive training and are fully competent in the safe administration of mediation. The medication was found to be securely stored within locked trolleys in the clinical room of Hammerson House. The home also has controlled drugs in use in the home, which were securely stored in locked metal cabinet in the Matrons office. We checked the fridges used for storing medication. Although the temperatures of these fridges are recorded on a daily basis, we noted that the actual temperatures were running at suboptimal temperatures for the safe storage of medication. For example, one of the fridges was extremely cold with temperatures ranging from minus four and minus nine degrees Celsius. This had been an issue for the last month and had not been identified as a problem. We found that the temperature of the other two fridges were too high for the safe storage of medication. We checked the contents of the fridge and found that an antibiotic dispensed for a resident in July 2008, was being administered to another resident. We also noted that Nurses are not recording the date of opening on all liquid medication. For example, eye drops were open and in use that had been dispensed for a resident in July 2008. There was no date of opening on the bottle. This particular drug has a short shelf-life of four weeks from the date of opening. As staff had not recorded this date, it was not possible to ascertain if the medication was in date, which puts the resident at risk. Immediate action is necessary to improve on the safe administration, recording and the cold storage of medication in the home. Our concerns have been referred to a specialist Pharmacist Inspector. The Matron informed us that the home has taken advantage of the input of the Pharmacist from the Primary Care Trust to assist them in keeping up-to-date. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes programme of activities is varied and imaginative and meets the individual needs and abilities of residents. Mealtimes are flexible and relaxed and meet cultural and dietary needs of residents. The service supports residents to be as independent as possible. Evidence: Residents spoken with during the inspection were very complimentary about the range of social, cultural and recreational activities on offer. The home has a programme of activities which is updated weekly. Copies of the programme were seen on display throughout the home on various notice boards. The programme of activities was found to be stimulating, varied and imaginative to meet the range of needs, interests and abilities of residents living at the home. All residents living at Hammerson House are Jewish, and the home provides religious services for residents and celebrates Jewish festivals. Training is arranged for staff to ensure they fully understand and respect the residents religion and culture. During the inspection we toured the building, and had the opportunity to visit the homes well-equipped art room. We observed some of the residents excellent work Care Homes for Older People Page 16 of 31 Evidence: including silk painting and mosaic work. One of the residents told us that they had only taken up silk painting as an interest since moving into the home. The Chief Executive commented within the AQAA that staff continue to encourage residents to try new activities e.g. play reading group. More of the residents excellent art work was seen on display in corridors within the home. We also observed the word games session taking place in the lounge, which was well-attended. On the second day of the inspection, we had the opportunity to observe an afternoon music session in the conservatory. Residents were observed to be interacting and enjoying the session. One of the residents spoken with told us that they are a member of the choir and that they would be attending the choir practice in the lounge during the afternoon. Other activities on offer for the week of the inspection included quiz, gentle exercises, discussion groups, shopping trips, concerts, gardening group and the showing of films. Residents also have access to the library, which includes books written in large print and has in it a range of board games and cards. All residents living at Hammerson House are Jewish, and the home provides Kosher food to meet residents religious obligations. Lunch time was observed in the main dining area. Tables were nicely laid out and the atmosphere was relaxed and staff were observed to be respectfully supporting residents and offering a choice of meal. The menu was displayed on the notice board outside the dining area. Residents spoken with during the inspection commented positively on the choice of food. Hammerson House makes every effort to ensure that the meals offered are of a high standard. Some of the quality assurance checks include inviting residents to be part of the food forum to have their say and to comment on proposed changes to the menus. The staff keep a daily food logbook, which records residents satisfaction with the meals. The home has also introduced the dining room monitoring group, which is where five or six relatives are invited to give their views on the food served in the home. An independent review of the catering service provided at Hammerson House was also recently undertaken. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure, which is accessible to residents. The home has an open culture that allows residents to express their views and concerns. Staff have received training and understand the policies and procedures for safeguarding adults from abuse. Evidence: The home has a complaint policy, which is accessible to residents within the homes brochure and was also seen on display on notice boards within the home. We also noticed during our tour of the home, that information about advocacy services was also on display for residents to access. Information within the AQAA outlined that the home has received eight complaints about the service within the last twelve months. Staff commented that they know what to do if a resident, their relative, advocate or friend has concerns about the home. One staff commented report the matter to the Matron or the deputy on duty if cant solve the problem. During the inspection, we checked the homes complaints records. The level of detail within the records varied and it is recommended that homes recording of complaints is improved to provide greater detail about the nature of the complaint and the steps taken to investigate the complaints received. The AQAA indicated that there have been no safeguarding adults investigations within the last twelve months. Staff receive training in the protection of vulnerable adults Care Homes for Older People Page 18 of 31 Evidence: from abuse as part of their NVQ training and also during in-house training, which was being facilitated by one of the Deputy Matrons. Staff spoken with were aware of their responsibilities for reporting concerns. The home has a policy on safeguarding adults and the prevention of abuse, which was updated in July 2008. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The living environment is appropriate for the lifestyle and needs of the residents and is homely, clean, safe and comfortable. There is a selection of communal areas both inside and outside the home. Residents are involved in decisions about the decor and any changes in their communal and personal accommodation. Evidence: The home is situated on the Bishops Avenue, a residential area of North London. The accommodation is situated over three floors and there is a lift access to all floors, making the home accessible for residents with a physical disability. During the inspection, we toured the building and found that the home is kept in a good state of repair. Since the last key inspection, new curtains have been purchased and fitted in the lounge and residents were involved in choosing new chairs which have also been bought for the lounge. Residents were also involved in choosing the paintings that now hang in the corridors. Residents have access to comfortable indoor facilities, which include lounge and dinning areas, a well-equipped arts room and library. There is a physiotherapy room, which is also well-equipped. There is also a shop within the home, which provides residents with the opportunity to purchase items including greeting cards, stamps, toiletries and confectionery. Care Homes for Older People Page 20 of 31 Evidence: The home has excellent, well-maintained outside spaces for residents to enjoy. Since the last inspection, the home has increased the number of pendants linked to the nurse call system available for use by residents who wish to spend time outside in the garden. This gives residents the freedom to spend as much time as they like outside but with the reassurance that they can call for assistance should they need it. Residents also have the opportunity to be part of the homes gardening group. The Chief Executive told us within the AQAA that the home plans within the next twelve months to explore the possibility of obtaining sponsorship for the residents to design a show garden for the Royal Chelsea Flower Show. The home employs a housekeeping team, which keep the home clean and fresh and free from malodours. Residents and staff who provided feedback about the service commented that the home is always fresh and clean and that the home provides a pleasant environment in which to live and work in. The home has a policy for dealing with communicable diseases and infection control and for the disposal of clinical waste, both of which have recently been updated. The Chief Executive confirmed within the AQAA that over 50 of staff have received training in the prevention and control of infection through on-site training and through NVQ level 2 and 3 training. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is committed to providing staff with relevant training so that they can meet the individual needs of residents. The homes recruitment procedure ensures that staff are properly vetted prior to working with residents. Evidence: Staff commented that there is usually enough staff on duty to meet the needs of the resident living at the home. One of the staff team commented we have a 3 week rolling off-duty but day to day changes alter that but usually there is good cover. Residents also commented that staff are available when they need them. The Chief Executive told us within the AQAA that there is flexibility in the number of staff that we rota depending on the residents needs i.e. if we have a resident who requires more care, we will rota additional staff on to take account of the increased care requirement. The home experiences a very low turnover of staff. It was confirmed within the AQAA that only one nursing/care staff have left employment within the last twelve months. A number of the nursing and care staff have worked at the home for a number of years, providing continuity of care to the residents. The staff team appeared to be very committed to delivering a high standard of care to the residents. Care Homes for Older People Page 22 of 31 Evidence: It was confirmed within the AQAA that all staff have completed an induction programme. Staff who commented on the service told us that they felt their induction covered everything they needed to know to do the job. Sixty two per cent of the staff team have achieved the NVQ level 2 or above. Staff were positive about the training opportunities available to them. One staff commented I have numerous study days in house and outside agencies. I have trained beyond my original status and given plenty of opportunity to extend my training. We noted from checking records and through discussion with staff that training have taken place in house and staff have taken advantage of external training on offer too. Some of the training undertaken by staff include promoting nutritional awareness, tissue viability training and continence promotion. Staff are encouraged to feedback to their colleagues on the training they attended so that staff can learn from each other. Group supervision is also provided where a specific topic or policy is discussed with staff. At the time of the inspection, staffs individual training records needed updating. In discussion with the Matron, it was confirmed that the home is currently in the process of transferring training records into electronic format to enable training records to be easily updated. We checked the personal files of four members of staff during the inspection. This provided the evidence that the homes recruitment procedures are satisfactory. Staff confirmed that their employer carried out checks such as criminal records bureau checks and references before they started work. The Chief executive confirmed within the AQAA that the home plans to involve residents more in the recruitment of staff on the future. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a well-run home, which employs highly committed staff. The Management team has a clear understanding of the aims and objectives of the home and work hard to improve the service. Residents financial interests are safeguarded by robust policies and procedures and staff are now appropriately supervised. Evidence: The home has a Registered Manager (Matron) in post, who has worked at the home for a number of years. The Matron is a qualified nurse and the feedback received indicates that she is very well respected by staff and is extremely dedicated and conscientious. The Chief executive supports the Matron well in the running of the home. Throughout the inspection process, he demonstrated a clear understanding of the aims and objectives of the home and showed commitment in delivering a high standard of service to the residents. Currently the management team also consists of four Deputy Matrons who collectively have a number of years of experience in caring for older Care Homes for Older People Page 24 of 31 Evidence: people. Regular meetings are arranged for all heads of departments to meet and discuss any issues and to develop any necessary action plans to ensure a high quality of service. The AQAA, which was completed by the Chief Executive was very well completed and very detailed, providing a good indication of the homes strengths and areas for development. The AQAA demonstrated that the home keeps abreast with changes in legislation and makes provision to ensure staff are also kept up-to-date through training. The home is very committed to seeking the views of residents and their relatives in order to ensure satisfaction with the service and to identify areas for improving the service. Residents meetings, food forums and activity forums with residents, including satisfaction surveys, provide residents with the opportunity for commenting on the service and to contribute to decision making. Checking the homes quality assurance documentation, provided the evidence that residents comments are taken very seriously and action plans put in place to address concerns raised by the residents and/or their relatives. Checking the completed satisfaction questionnaires provided the evidence that on the whole residents and/or their representatives are very happy with the quality of the service provided at Hammerson House. A suggestion box is also available for residents and/or their relatives to make suggestions as to how the service could be improved. The home also uses a quality assurance tool for selfaudit and the Chief Executive showed us their annual plan of self-assessment and selfaudit. As discussed earlier within this report, there were shortfalls in the safe storage, administration and recording of medication in the home, which put residents at risk. Careful auditing of the homes management of medication must be undertaken so that standards in this area are improved to ensure residents are not put at risk. Careful auditing of the complaints documentation should also be undertaken to ensure that records are of a good standard. Residents living at the home are encouraged to remain as independent as possible with regards to managing their own finances. For those residents who require assistance however a very robust system is in place for handling their money. During the inspection, we checked the financial records of six residents and saw that receipts are kept for each transaction and accurate records are maintained on the bespoke database system. Regular checks are undertaken to ensure standards in this area. Since the last key inspection, there have been improvements in the provision of staff supervision. Checking the staff files demonstrated that they now receive regular oneto-one supervision as well as group supervision. All staff who provided feedback commented that their manager meet with them regularly to give support and to discuss how they are working. Care Homes for Older People Page 25 of 31 Evidence: Maintaining the health and safety of residents and staff is given serious consideration. Weekly health and safety walk abouts are carried out by the Matron and the Chief Executive. Staff commented that they felt that these checks were beneficial for ensuring the health and safety of all. Records in the home demonstrated weekly tests of the fire alarm system is undertaken and regular fire drills are arranged. The home was subject to a fire inspection by the London Fire Authority in September 2008. The report concluded that the home is compliant with the requirements of the fire regulations. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 17 Documentation in relation to 30/12/2008 wound care must be improved to provide clear records so that any wounds can be appropriately monitored and the plan of care assessed to ensure it is effective. This is so that there is a clear record of whether wounds are improving or if there is a need for the plan of care to be reviewed in order to improve outcome for the resident. 2 9 13 Regular medication audits must be carried out by the Matron or the Deputy Matrons. This is to ensure that any issues with regards to the safe storage, safe administration and any gaps in recording are quickly identified and rectified. 15/12/2008 Care Homes for Older People Page 28 of 31 3 9 13 The Manager must ensure 30/11/2008 that staff who are responsible for the administration of medication receive training and must be assessed as competent to administer medication to residents. This is to ensure that residents receive their medication as prescribed. 4 9 13 The date of opening must be 15/12/2008 recorded on all liquid medication. This is to enable the medication to be audited and to ensure that the medication is not used past its shelf-life. 5 9 13 Codes used to explain why medication was not administered must be clear and specific. This is so that there is a clear reason why the medication was not administered. 15/12/2008 6 9 13 Medication must be given as perscribed so that residents receive the correct dosage. To ensure correct dosage is given as per prescribers instructions to ensure the safety and well-being of residents. 15/12/2008 Care Homes for Older People Page 29 of 31 7 9 13 Action must be taken to 15/12/2008 ensure that all mediation is kept at safe temperatures and are not used pased their shelf-life. So that there are no changes in the composition of the drug and that the drugs have not expired. Eye drops must not be used past their shelf-life as this could put resident at risk of infection. 8 9 13 Action must be taken to 15/12/2008 ensure that accurate records are kept in respect of all medicines administered in the home. When not administered the correct endorsement must be used. This is to ensure that the records are accurate and upto-date and reflect that medication is given as prescribed. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Residents care plans should be more person centred and better reflect residents wishes and choices and to identify their strengths and abilities as well as areas of need. Consideration should be given to improving the recording of and action taken to investigate complaints. The complaints records should be regularly audited to ensure the records are of good quality and to enusure that action taken to investigate complaints are well documented. 2 16 Care Homes for Older People Page 30 of 31 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!