Inspection on 29/06/05 for The Flowers Hall

This inspection was carried out on 29th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

The Flowers Hall 17/07/07

The Flowers Hall 24/08/06

The Flowers Hall 22/11/05

The Flowers Hall 02/11/04

The Flowers Hall 13/07/04

The Flowers Hall 22/04/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE The Flowers Hall 80 Lascelles Hall Road Kirkheaton Huddersfield HD5 0BD Lead Inspector Jacinta Lockwood Unannounced 29 June 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Flowers Hall J51J01_s26275_The Flowers Hall_v235968_290605.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Flowers Hall Address 80 Lascelles Hall Road Kirkheaton Huddersfield HD5 0BD 01484 424184 01484 424184 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Christine Matthews Mrs Christine Matthews Care home 22 Category(ies) of Old age (over 65 years) 22 places registration, with number of places The Flowers Hall J51J01_s26275_The Flowers Hall_v235968_290605.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 2 November 2004 Brief Description of the Service: The Flowers Hall is a privately run residential home providing personal care and accommodation for up to twenty two older people on the outskirts of Huddersfield. The home is set in its own grounds, reached by a private driveway. There is parking to the front of the building and a garden for service users to the rear. There is a lack of public transport to the care home.Accommodation is provided on two floors with bedrooms on the ground and first floor, which can be accessed by a passenger lift. Both shared and single rooms are available.The home is staffed 24 hours a day. Wakeful night staff are on duty and an on-call system is in operation. The Flowers Hall J51J01_s26275_The Flowers Hall_v235968_290605.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out an unannounced inspection of The Flowers Hall on 29.06.05 from 10am to 6.45pm. A senior member of staff and the assistant care manager assisted the inspector. The following inspection methods were used: discussion took place with staff, service users, management and a relative, a limited tour was made of the premises, inspection of records including service user plans, pre-admission assessments and risk assessments; medication stock and records; activity information; service user meeting minutes; complaints records; accident records, staffing rota, recruitment and training records; health and safety records, including fire safety; some policies and procedures. It is disappointing that some standards have not been maintained. It was evident from discussion with the assistant care manager that she and the registered manager were aware that standards were falling. Staffing difficulties were given as a reason for this. It is not acceptable for standards to fall below the minimum required as this places service users and staff at potential risk. Action must be taken to address the issues identified. The Commission will consider enforcement action where there is a failure to raise standards. What the service does well: Service users are welcome to visit the home prior to admission and preadmission information is obtained. There is good contact with the local community and a range of activities available to service users both within the home and the local community, which service users enjoy and which is beneficial to them. Service users are consulted about the food provided which meets their needs and is enjoyed by them. The dining area provides a pleasant environment. The Flowers Hall J51J01_s26275_The Flowers Hall_v235968_290605.doc Version 1.40 Page 6 What has improved since the last inspection? 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 Flowers Hall J51J01_s26275_The Flowers Hall_v235968_290605.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Flowers Hall J51J01_s26275_The Flowers Hall_v235968_290605.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Service users’ needs are assessed before they move into the home. EVIDENCE: The Flowers Hall does not provide intermediate care. Assessment information was available for a recently admitted service user who said that information was provided about the home and that a pre-admission visit was made. The Flowers Hall J51J01_s26275_The Flowers Hall_v235968_290605.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 Service users’ health, safety and welfare is compromised by the lack of care planning and risk assessment. Service users are not 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. EVIDENCE: Care planning documentation for three service users was inspected and found to be lacking in detail and incomplete. The inspector was concerned that a care plan had not been fully completed for a recently admitted service user and contained information that contradicted the service user’s assessment. A care plan noted that a service user’s walking frame should be with the service user who, it was noted, should be supervised at all times during the day. This was not happening during the inspection and the service user was seen using someone else’s walking stick to mobilise because the walking frame had not been made available. The Flowers Hall J51J01_s26275_The Flowers Hall_v235968_290605.doc Version 1.40 Page 10 A number of accidents were recorded for two service users. One service user had fallen three times in two days but there was no risk assessment in place. Another service user had fallen or rolled out of bed on four occasions, sustaining an injury on three occasions, but there was no risk assessment in place regarding this and there was no evidence that action had been taken to address the risk. This is unacceptable and compromises the health, safety and welfare of service users. Discussion with staff suggested that some needs were being addressed, even though there was a lack of clear plans and guidance. The inspector’s concerns were drawn to the attention of the assistant care manager during the inspection. The registered provider/manager was informed in writing with timescales provided for care planning and risk assessments to be completed for those service users whose care plans were looked at during the inspection. Service users said that they have access to healthcare professionals and records and discussion with staff and management supported this. Service users said that they receive their medication on time. Staff asked service users if they needed any pain relief medication prescribed on an as required basis. Poor practice was evident in the operation of some parts of the home’s medication system. It was not possible to reconcile medication stock against records held as medication had not been booked into stock consistently and where medication was carried forward the amount was not recorded. It was of concern to note that Movicol, a medication prescribed for one service user, was being used communally for other service users prescribed Movicol. The home’s medication policy and procedure does not provide sufficient detail regarding the operation of the system, for example, the recording of medication into stock or disposal and record keeping. Medicines for internal and external use were not being stored separately and a record of fridge temperatures was not being maintained. Service users said that staff treat them with respect and maintain their privacy and dignity when providing care. Staff were observed to knock on service users’ bedroom doors before entering. The Flowers Hall J51J01_s26275_The Flowers Hall_v235968_290605.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 Service users have access to a range of activities suited to their needs and are supported to maintain contact with family, friends and the wider community. Meals reflect service users’ preferences and can be taken at times convenient to them. EVIDENCE: It was evident from records and discussion with service users that the range of activities provided both at the home and in the wider community meets their needs and expectations. Aromatherapy and motivation sessions are provided on alternate weeks. Outings and shopping trips are arranged. Some service users visit a local place of worship and a priest visited a service user on the day of the inspection. A secure garden to the rear of the building is available to service users in fine weather. A member of staff read items from the daily paper to service users, which generated some discussion and another service user has a daily paper delivered. Library books are available. Information about forthcoming activities was displayed on the notice board in the reception hall, an area where service users seem to like to sit to watch the comings and goings throughout the day. Relatives and friends are able to visit and a relative said they are made welcome by staff. The Flowers Hall J51J01_s26275_The Flowers Hall_v235968_290605.doc Version 1.40 Page 12 Service users said they have choice in how they spend their day and that they were able to make friends with other service users. Service users who are able were seen to move freely between communal and private areas. Service users were seen to get up and breakfast at different times throughout the morning. Meals are taken in the communal dining area, which overlooks the gardens. Special diets are catered for and service users commented positively about the food provided which was freshly prepared and looked well presented. Menus were discussed at the residents’ meeting in April and residents’ food preferences are taken into account when planning menus. Tables were set with fresh flowers and condiments and service users could help themselves to condiments and hot drinks. Linen napkins were placed on tables but service users were not encouraged or supported to use them. A creased table cloth on one of the dining tables did not look welcoming for service users having their meal. The Flowers Hall J51J01_s26275_The Flowers Hall_v235968_290605.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 Complaints are dealt with appropriately. Some processes are in place to protect service users from abuse, but all staff need to receive adult protection training to ensure that service users are protected from the potential risk of abuse. EVIDENCE: The home’s quality survey indicated that service users felt they could complain and service users spoken to said they knew who to complain to should they have cause to. The complaints procedure is on display and the complaints log shows that where service users and relatives have complained their concerns have been addressed. There were policies relating to abuse, whistle-blowing and missing persons, however, not all staff have received adult protection training. The Flowers Hall J51J01_s26275_The Flowers Hall_v235968_290605.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 26 Some processes are in place to ensure a safe and well-maintained environment for service users but health and safety checks are not being carried out, or are overdue and this places service users at potential risk. Although the home was generally clean and free from offensive odours, some parts of service users’ private accommodation were not. EVIDENCE: The home’s maintenance person has recently left and the post is currently vacant. There was evidence that the home is not being maintained to secure a safe environment for service users. Some bedroom fire doors were not fully closing into the rebate to prevent smoke seepage and flammable items were being stored close to a boiler in the laundry room although a notice states this should not happen. A hoist and other items, which were later removed, blocked a fire exit. Checks are carried out on the fire system but were overdue. The Flowers Hall J51J01_s26275_The Flowers Hall_v235968_290605.doc Version 1.40 Page 15 A report dated 21.04.05 was available regarding the risks from Legionella, which identified that non-urgent work was necessary to minimise risk. Water temperature checks are carried out, but two outlets were recorded as having a temperature of 69 and 70 degrees Celsius and action should be taken to address this to minimise the risk of scalding. The home was generally clean and free from offensive odours but one service user’s bedroom had urine odours and it was of concern that the duvet cover on the bed was damp and smelled of urine. A commode in another service user’s bedroom had not been cleaned properly. Poor hygiene practice is not acceptable and action must be taken to address this. The Flowers Hall J51J01_s26275_The Flowers Hall_v235968_290605.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 Generally, there are sufficient skilled staff to meet the needs of service users, however, gaps in staff availability and training has implications for the ability of the home to meet service users’ needs in a consistent manner. The home’s recruitment practices are not sufficiently robust to ensure that service users are supported and protected. EVIDENCE: There were 20 service users in residence at the time of the inspection. Staffing levels are three carers including a team leader on the morning and afternoon shift plus two wakeful night staff. There are staff vacancies at the home, which the assistant care manager said were being advertised. Existing staff are covering vacant shifts. Staff acknowledged that there are staffing difficulties, but saw this as a short term issue and were satisfied that management were taking action to address vacancies. The assistant care manager and registered manager are also covering care shifts. Whilst it is positive that management are working alongside care staff, the registered manager’s hours should be supernumery to ensure that adequate time is available for her to carry out her responsibilities so that management systems do not fail. The Flowers Hall J51J01_s26275_The Flowers Hall_v235968_290605.doc Version 1.40 Page 17 A staffing rota examined for a two week period shows that staffing levels drop to two carers for up to an hour on most days and sometimes for up to two to three hours. Agreed staffing levels must be maintained. When the inspector arrived there were only two care assistants on duty as one carer had escorted a service user to a hospital appointment. Because of this, for a limited period, staffing levels were not sufficient. The registered person must ensure that adequate staffing levels are maintained at all times and appropriate arrangements made when service users require an escort to appointments. The home’s recruitment policy and procedure is not being followed consistently. One of the three staff recruitment files examined contained only one reference and a recent photograph was also not available. It is important that the home’s recruitment policy is followed so that all required information is obtained prior to a person being employed to work at the care home. This must be addressed to ensure the continued safety of service users. There is an induction programme in place, but from records examined this is not being completed within the timescale specified in the home’s recruitment policy and procedure. Not all staff have completed basic training in areas such as infection control, first aid, adult protection and movement and handling. The assistant care manager said that there had been no training for quite a while. It is important that relevant training is provided to ensure that staff are trained and competent to do their jobs. The inspector was concerned to overhear a member of staff speak to and about two service users in a derogatory manner. This is evident of poor practice and was raised with the assistant care manager during feedback on the day of the inspection. The Flowers Hall J51J01_s26275_The Flowers Hall_v235968_290605.doc Version 1.40 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Some systems are in place to ensure that the health, safety and welfare of service users and staff are promoted and protected, however, some practices and omissions place staff and service users at risk. EVIDENCE: The home’s risk assessment and fire risk assessment are not being followed. There is not always three members of care staff on duty at all times during service users’ waking hours and fire training is not being carried out as required. It is positive to note, however, that new staff receive fire awareness training as part of the home’s induction. On occasion during the inspection, staff were observed to use poor movement and handling practices which puts themselves and service users at risk of injury. Accident records are available but the number of accidents involving two service users case tracked as part of the inspection are a cause for concern. The Flowers Hall J51J01_s26275_The Flowers Hall_v235968_290605.doc Version 1.40 Page 19 Checks of the fire alarm system are not being carried out weekly as required. Products subject to COSHH (Control of Substances Hazardous to Health) were left unlocked and unsupervised on the first floor corridor, which places service users at potential risk. A sample of equipment service certification was checked and found to be satisfactory. However, the gas safety inspection was overdue and the registered person must make available for inspection the report following a thorough examination of the passenger lift by a competent person. Risk assessments were available but were overdue for review. Schedule 1 and 2 works identified by West Yorkshire Fire and Rescue Service have been completed. However, the registered person should make available for inspection an original, signed document regarding compliance of the fire alarm system. The Flowers Hall J51J01_s26275_The Flowers Hall_v235968_290605.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 1 x x x x x x 1 STAFFING Standard No Score 27 1 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 x x x x x x x 1 The Flowers Hall J51J01_s26275_The Flowers Hall_v235968_290605.doc Version 1.40 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 Requirement Service user plans must be complete and up to date for those service users identified at the time of the inspection and detail how the service users needs in respect of health and welfare are to be met. Risk assessments must be completed for those service users identified at the time of the inspection. Accurate and detailed medication records must be maintained; medication prescribed for one service user must not be used communally. All staff must receive training in adult protection. Adequate precautions must be taken against the risk of fire, therefore, an audit of all fire doors must be carried out to ensure fire doors close into the rebate to prevent smoke seepage; flammable items must not be stored close to the boiler in the laundry room; fire exits must not be blocked; weekly checks of the fire system must be carried out. Suitable arrangements must be Timescale for action 06.07.05 2. 7 13(4)(c) 01.07.05 & 06.07.05 05.08.05 3. 9 13(2) 4. 5. 18 23(4) 13(6) 19 21.09.05 05.08.05 6. 26 16(2)(j) 05.08.05 Page 22 The Flowers Hall J51J01_s26275_The Flowers Hall_v235968_290605.doc Version 1.40 7. 8. 27 29 18(1)(a) 19(1)(b) Schedule 2 18(1)(c)(i ) 17 23(4)(d) 13(1)(c) 9. 30 10. 11. 12. 37 38 37 made to clean carpets, commodes and bed linen and so maintain satisfactory standards of hygiene in the care home. Agreed staffing levels must be maintained. All required information must be obtained prior to staff being employed to work at the care home. Staff must receive appropriate basic training including movement and handling; infection control and first aid. Records required by regulation must be available and up to date. All staff must receive suitable training in fire prevention twice each year. An up to date thorough examination report of the passenger lift must be available for inspection. 05.08.05 05.08.05 21.09.05 05.08.05 21.09.05 05.08.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 9 9 25 29 Good Practice Recommendations Medication for internal and external use should be stored seperately; a written record of fridge temperatures should be maintained. The homes medication policy and procedure should be reviewed and provide sufficient information to staff about the operation of the homes medication system. Work identified in the Legionella report dated 21.04.05 should be undertaken; water temperatures at the point of delivery should be around 43 degrees Celsius. The providers recruitment policy and procedure should be followed; a record should be kept of contact made with referees regarding the authenticity of the references supplied for prospective employees. Staff induction programmes should be completed within J51J01_s26275_The Flowers Hall_v235968_290605.doc Version 1.40 Page 23 5. 30 The Flowers Hall 6. 7. 8. 9. 10. 11. 30 38 38 38 38 8 the timescale provided within the recruitment policy and procedure. Care staff should not speak to or about service users in a derogatory manner. Staff movement and handling practice should be monitored and refresher movement and handling training provided where appropriate. Products subject to COSHH should not be left unattended and should be stored securely when not in use. An up to date gas safety certificate should be obtained and be available for inspection. Risk assessments should be audited to ensure they cover all safe working practice topics; they should be up to date and kept under review. Where risk assessment identify referral to a dietician this should be actioned; service users weight should be monitored and recorded. The Flowers Hall J51J01_s26275_The Flowers Hall_v235968_290605.doc Version 1.40 Page 24 Commission for Social Care Inspection Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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