CARE HOMES FOR OLDER PEOPLE
The Hawthorns Hawthorn Street Wilmslow Cheshire SK9 5ES
Lead Inspector June Shimmin Unannounced 11 April 2005 09:25 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 Hawthorns Version 1.10 Page 3 SERVICE INFORMATION
Name of service The Hawthorns Address Hawthorn Street Wilmslow Cheshire SK9 5ES 01625-527617 01625-539398 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) CLS Care Services Limited Ken Kingsmill Care Home 39 Category(ies) of OP Old Age (38) registration, with number DE(E) Dementia (1) of places The Hawthorns Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 1 The care home is registered for a maximum of 39 service users to include: up to 38 service users in the category of OP (old age not falling within any other category) requiring personal care only up to one service user in the category of DE (E) (Dementia aged over 65) requiring personal care only 2 The registered person must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 13th September, 2004 Brief Description of the Service: The Hawthorns is a purpose built care home for older people requiring personal care run by the CLS Group, a non-profit making organisation based in Cheshire and Wigan. The care home is in a residential area about ten minutes walk from the centre of Wilmslow. It is on 2 floors and there is a passenger lift to both levels. Seven of the 39 single rooms have an ensuite toilet and washbasin; the rest of the rooms have washbasins in them and toilets nearby. There are four lounges, two dining rooms, a small sitting area in the entrance hallway, and a fully equipped hairdressing room. There is a variety of aids and adaptations around the building to allow people who live there to move about more independently. There is a garden with benches in an enclosed patio. The Hawthorns Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over 6 hours. Six residents, two relatives, the manager and four members of staff were spoken with. A tour of the home was undertaken. Care records for three service users were inspected as well as records on fire safety, accidents, training and complaints. What the service does well: What has improved since the last inspection?
Staff have been recruited so that the home does not have to use as many staff from agencies or the bank run by CLS. New staff are thoroughly vetted so that residents continue to be protected. The current manager has now been in post for eight months, providing stability in the home after a period of management changes. Decorations and furnishings have been improved in the main lounge, the dining room on the ground floor and the entrance hallway. A new fridge for storing medication has been bought. A permanent chef has been employed and the catering standards, which were already good, have improved. The chef visits the residents every day to ask them about what meal they would prefer. The Hawthorns Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Hawthorns Version 1.10 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 Hawthorns Version 1.10 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 Adequate assessments are carried out before residents move in to make sure that their care needs can be met at the home. EVIDENCE: The assessment documents used at the home identify a full range of care needs. The assessments of two residents who had recently moved in were completed. The information on care needs was adequate to make a care plan but more information could have been obtained about their life history and interests. One resident was unable to remember being assessed or being invited to visit the home, but did have short term memory loss. The manager confirmed that the resident had declined the invitation to visit the home before moving in. The staff ensure that when the care needs of residents change a review is held to discuss the most appropriate way to meet those needs. The Hawthorns Version 1.10 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 and 10 Some progress has been made with care plans but further improvements are needed to make sure that all residents’ care needs are met effectively. The system for managing the residents’ medications is safe but some minor improvements are needed. Residents’ rights to privacy and dignity are upheld. EVIDENCE: Residents said that staff knocked on their room doors before entering. They felt their privacy and dignity were respected at all times. Two visitors said they were satisfied with the standards of care at the home. The content and quality of information in the three care plans the inspector checked were varied. The new care planning system being introduced at the home was taking some time to implement. Although two of the care plans had been written in February 2005, there were still problems reviewing and evaluating the care given. There was no care plan or risk assessments for a resident who moved into the home in February 2005. Daily progress records, containing appropriate and relevant information, were made about residents. Care records showed that residents were referred for routine health checkups as required. Staff were able to describe the care needs of residents well.
The Hawthorns Version 1.10 Page 10 Medicine was stored correctly and medicine administration records seen were completed accurately. However, creams and lotions were being prescribed to be used ‘as directed’ with nothing to say where or how they should be applied. There was no record that they had been applied. Some medicines were prescribed to be used ‘as necessary’ but there was no information about how often these could be given or what the maximum dose within 24 hours was. GPs had been contacted for further information about this but had not responded. The pharmacist who provided the medicines was due to visit the home to look at these problems. Four residents are being helped by staff to look after their own medication, which is good practice in maintaining people’s independence. The Hawthorns Version 1.10 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 and 15 Residents can make some choices about their lives at the home but limits to the range of activities on offer mean some residents cannot do some of the things they would like to without having a relative to help them. The quality of the food at the home is good and enjoyed by residents. EVIDENCE: A part time activities co-ordinator is employed at the home. Information about activities was displayed in the main lounge but did not give a date for any of the activities listed. These included games such as dominoes, exercise, painting, individual cookery sessions, bingo and reminiscence. One resident said that the home provided occasional entertainers and that birthdays were always celebrated. Another said special occasions were celebrated, there was hymn singing on Tuesday afternoons and communion was celebrated every Sunday but there were no trips out of the home unless a relative took a resident out. There was not a lot of information recorded about each person’s life and interests before they moved into the home for staff to help residents keep up their interests.
The Hawthorns Version 1.10 Page 12 Two residents help with the upkeep of the gardens at the home. Two relatives visiting the home said that they were made to feel welcome and could visit their family member where they wished. The menus are varied, provide choice at every meal, and are changed according to the season. They are displayed in large print in the dining rooms. Residents said they were happy with the food at the home. One said “the chef is marvellous.” The main meal of the day is lunch. On the day of inspection, it was poached fish in parsley sauce or chicken drumsticks served with mashed potato and vegetables, followed by homemade bakewell tart and custard. The evening meal is served at 4 30pm. Drinks and snacks are available at all times. The chef knows each resident’s diet requirements. Relatives said that drinks needed to be kept warm whilst staff were giving them out to people so the manager was buying thermos flasks to solve this problem. The Hawthorns Version 1.10 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 and 18 Residents and their relatives know how to make complaints and who to make them to so that they will be acted on. Steps have been taken so that staff know how to protect residents from abuse. EVIDENCE: There is a complaints procedure for The Hawthorns included in the information pack that residents receive when they move in. Residents know who to complain to if necessary. There had been no complaints since the last inspection. There is a policy on protecting adults from abuse and a policy which makes it clear that staff are expected to report suspected abuse or poor care. Staff at the home have received training so they know how to keep residents safe from abuse. The Hawthorns Version 1.10 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 and 26 Improvements to the decor have been carried out to keep the home comfortable for the residents. However, steps need to be taken to make sure that residents are not scalded by hot water from some of the taps. EVIDENCE: The home was clean and tidy and residents said this was always the case. Since the last inspection new carpets have been laid in the downstairs dining room, the main lounge and the reception hallway of the home. Two bedrooms have been redecorated and new carpets laid. A new carpet is due to be laid in the upstairs dining room. The home is decorated to a good standard and the furniture is domestic in character to help residents feel comfortable. The Hawthorns Version 1.10 Page 15 The water temperature from fifteen of the hot water taps used by residents was more than 500C, which is hot enough to scald people. Warning signs are displayed above the taps and replacement valves to control the temperature are to be fitted. There was no risk assessment about this situation and no records to show that staff were testing the hot water temperatures before helping residents to wash. The Hawthorns Version 1.10 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 and 29 Effective steps have been taken to recruit permanent staff for the home with the result that there will be a stable staff team to provide continuity of care for the residents. CLS, which runs the home, make sure that staff are properly vetted before they start work, to protect the safety of residents. EVIDENCE: There is a group of senior staff who have worked at the home for many years. From the week following the inspection the home would be fully staffed with permanent staff so staff from agencies or the ‘bank’ run by CLS would not have to used as much. This will mean better continuity of care for residents and that senior staff can focus more on their role rather than having to constantly introduce new staff to the home and residents. Several residents and visitors commented that the staff at the home were excellent. Staff recruitment files were up to date and no staff had started work without full clearance from the Criminal Records Bureau. The Hawthorns Version 1.10 Page 17 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) 33 and 38 The registered manager has been able to provide leadership and stability at the home following a period of changes to the management. Improvements are being made and, to make sure that residents are as safe as possible at all times, fire drills and moving and handling training need to be carried out. EVIDENCE: The registered manager, who is well qualified and experienced, has been in post at this home for eight months. He has started to make improvements, notably a full permanent staff group. Staff said they were satisfied with the management style at the home but not all visitors and residents knew who the manager was. There are a number of quality assurance mechanisms in place to check that the home is being run in the best interests of the service users. These include monthly visits from senior members of CLS staff and regular audits by the manager. Staff at the home are working towards Investors In People which is a nationally recognised quality assurance award.
The Hawthorns Version 1.10 Page 18 The fire safety officer visited the home and highlighted a number of issues for attention, some of which have been dealt with. Although fire safety training for staff had been arranged, the records showed that no fire drills had taken place since June 2004. Checks of fire safety equipment are carried out regularly. The records showed that a number of staff had not received an update to moving and handling training in the last year. Although there were no further requirements from this inspection, four requirements from the last inspection have not yet been met The Hawthorns Version 1.10 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 2 x x x x 2 The Hawthorns Version 1.10 Page 20 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 13 and 15 Requirement Timescale for action 11/05/05 2. 3. 9 25 and 38 13 13 and 23 4. 5. 38 23 All service users must have a care plan and appropriate risk assessments. All service user care plans must be kept under review. (Timescale of 13/11/05 not met) All medication, including creams 11/05/05 and lotions must be signed for. (Timescale of 13/11/04 not met) A risk assessment of the 11/05/05 temperature of water from the hot taps must be undertaken and steps to minimise any risk of scalding must be taken. (Timescale of 20/09/2004 not met) All staff must take part in a fire 11/05/05 drill (Timescale of 13/11/2004 not met) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 9 Good Practice Recommendations The person prescribing medications should be asked to
Version 1.10 Page 21 The Hawthorns 2. 12 3. 20 write full and precise instructions for usage on the prescription. (Royal Pharmaceutical Society of Great Britain guidelines 4.4 (June 2003) More information about residents social, cultural, religious and recreational interests should be recorded when they move into the home to be included in their care plans, and more activities should be provided to meet individual needs. Stained dining chairs should be replaced and the downstairs dining room should be redecorated The Hawthorns Version 1.10 Page 22 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich Cheshire, CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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