Inspection on 12/09/05 for The Hawthorns

This inspection was carried out on 12th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Hawthorns 19/09/06

The Hawthorns 11/04/05

The Hawthorns 13/09/04

The Hawthorns 07/04/04

The Hawthorns 26/01/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE The Hawthorns Hawthorn Street Wilmslow Cheshire SK9 5EJ Lead Inspector June Shimmin Announced 12 September 2005 th 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 F51 F01 S6541 The Hawthorns V238401 120905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Hawthorns Address Hawthorn Street Wilmslow Cheshire SK9 5EJ 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 Kenneth Kingsmill Care Home 39 Category(ies) of OP - Old Age (38) registration, with number DE(E) - Dementia over 65 (1) of places The Hawthorns F51 F01 S6541 The Hawthorns V238401 120905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 This 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) * one named service user in the category of DE(E) (dementia over the age of 65 years) who may be accommodated within the total of 39 beds 2 The registered provider, 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 11th April 2005 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 are 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 F51 F01 S6541 The Hawthorns V238401 120905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and took place over 7 hours. Eleven residents, one care professional, the manager and six members of staff were spoken with. A tour of the building was undertaken. Care records for three service users were inspected, information from the pre-inspection questionnaire (PIQ) as well as records on fire safety, complaints, medication, and training. Written comment cards were received from 2 residents, 2 relatives and 3 social workers. What the service does well: The Hawthorns is a well run home. The manager is a first level registered nurse and has many years experience of running care homes. Few complaints are received. A number of staff have worked at The Hawthorns for several years providing stability and continuity. Staff are known to relatives and friends and are well regarded by both residents, families and care professionals. Senior staff assess the care needs of people before they move into The Hawthorns to make sure that the home can meet their needs. There are good links with care professionals so that other care needs can be met. The standard of catering is good. Residents are encouraged to self medicate where possible. The Hawthorns has signed up to “Care Aware” a free advocacy service. The Hawthorns F51 F01 S6541 The Hawthorns V238401 120905 Stage 4.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 Hawthorns F51 F01 S6541 The Hawthorns V238401 120905 Stage 4.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 Hawthorns F51 F01 S6541 The Hawthorns V238401 120905 Stage 4.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) 1 and 3 Residents and their families are given information about The Hawthorns. Assessment of the care needs of residents are carried out before admission to The Hawthorns so that the home can confirm that it can meet their needs. EVIDENCE: The statement of purpose and service user guide were not looked at. However, during a tour of the building it was noted that a plastic holder was located on the door of each bedroom. This held the “service user guide” which is a booklet containing information about the staff and facilities provided at the Hawthorns. The new statement of purpose and service user guide had also been discussed during a recent residents` meeting and minutes of this meeting provided. The Hawthorns F51 F01 S6541 The Hawthorns V238401 120905 Stage 4.doc Version 1.40 Page 9 The assessment documents of three residents were looked at. These had been completed by the manager and provided sufficient information about the care needs of the residents. Social workers and health professionals had also carried out assessments and copies of these made available to the manager. This helps the care home to form an in-depth view of the care needs of the resident. If the care needs of residents change a meeting may be held to discuss whether The Hawthorns can continue to meet those needs. The Hawthorns F51 F01 S6541 The Hawthorns V238401 120905 Stage 4.doc Version 1.40 Page 10 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 Improvements have been made to the process of care planning and risk management. Care plans have been kept under review but do not adequately evaluate care. The health care needs of residents are recognised and met. The management of medication at The Hawthorns is safe. The privacy and dignity of residents are respected. EVIDENCE: Those residents spoken to said that their privacy and dignity were respected. Other residents also confirmed this in their written comment cards. The care plans of three residents were checked and identified most care needs. Progress records were provided about the daily lives of the residents. These highlighted if any new problems had occurred. Three new needs were identified for one resident but no care plans provided for these needs. Care staff had signed and dated care plans as having been reviewed but there was no written review provided which evaluated the care received by the residents. The Hawthorns F51 F01 S6541 The Hawthorns V238401 120905 Stage 4.doc Version 1.40 Page 11 However, the residents had signed the care plan to demonstrate that they were aware of the care plan. Some minor improvements needed to be made to the care plans. The care plans were not written within five days of the residents` admission to The Hawthorns. This is important to show what actions the home will take from the day of admission to meet the residents` needs. The weight of two residents had not been recorded. The third resident had gained 7 and a half kilograms since admission and the home is commended for this. The weight was not linked to the nutrition care plan which is important to show if there has been a weight gain or loss and any actions to be taken as a result. Care records showed that residents received routine health checks such as eye tests. During conversation the manager and care staff were knowledgeable about the care needs of residents. Medication at The Hawthorns was well managed. Risk assessments were provided for residents who wished to administer their own medication. One resident was spoken with and was able to show the lockable facilities in the bedroom for the storage of medication. The Hawthorns is commended for encouraging residents to self medicate where possible. One resident was refusing to take medication. The care staff had been in touch with the doctor about this. The Hawthorns F51 F01 S6541 The Hawthorns V238401 120905 Stage 4.doc Version 1.40 Page 12 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 The standard of catering at The Hawthorns is good. Residents are able to make choices in their daily lives. Visitors are made to feel welcome. The range of activities at The Hawthorns is still limited. EVIDENCE: The Hawthorns has signed up to “Care Aware” which is a free advocacy service. This means that residents who have no one to speak on their behalf can contact this organisation to request an advocate. Residents can express choice in their daily lives in a number of ways. This includes choice of food and about times of going to bed and getting up. The standard of catering at The Hawthorns is good. The manager said that the home now has two permanent cooks. The menus are changed between winter and summer. There is always an alternative and the cook keeps a list of the individual preferences of residents. The lunch was gammon in white sauce, accompanied by green beans, cauliflower and mashed potato. The alternative was cheese and vegetable bake or poached fish. The dessert was spotted dick with white sauce or fresh fruit. The evening meal is served at 4 30pm and includes a hot choice. This was soup, sausage, baked beans and chips or an assortment of sandwiches followed by a jam donut. Residents spoken with said that they thought the standard of catering at The Hawthorns was good. The Hawthorns F51 F01 S6541 The Hawthorns V238401 120905 Stage 4.doc Version 1.40 Page 13 No visitors were seen during the visit. Two comment cards were received from relatives. Both stated that they were made to feel welcome at The Hawthorns at any time and that they could visit their relative in private. There was limited recorded information recorded about the past and present social and leisure interests of residents. The Hawthorns employs an activity coordinator who has just returned to work after a period of two months. A wipe on/off board in the main lounge referred to activities on three days of the week. Activities included manicures, a visit from the Christian Mission, a birthday party, one to one with residents, the shopping trolley, dominoes and cards. Several residents commented that there were few activities at The Hawthorns. More independent residents are able to go out into the local community either by themselves or with family members. The minutes of a residents` meeting referred to a recent cheese and wine evening and visit by an entertainer. The Hawthorns F51 F01 S6541 The Hawthorns V238401 120905 Stage 4.doc Version 1.40 Page 14 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 The Hawthorns has a satisfactory system for the management of complaints. Steps have been taken to protect residents from possible abuse. EVIDENCE: Information about how to complain is displayed in the reception area and is also contained within the information pack “service user guide” given to residents. Residents who were interviewed knew who to speak to if they were unhappy about any aspect of their care. The manager keeps a record of complaints received and the actions taken as a result. The Hawthorns has a policy and procedure for the protection of vulnerable adults. Several staff said that they had done training on this subject either as part of the NVQ training programme or at a session held at the home by the manager in April 2005. The Hawthorns F51 F01 S6541 The Hawthorns V238401 120905 Stage 4.doc Version 1.40 Page 15 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, 20, 21, 22, 24, 25 and 26 The standard of décor at The Hawthorns is satisfactory. Residents are potentially at risk from scalding. Several uncovered radiators and towel rails might put residents at possible risk of contact burns during cooler months. EVIDENCE: The home was clean and tidy. Outside contractors visit the home when necessary to steam clean carpets and furniture. Since the last inspection a new carpet has been laid to the upstairs dining room. A number of bedrooms were looked at and these were decorated and furnished to a good standard. Residents spoken with said that they were satisfied with their rooms and that they were kept clean. It was noted that several bedrooms were dark as a result of neighbouring Lleylandii trees. However, the manager was taking action to try and have these cut to a lower level. The Hawthorns F51 F01 S6541 The Hawthorns V238401 120905 Stage 4.doc Version 1.40 Page 16 The manager said that the temperature of hot water outlets was being tested once a month and records were seen. The records indicated that 15 outlets were still registering around 50 degrees C. Generic risk assessments drawn up in July 2004 had not been reviewed. An individual risk assessment for one resident was checked and this had not been reviewed since April 2004. Concern was expressed about confused residents who might be at greater risk of scalding. Other residents may not use the hot water for fear of being scalded. The manager said that a new system was to be installed by the end of 2005. This has been an outstanding requirement for the last three inspections. The CSCI remains concerned by the apparent slowness of CLS Care Services to take action over an issue that potentially puts residents at risk. The Hawthorns provides a number of aids and adaptations which help residents to retain some degree of independence. It was noted that three radiators were not covered. There was a warning sign on one radiator in a corridor but no signs on two other two radiators in a shower room and a bathroom. The radiators were not switched on. Two towel rails were also unprotected but again were not switched on. The Hawthorns F51 F01 S6541 The Hawthorns V238401 120905 Stage 4.doc Version 1.40 Page 17 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, 28 and 30 Staffing levels at The Hawthorns are satisfactory. Staff are well regarded by care professionals, residents and relatives. The home supports staff to undertake training relevant to their role. EVIDENCE: Staffing levels at The Hawthorns remain unchanged since the last inspection and are satisfactory. There is a decreasing dependency on agency staff. There is a low turnover of staff and a core of staff who have worked at The Hawthorns for a number of years. Residents said that they felt well cared for. Positive comments about staff were also made verbally by a health professional and in writing by social workers. Five care staff have achieved NVQ level 2 or above. Eleven staff are working towards level 2 and two staff towards level 3. Domestic staff are working towards their own NVQ qualifications. One domestic assistant was particularly pleased to have attained a qualification after many years working at the home. The manager has started to complete a development plan with every member of staff so that their training needs can be identified. The Hawthorns F51 F01 S6541 The Hawthorns V238401 120905 Stage 4.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) 31, 32, 33, 35, 36, 37 and 38 The Hawthorns is well managed. To ensure fire safety at the home several staff need to take part in a fire drill. EVIDENCE: The manager is a first level nurse and is also an experienced manager of care homes. Staff described the manager as being approachable. Residents were aware of who the manager was and he was seen chatting to residents on several occasions during the day. The manager expects to complete NVQ level 4 in management in the near future. The Hawthorns F51 F01 S6541 The Hawthorns V238401 120905 Stage 4.doc Version 1.40 Page 19 There are a number of ways in which the manager checks whether the home is delivering a quality service. This is done informally by talking to residents. A residents` meeting was held recently and residents were able to put forward their views and wishes. A questionnaire had been recently given to residents to express their opinions about The Hawthorns. Senior members of CLS Care Services visit every month and provide a report about the running of the home to the manager and to the CSCI. Much of the focus of these reports is on working towards the Investors in People standard which the home hopes to achieve towards the end of the year. The manager carries out audits, one of which is on care plans. Records relating to residents are kept securely. The manager has started the process of ensuring that staff receive formal supervision about their work, training and development and care practices. Written records of this were seen. During a tour of the building it was noted that the door of a sluice which contained potentially hazardous materials was unlocked. The fire officer visited the home in February 2005 and recommended that night staff in particular take part in fire training more frequently. The manager said that several night staff had still not done a fire drill within the last year. This puts these staff and residents at potential risk in the event of an outbreak of fire. Most of the other recommendations had been carried out. The manager said that a carpenter was awaited to adjust doors where the smoke seal was not adequately sealing the door. This related to 39 doors in the home. The pre inspection questionnaire indicated that the home is well maintained and that equipment and installations are serviced on a regular basis. The Hawthorns F51 F01 S6541 The Hawthorns V238401 120905 Stage 4.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 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 3 x 3 1 3 STAFFING Standard No Score 27 3 28 2 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x x 3 3 2 The Hawthorns F51 F01 S6541 The Hawthorns V238401 120905 Stage 4.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 25 and 38 Regulation 13 and 23 Requirement Timescale for action 12/10/05 2. 25 13 and 23 3. 4. 38 38 23 13 and 23 Steps must be taken to minimise the risk of scalding from hot water outlets. Risk assessments must be kept under review. (Timescales of 20/09/04 and 11/04/05 not met) Action must be taken to protect 12/10/05 residents from possible contact burns from unprotected radiators and towel rails. All staff must take part in a fire 12/10/05 drill. (Timescales of 13/11/2004 and 11/04/05 not met) Substances which are hazardous 12/10/05 to health must be kept locked at all times. 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 7 Good Practice Recommendations Care plans should be drawn up within a maximum of five days following admission to the home. Care plans should provide a written evaluation of care delivered to residents and the care plan should be amended to reflect changing needs. F51 F01 S6541 The Hawthorns V238401 120905 Stage 4.doc Version 1.40 Page 22 The Hawthorns 2. 12 3. 38 The weight of residents should be recorded on admission to the home and kept under review. The weight of residents should be linked to the care plan for nutrition. Any new, identified needs of residents should be added to the care plan together with actions to be taken by staff to meet those needs. More information about residents` social, cultural, religious and recreational needs 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. Action should be taken to ensure that smoke seals on doors identified by the fire officer are adjusted to ensure efficacy. The Hawthorns F51 F01 S6541 The Hawthorns V238401 120905 Stage 4.doc Version 1.40 Page 23 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 © 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 The Hawthorns F51 F01 S6541 The Hawthorns V238401 120905 Stage 4.doc Version 1.40 Page 24 - 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!