Inspection on 16/05/07 for The Hermitage

This inspection was carried out on 16th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Hermitage 28/02/06

The Hermitage 05/07/05

The Hermitage 31/01/05

The Hermitage 27/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE The Hermitage 6-12 St Mary`s Street Whittlesey Cambridgeshire PE7 1BG Lead Inspector Dragan Cvejic Key Unannounced Inspection 16th May 2007 8:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Hermitage DS0000015194.V341379.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Hermitage DS0000015194.V341379.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Hermitage Address 6-12 St Mary`s Street Whittlesey Cambridgeshire PE7 1BG Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01733 204922 01733 350041 Mr Peter John Thory Mrs Judy Maria Wilson Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places The Hermitage DS0000015194.V341379.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th February 2006 Brief Description of the Service: The Hermitage is a privately owned care home providing personal care and accommodation for up to 24 older people. Accommodation is provided in 16 single and 4 shared bedrooms. Whilst service users may have a range of physical disabilities, such as the need for wheelchairs, the home does not offer specialised care for people with dementia. The home is situated in the centre of Whittlesey, within easy reach of the shops and local library. The main entrance opens onto a large car park; a second entrance opens onto St. Marys Street. The home is on two floors, with communal rooms and some bedrooms on the ground floor. Other bedrooms are on the first floor, which is accessed by a shaft lift or stairs. Staffing is provided by a team of care staff who are supervised by the manager and her deputy. Staff are on duty overnight to provide assistance to those who need it. The fee is in the range around £380. The Hermitage DS0000015194.V341379.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection of the service. Some relevant findings from the thematic inspection carried out on 29/12/06 have also been incorporated into this report. This inspection included a site visit on 16/05/07 and lasted for 3 hours during which two service users were case tracked. A further 5 service users spoke to the inspector, as well as three staff members and the manager. Some documents, user and staff files and were also checked. A tour of the home provided direct information about the environment. A pre-inspection questionnaire and the home’s newsletter were also used to present the findings in this report. What the service does well: What has improved since the last inspection? The Hermitage DS0000015194.V341379.R01.S.doc Version 5.2 Page 6 Water taps were being changed to a different type to allow service users to use them more easily. Service users were commenting, either verbally or in writing on a suggestion form provided in the newsletter. Some suggestions seen related to the menu: “I would like more sausages on the menu”. Some others addressed activities: “We could get simpler jigsaws”. Generally both addressed areas were well organised and comments similar to these were incorporated into practice. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Hermitage DS0000015194.V341379.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection The Hermitage DS0000015194.V341379.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users were choosing the home from the well prepared information, their trial visits and with the reassurance that their needs would be met if they decided to move into this home. The process of choosing was excellent. EVIDENCE: Both the thematic and this key inspection demonstrated that this group of standards exceeded minimum standards. Information about the home was up to date and provided in different formats, large print, with pictures, in simple and understandable language. Two files contained the assessment notes from the admission and showed that a comprehensive assessment was done. Two service users stated that they had made the trial visit, met staff, and users and were assessed prior to moving in. Previous thematic inspection also showed that the admission process was excellent. The Hermitage DS0000015194.V341379.R01.S.doc Version 5.2 Page 9 Contracts were checked during the thematic inspection and the manager stated that this years increase in fees would be applicable from June, allowing a months notice for service users. The Hermitage DS0000015194.V341379.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users enjoyed the full respect shown to them both through the attitude of staff and the philosophy of the home. However, a minor shortfall in medication procedure determined a good rating rather than excellent. EVIDENCE: Three files of case tracked service users were checked. They all contained a form used for the assessment of needs addressing all the important aspects of users’ lives. All service users spoken to confirmed that they were involved in care planning. Care plans were drawn up for both day and night. A brief history for each individual was produced in story style, making the information easy to remember. Reviews were held regularly. The proprietor regularly checked selected care plans on his monthly visits to the home. The Hermitage DS0000015194.V341379.R01.S.doc Version 5.2 Page 11 One of the checked files contained a user’s wish not to be supported by a male carer. The manager explained that the rota was constructed in such a way that a female carer was available for that user and that the management’s on-call system was in place to ensure that extra staff could be brought in when needed. The home’s dealings with healthcare needs were checked with service users. A user explained that she had a letter from GP specifying the food she could not have due to her diabetes. “All staff know what I can’t have”. Another user explained: “I tell staff to call a GP or optician if I need them.” Staff spoken to stated that good communication was essential to ensure good healthcare was offered to service users. Medication was stored in a medication room that did not have windows and where the temperature could potentially raise above a safe level. This issue was discussed with the manager and the agreed action was for the home to contact their local pharmacist to try to find a solution. Records checked were accurate, but it was difficult to check the amount of medication prescribed as “when required” against records, as the home did not record the amount of tablets left when a new MAR sheet started. It was discussed that they would record the amount as Brought forward when new sheets start. The home kept some medication in their controlled drugs box, as there were no prescribed controlled drugs at the time of site visit. A home’s headed paper was used to make a list for medication that needed returning to the pharmacy and the copy was kept in the home. All liquid medication was labelled and when appropriate when measured with a pipette. Privacy and dignity were highly respected in the home and this was one of the home’s strengths. A service user who spoke about her experience of life in this home during the thematic inspection, stated this time: “This is still the best place to be in. I am telling you.” Staff were observed helping a user in a wheelchair and they showed care and respect. Service users were clean and admirable in their clothes, and it was visible that appearance was given special attention. The Hermitage DS0000015194.V341379.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users were deciding how to spend their time in the home and were pleased that their choices were not only respected, but were well known by staff. The home exceeded these standards. EVIDENCE: The home had varied and appropriate activities for service users. They had their say in what was going on in the home. The home’s newsletter provided an extra opportunity for service users to give their suggestions. Those spoken to stated that they had the choice whether to join activities or not. Daily life and routine was arranged according to the users’ wishes. Users had regular contact with their families. The majority of service users had their families involved in their financial matters. Users’ choices were recorded in care plans and their individual care respected their wishes. A female user did not want to have a male carer and the home’s rota arranged for a female staff member to be on duty at any time. The Hermitage DS0000015194.V341379.R01.S.doc Version 5.2 Page 13 All service users spoken to enjoyed the quiz, that appeared not only as a timed activity, but was also in the newsletter. Menus were varied and nutritional. Service users praised the food in all questionnaires submitted as a part of quality assurance review. Service users spoken to described the food as excellent. One of them stated: “Food is better here than what I had at home”. “We can have something to drink whenever we wanted”, stated one of the users. A diabetic user’s care plan clearly identified food she could not have. A cook was fully aware of preferences, likes and dislikes and users were pleased that they did not need to repeat their wishes each time to get what they liked. The Hermitage DS0000015194.V341379.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were clear of how to complain if they wanted to and were protected by an open atmosphere where all concerns would be dealt with immediately. EVIDENCE: The home had a complaints procedure. It was included in their statement of purpose and in the service user’s guide. It was also produced in large print and displayed in the hall. The content of the procedure clearly described how the investigation would be carried out with a time scale. The procedure contained the form for feedback when the outcome was reached. The complaints form for making written complaints was given to service users and their relatives at the point of admission to the home. In discussion with three case tracked service users, it was clear that they had the information about how to complain and what would happen with their complaints. Individual comments from service users included: “This is a wonderful place. I would never complain. If other people complain? I don’t know, they would complain to the manager and they would sort everything out. I believe in 10 days.” The other user’s commented: “I don’t have any complaints. They told my son how to complain, he wanted to know anyway.” The Hermitage DS0000015194.V341379.R01.S.doc Version 5.2 Page 15 “If I had a complaint, I would complain to the manager. The procedure is on the wall.” The home had robust measures in place to protect service users. However, the staff atmosphere and team spirit were the best protective reassuring elements and users trusted staff. The Hermitage DS0000015194.V341379.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,23,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was pleasant, homely arranged and service users enjoyed a very good state of repair and regular maintenance. EVIDENCE: The home was regularly maintained. The manager explained that any request from the home to the proprietor was approved almost immediately. The local workmen and maintenance companies were used for repairs. This procedure reduced any potential risk to service users. The water taps were change to a different type, allowing users with arthritis to use them more easily. The manager stated that the flooring for the kitchen had just been ordered. Hospital beds were in all individual bedrooms, but users could bring their mattresses if they wanted. The garden was very pleasant and the owners The Hermitage DS0000015194.V341379.R01.S.doc Version 5.2 Page 17 asked the manager and the staff to arrange it for each season, planting summer or winter flowers. The home had 4 double rooms. Service users signed the agreement to share rooms and in one bedroom they requested for a screen to be removed, while in other users were pleased that they had a screen, but still wanted to share the bedroom. The home had effective infection control measures in place. The laundry room was in an adjacent building, separate from the main building. Staff working in the laundry saw that as a very effective infection control measure. Three staff members were asked about the laundry being separate from the home, but they all were pleased with that arrangement and did not mind taking the washing to a building next door to the main. The home also had a CCTV system in place, but the cameras were recording only outside movements, protecting users privacy while improving security, especially at night time, as staff stated. The Hermitage DS0000015194.V341379.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The staff complement was decided against users’ needs and ensured that sufficient, well-trained and skilled staff were on duty at any time. Service users particularly liked the principle that staff could start working independently when they knew each user by their name. EVIDENCE: The staff rota was sent as part of the pre-inspection questionnaire. Three staff were employed to work morning or day shifts, while the evenings and nights were covered by two staff. In addition, the management team was on-call and could arrange for an extra staff member to come in at any time. Service users thought that the current staff number was sufficient to meet their needs. Staff felt well supported, they had regular supervision and appraisals and informal support at any time. A newer staff member stated: “I worked previously in a hospital and some other home, but this is by far the best staff team and place to work. Communication is the best tool for effective work and we have it here.” She stated that her induction was excellent. Staff were not allowed to start working independently until they knew all service users by name. The Hermitage DS0000015194.V341379.R01.S.doc Version 5.2 Page 19 One vacant staff position did not affect the standard of work. The manager had been working in this home for 24 years and stated that they did not advertise for staff vacancies, “word of mouth” was the way to fill in vacancies. Each staff member was properly voted, 3 references, POVA and CRB were obtained before they started. There were 14 staff already NVQ qualified, two more were starting this programme and two assessors working in the home offered reassurance that the home could keep the number above minimum standards. Staff were up to date with their mandatory training. The home provided some extra training for a few staff members, such as continence, or challenging behaviour. The extra training was evenly spread allowing all staff to develop particular knowledge. The Hermitage DS0000015194.V341379.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were protected by safe working practices and felt safe and secure in the home. EVIDENCE: The manager was working in this home for 24 years. Her skills, experience and management style ensured the stability and satisfaction of service users and staff. A staff member described the atmosphere in the home as “exceptional” and stated that a team atmosphere among staff spread beyond the work place. A strong staff team, when no agency was used at all, meant consistency of care for service users. The Hermitage DS0000015194.V341379.R01.S.doc Version 5.2 Page 21 The home used their newsletter and users comments provided throughout the year as the base for quality assurance review. All comments were given attention, even simple suggestions as: “We would like meat pie and mashed potato on a menu.” The menu was checked and the suggestion was there. The newsletter was produced in large print allowing all service users to easily read it. Pictures in the newsletter made it more interesting and all service users showed interest and used this opportunity to influence daily life and express their feelings about the life in the home. Most families helped service users with their money. Several service users held their personal allowances with them. Users spoken to stated that they were happy with the arrangements for their money. A copy of the contract between Hermitage and social services (council’s document) gives dates and figures and also states the personal allowance for each individual. However, when records were checked, there was no space allocated for service users to sign them. In discussion with the manager it was agreed that service users would be asked to sign checks at appropriate intervals and demonstrate that they were fully aware of their balances. The home had safe working practices in place. Staff were regularly renewing their mandatory training and they used the knowledge in practice when they helped service users. A service user confirmed that she saw the benefits from staff’s training as they “Knew better how to help me”. The home kept appropriate records of accidents incidents and used records to analyse and minimise further accidents. The Hermitage DS0000015194.V341379.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 3 4 3 4 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 3 X X 3 STAFFING Standard No Score 27 3 28 4 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 3 X X 3 The Hermitage DS0000015194.V341379.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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 OP9 Good Practice Recommendations The home should record the amount of medication carried over from one to another MAR sheet in order to make the audit process simple and ensure individual medication can easily be checked at any time. The home should consult their local pharmacist to try to find a solution for storing medication in the room where the temperature potentially might exceed the recommended 250C. The home should arrange that service users sign the audit of their money, confirming that users are fully aware of records kept in relation to their money deposited for safe keeping in the home’s safe. 2 OP9 3 OP35 The Hermitage DS0000015194.V341379.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Hermitage DS0000015194.V341379.R01.S.doc Version 5.2 Page 25 - 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!