CARE HOMES FOR OLDER PEOPLE
Hurstway, The 142 The Hurstway Erdington Birmingham West Midlands B23 5XN Lead Inspector
Jill Brown Announced Inspection 17th October 2005 09:15 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 Hurstway, The DS0000024850.V259862.R01.S.doc Version 5.0 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. Hurstway, The DS0000024850.V259862.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Hurstway, The Address 142 The Hurstway Erdington Birmingham West Midlands B23 5XN 0121 350 0191 0121 386 4225 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) Heart Of England Care Ms Marie Ann Swadkins Care Home 59 Category(ies) of Dementia - over 65 years of age (59), Physical registration, with number disability over 65 years of age (59), Terminally of places ill over 65 years of age (59) Hurstway, The DS0000024850.V259862.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. That Marie Ann Swadkins successfully obtains the registered Managers Award or equivalent by April 2005 That the home can accommodate a total of 59 people of which up to three persons are over 60 years of age but under 65 years of age in line with their categories of registration. 10 February 2005 Date of last inspection Brief Description of the Service: The Hurstway is a purpose built home located in a residential area of Birmingham, and owned by The Heart of England Care charity. The home is registered to provide nursing care for up to 59 older adults. All bedrooms are for single occupancy with shared bathroom and toilet facilities. The accommodation is laid out over 2 floors, in 4 separate units, known as Primrose, Bluebell, Lavender and Jasmine, each unit having a lounge/dining room for service users to enjoy. Downstairs there is a reception area with chairs and settees, which the service users have use of. There are ranges of aids and adaptations designed to accommodate residents with limited mobility, including a shaft lift between floors, a call system, grab rails and assisted bathing and toilet facilities. A range of well cooked and presented nutritious food is provided, with alternative choices available if requested by the service users. At the front of the building is a car park for visitors, and at the rear is an enclosed garden, which provides a safe area for people to enjoy the fresh air should they wish. Hurstway, The DS0000024850.V259862.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Two inspectors, Jill Brown and Liz Mackle undertook the announced inspection over 10 hours one day in October. Seven comment cards were received from health care professionals all of whom were happy with the health care provided. One anonymous comment card was received raising some concerns; these are reflected in part in the report. Thirteen residents and three staff above the manager and responsible individual for the home were spoken to during the inspection. A full tour of the building was not conducted but each unit was seen and a number of bedrooms checked. Case records for eight residents and three staff files were sampled. Three residents financial records were checked and medication administration for one unit was looked at. The homes maintenance and inspection records for fire safety, electrical and gas services were looked at. What the service does well:
The home works well with health professionals to ensure the health of residents in the home. The staff knew the medical needs of residents and how care was to be given. Care plans were good on areas such as wound care, communication and foot care. Medication administration appeared good but a full check was not taken on this inspection and a requirement about auditing was brought forward. Relationships between residents and staff appeared good with those residents that could comment saying they were happy in the home. There appeared to be no undue restrictions to visitors to the home. The home was clean, fresh and well maintained. The home had good records of maintenance and inspection of services such as fire safety and gas supplies. The home had the appropriate policies and procedures on complaints and adult protection and staff were aware of their responsibilities under these procedures. This protects residents from harm.
Hurstway, The DS0000024850.V259862.R01.S.doc Version 5.0 Page 6 Resident’s rooms were personalised, residents having their own belongings around them and their name on the door. The home has a large proportion of staff that has undertaken the NVQ2 and this exceeds the standard. The home has had an independent audit of the service they provide and have performed well in this audit. The financial records for residents’ money are well kept and those checked were correct. What has improved since the last inspection? What they could do better:
Care plans for death and dying were standard for all residents and these did not reflect individuality of resident’s wishes. Care plans about risks such as challenging behaviour, use of alcohol and delivery of personal hygiene needed improvement to ensure consistent care for residents. Recording of challenging incidents could be improved to enable future planning. Care plans on moving and handling needed to be more prominent and needed to show clearly what aids were should be used to deliver the care rather than those that could be used. Reviewing of what has happened in the resident’s care in the previous month needed to be clearer if it was to inform changes in the resident’s care plan. The home cares for residents that have dementia and some individual planning on activities would enhance their quality of life. A comment card and one resident stated that the food could be improved. The home’s menu showed that a number of ready prepared foods were included especially on the second choice. Vegetables and so on were not specified on the menu. The second formal choice was fish and a more varied menu would improve the options for residents. An immediate requirement was left at the home about the assessment process and the safety of the bedrails that were being used as these posed potential risks to residents. Hurstway, The DS0000024850.V259862.R01.S.doc Version 5.0 Page 7 In the building, work on the toilets to ensure there is space for wheelchair users and to ensure privacy would be an improvement. An inspector was informed that this work is planned. Some of the bedrooms are too small to provide the level of care needed comfortably and this must be kept under review for existing residents and be a factor in admissions for new residents. The homes practice is for staff to rotate working on all of the units. This does not assist residents with dementia and does not show a continuity of care. A number of updates on core training such as first aid were out of date for staff and individual recorded supervision of staff was not happening and this potentially puts residents at risk. 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. Hurstway, The DS0000024850.V259862.R01.S.doc Version 5.0 Page 8 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 Hurstway, The DS0000024850.V259862.R01.S.doc Version 5.0 Page 9 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 the following standard(s): 3,4 & 5 The homes assessment records were improving and staff seen were clear about the care needs of residents and this ensures good care. EVIDENCE: The assessment information held on residents at the home was variable with basic information being collected but sometimes detail was lacking to inform the care plan. The information that is being collected on more recent admissions had improved although there was some repetition. The home was revising its paperwork and some work was needed to ensure it was consistent and clear. Senior nursing staff complete an assessment of the resident’s needs before a resident is admitted. Staff interviewed were able to demonstrate a knowledge of the care needs of specified residents. It was clear that advice was sought from health professionals and that the home worked with these professionals to maintain residents health. Hurstway, The DS0000024850.V259862.R01.S.doc Version 5.0 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 the following standard(s): 7,8,9 & 10 Care planning needed improvement in organisation and in a number to ensure the correct care for residents. The home has good working relationships with health professionals and this with the good administration of medication ensures the health of residents. EVIDENCE: Care plans were not focussed enough on how personal care was to be delivered and so did not become a working tool for staff to deliver the care. Information about part of the residents care was kept separately in wound care folders and not cross-referenced with the main care plan. However the home had good, clear plans about communication, sleeping and foot care. There was some evidence of core care plans on death and dying and these do not reflect individual resident’s wishes or religious needs. Some elements of risk for individual residents were identified and result in planning. One resident’s plan did not show that the risks involved in drinking alcohol had been considered such as the resident’s medication, mobility and so on. Moving and handling assessments were extensive. Some planning appeared repetitive especially about mobility and moving and handling. The
Hurstway, The DS0000024850.V259862.R01.S.doc Version 5.0 Page 11 Commission only expect a risk assessment for bedrails and wheelchairs if there are issues where these may prove to be a solution. There was no appropriate planning for a resident that had challenging behaviour. Challenging behaviour displayed was not being recorded appropriately. The time it occurred, any triggers to the behaviour or responses that made the behaviour change. This means that future medication; management and resolution of the behaviour cannot be achieved. The home kept daily records and had key worker notes. The key worker report did not summarise the previous months events as the home expected and did not feed into the review. It was clear that residents had access to specialist care when needed and records were kept of visits from Consultant Psychiatrists, GPs, Hospice Consultants, ophthalmologists, dentists and so on. All the comment cards from health professionals were appreciative of the professional conduct of the manager of the home and had commented on the good working relationships they had. Nursing staff reported easy access to Tissue Viability Nurse and wound management within the home was good. The medication administration was inspected on one unit and this was found to be generally satisfactory. The requirement about medication audits were not inspected on this occasion and this requirement was brought forward. Relationships between residents and staff were good and residents were talked to appropriately during the inspection. Hurstway, The DS0000024850.V259862.R01.S.doc Version 5.0 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 the following standard(s): 12,13, & 15 The home’s arrangements for food and activities whilst providing an adequate level of provision did not show that the individual preferences and needs of residents were catered for. EVIDENCE: One resident spoken to said ‘the home was Ok’ ‘I get up about 7.30am and go to bed at 6pm that suits me.’ The resident showed some concern that an activity they enjoyed had not been available because of the lack essential equipment. Another resident said she was very satisfied with the care, the food and the home generally, and said, “I wouldn’t want to be anywhere else”. Some residents were heard to have a music session on the morning of the inspection. Residents in one lounge were looking at magazines. One resident said they liked to have a cigarette and sing old war songs. It was difficult to track whether activities provided for people with dementia were based on previously enjoyed activities or the individual residents history. There appeared to be no undue restrictions on visitors calling into the home.
Hurstway, The DS0000024850.V259862.R01.S.doc Version 5.0 Page 13 The meals were not inspected on this occasion, however the home submitted a menu for 2 weeks for inspection. The menu did not show what vegetables were to be offered so a nutritional assessment could not be made and the second formal choice appeared always to be fish. There appeared to be a lot of fast foods on the menu in the form of meat bites, fish fingers, faggots, salmon cakes and so on. One service user and one comment card stated that the meals needed improvement especially that food with breadcrumbs was difficult for residents to eat. The meals did not reflect the frail condition of many residents and a more varied alternative should be provided. The menu must show all aspects of the food to be provided. Hurstway, The DS0000024850.V259862.R01.S.doc Version 5.0 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 the following standard(s): 16 & 18 The home has procedures for complaints and adult protection that protect residents. EVIDENCE: The homes record of complaints was clear and showed that the home had three formal complaints since the last inspection. These complaints were investigated and steps taken to remedy any shortfalls identified. The home had referred appropriately a resident’s concerns through the adult protection process and this external process had not satisfactorily resolved this. Staff when interviewed were aware of the need to report. The home has appropriate guidelines in place and is aware of the updated Multi Agency guidelines. Hurstway, The DS0000024850.V259862.R01.S.doc Version 5.0 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 the following standard(s): 19,21,22,23,24 & 25 The home environment was well maintained clean and fresh and this provides a comfortable environment for residents. A number of issues such as use of bedrails and the delivery of personal care in small bedrooms needed improvement to ensure the safety of residents and staff. EVIDENCE: A full tour of the home was not completed on this inspection however the areas of the home seen were tidy and clean at the time of the inspection. The home has an appropriate lay out. The inspector was advised of discussions on increasing the communal space in the future. Some of the shared toilets need improvements to space to accommodate wheelchair users and to maintain privacy and the inspectors were informed that this work was planned. The inspectors found a mixture of aids and adaptations in the home to assist residents. The bedrails that were in use appeared to allow residents limbs to
Hurstway, The DS0000024850.V259862.R01.S.doc Version 5.0 Page 16 become trapped even with the use of bumpers and an immediate requirement was left in respect of this. There were some accident records that showed bedrail injuries. One resident had an inappropriate covering on their hand and this must be replaced and stores kept to replace when necessary. The bedrooms are in the majority of cases small and this causes some difficulty in rooms where residents need to be hoisted and clear instructions must be reflected in the care plan. One resident’s bedroom had a large amount of peg feeds stored and this limited the space. Bedrooms were personalised with residents’ belongings and names were on residents’ doors. A shower and a wash hand basin were tried for the hot water temperature and these were appropriately restricted to prevent scalds. Hurstway, The DS0000024850.V259862.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 & 29 The home has safe recruitment and selection procedures and this protects residents. Improvements were required in training and staff deployment to ensure the needs of residents are met. EVIDENCE: It was clear from the inspection that the majority of residents in the home needed a lot of care and attention with a large number of residents requiring two staff to provide that care. The rotas did not show how shortfalls in staffing were rectified and this will be an area for the next inspection. The home had a practice of allocating staff on a daily basis to the units although this gives staff the experience of all the residents the inspectors were concerned that it makes it difficult for residents with dementia to build relationships. The home state that they exceed the required number of care staff who have achieved NVQ2 in care and this helps to protect residents. The records of the home’s employment of staff met the requirements. However the inspectors did not view the CRBs for staff on this occasion once audited by the inspectors can be destroyed. Hurstway, The DS0000024850.V259862.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35,36 & 38 The arrangements for assisting with residents’ finances, records for the maintenance and inspection of services were good and this protects residents. The lack of formal supervision to staff could potentially put residents at risk. EVIDENCE: The home has used an independent company to audit its service and has performed well on this audit. Care planning was identified as an area needing improvement in this audit. The home manages a small amount of money for some residents. This money is usually left by relatives of the service user for services such as the hairdresser or the chiropodist. Those residents money checked had appropriate receipts and the money balanced with the record. Hurstway, The DS0000024850.V259862.R01.S.doc Version 5.0 Page 19 Staff supervision had not been undertaken within the home with a number of staff not having had supervision for some considerable time. An effective system of supervision does much to ensure that issues related to employment, performance, training and whistle-blowing issues are dealt with in a confidential manner. The home had appropriate fire records and showed that they took fire drills seriously and ensured that staff kept to the required standard. The home had the required maintenance and inspection records of the services checked by the inspector, and these appeared to be in order and up to date. Hurstway, The DS0000024850.V259862.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 2 2 3 3 X STAFFING Standard No Score 27 2 28 4 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 1 X 3 Hurstway, The DS0000024850.V259862.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 2 Standard OP3 OP7 Regulation 14(2) 15(1) Requirement Assessment information must be consistent and changes dated. Care plans must reflect how the individual care is to be given on every new assessment and for existing residents by. Care plans must be cross referenced with wound records. Risk assessments must be carried out on residents that drink alcohol. Care plans for all elements of need identified must be provided such as challenging behaviour and clear records must be kept of challenging incidents. Timescale for action 31/12/05 31/03/06 3 4 OP7 OP7 12(1)(a) 13(4)(c) 31/12/05 31/01/06 5 OP7 13(4)(c) 31/12/05 6 OP7 15(2)(b) 31/02/06 The manager must ensure that all service users care plans are regularly reviewed to ensure that they accurately reflect the care needs of the individual. This requirement was outstanding since 31/03/05 7 OP9 13(2) Audits must be carried out to
DS0000024850.V259862.R01.S.doc 31/12/05
Page 22 Hurstway, The Version 5.0 ensure that boxed medicine counts are accurate. This element of the standard was not inspected and was brought forward 8 OP12 16(2)(n) The homes care planning on activities must show how these are appropriate for individual residents especially for residents with dementia. The homes menu must show variety in choices and detail of the meal provided. The Commission must be informed of the planned improvement to the toilets in the home. The assessment process for the use of bedrails must be clear and where appropriate to minimise risk must be fitted. The bedrails and their covers must be audited by 24/10/05 and remedial action taken to improve their safety. A named resident must have an appropriate covering to their hand available. All new residents must be assessed to ensure their needs can be met safely in their bedroom. The home’s policy on rotating staff daily must be reviewed to meet the needs of residents in the home. All care and nursing staff must receive one to one recorded supervision at least 6 times a year. A supervision rota is to be sent to the Commission by 31/10/05. All staff must have had initial supervision by 31/01/06 9 10 OP15 OP21 16(2)(i) 12(4) & 23(2)(n) 13(4)(c) 31/01/06 31/12/05 11 OP22 31/12/05 12 OP22 13(4)(c) 10/11/05 13 14 OP22 OP23 23(2)(n) 13(4)(c) 15/12/05 31/12/05 15 OP27 18(1)(a) 31/12/05 16 OP36 18(2) 31/11/05 Hurstway, The DS0000024850.V259862.R01.S.doc Version 5.0 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hurstway, The DS0000024850.V259862.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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