Care Home: Hadrian House

What the care home does well Action had been taken to comply with the requirements from the last inspection to introduce care plans for use of sensory aids, enable people to exercise more choices in daily living, and improve some aspects of training and staffing. The home is clean, comfortable and attractively decorated and furnished. More effective systems are being introduced to monitor and assure the quality of the service. What the care home could do better: Sufficient information should always be obtained about each person`s needs before they are admitted to the home to enable their care and support to be properly planned. An assessment to identify and monitor the mental health needs of people with dementia is to be introduced. Care recording needs to be further improved to ensure social and spiritual needs are addressed, that care plans are more robustly evaluated, and demonstrate that people are suitably supported to meet their personal hygiene and continence needs. The administration of medication and associated records must be made fully robust to show people are properly protected by a safe medication system. Staff need training to understand the nutritional needs of older people and to improve people`s meal time experience through improved care practices. Although complaints records are now kept in better order the actual recording of the complaints still needs to be made clearer. Further staff training is to be arranged that is relevant to meeting the diverse needs of the people living at the home. Random inspection report Care homes for older people Name: Address: Hadrian House Garden Street Blaydon on Tyne Gateshead Tyne and Wear NE21 4AG one star adequate service 25/11/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Elaine Malloy Date: 2 6 0 5 2 0 1 0 Information about the care home Name of care home: Address: Hadrian House Garden Street Blaydon on Tyne Gateshead Tyne and Wear NE21 4AG 01914143330 01914143332 hadrian.house@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Patricia Ann Coxon Type of registration: Number of places registered: Conditions of registration: Category(ies) : Southern Cross OPCO Ltd care home 63 Number of places (if applicable): Under 65 Over 65 20 43 dementia old age, not falling within any other category Conditions of registration: 0 0 The maximum number of service users who can be accommodated is: 63 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling wtihin any other category - Code OP, maximum number of places: 43 Dementia, over 65 years of age - Code DE(E), maximum number of places: 20 Date of last inspection 2 5 1 1 2 0 0 9 Care Homes for Older People Page 2 of 12 Brief description of the care home Hadrian House is a modern, purpose built care home that is situated in the Blaydon area of Gateshead. The home is registered to provide care for up to 63 older people, including 20 places for people who have dementia. The home can provide personal care but cannot provide nursing care. Bedrooms and communal facilities are situated over 4 floors. The 1st floor is an 8 bedded residential unit, the second floor can accommodate up to 20 people with dementia, the 3rd and 4th floors offer 19 and 16 residential places respectively. All bedrooms have en suite toilet and shower facilities. Throughout the home there are six lounges and four dining rooms. A lift is provided to take people to each floor of the home and an emergency call bell system is fitted in all bedrooms and communal areas. The entrance has level access and the well laid out garden has a paved walkway that residents may use. There is a car park to the side of the building offering parking facilities for visitors to the home. The home is situated close to a number of local facilities and amenities such as shops, GP surgeries, Health Centres and pubs and the public transport system runs nearby. It is owned and operated by Southern Cross. A Service User Guide has been developed and this informs residents and other interested parties about the services the home offers and a copy of the most recent inspection report is available to read. Fees charged by the home range from £438 - £569.61 Care Homes for Older People Page 3 of 12 What we found: The inspection was carried out by: Looking at information received since the last key inspection on 25th November 2009. Two inspectors visiting the home unannounced on 26th May 2010. Talking to the management and other staff about the service. Getting the views of people living at the home and observing the care and supervision provided. Looking at relevant records. Checking if improvements required from the previous inspection had been made. The inspection was carried out over eight and a half hours. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use the service are not put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. We found that: Comprehensive pre-admission assessments of care needs were carried out for most of the people who had moved into the home in recent months. The home had also obtained assessments from the referring care manager and nursing discharge summaries where people were admitted from hospital. One person was admitted as an emergency admission, and this persons assessments were carried out on the day after admission. There was no record as to the circumstances of this emergency admission, or any reason given for the lack of pre-admission assessment. A range of assessments were regularly updated to identify peoples current health and personal care needs and risks associated with individual vulnerability. These included physical and social, dependency, moving and handling, nutritional, and falls and pressure ulcer risk assessments but there was no mental health assessment for people with dementia. Care plans were drawn up promptly, usually on the day of admission, though one persons plans had been delayed despite a pre-admission draft care plan summary being in place. The quality of recording within care plans varied. The majority were specific, well-personalised and sensitively recorded whilst others were less detailed and more general. Care plans were in place for most, but not all, assessed needs in that some people did not have social and spiritual plans. Monthly care plan evaluations were recorded but again the quality of recording was Care Homes for Older People Page 4 of 12 variable and evaluations were not always rigorous enough to show whether the plans were achieving or working towards the stated goals. The manager stated that senior care staff were being given care planning training. Charts relating to assistance with personal hygiene were not always consistently completed on a daily basis and in some instances omitted recording of nail care, shaving and hairdressing. It was also observed that some male service users had several days beard growth. Records were kept of visits from health care professionals and attendance at hospital appointments. There was evidence of appropriate access to health services and specialist advice was incorporated into care plans for health care needs. Equipment was obtained to aid moving and handling and minimise the risk of people developing pressure ulcers, and body mapping was being carried out to maintain records of individuals skin integrity. Whilst there were supplementary records that cross-referenced to associated care plans, for example nutrition intake and incidents of challenging behaviour, records were not always kept of support provided with toileting routines to help people with identified continence needs. Senior care staff are trained in safe handling of medication and take responsibility for administration. Medication records contained a list of signatories and a front sheet for each service user with photograph, name and room number for identification purposes. Balance records were kept of boxed and bottled medication that was separate to the monitored dosage system packs. The administration records examined showed some gaps where staff had not signed to verify medication was given or entered a code for the reason why it was not given. There was also some discrepancies in the use and definitions of codes. One service user was prescribed a course of 21 antibiotics but only 20 tablets were signed as given before the course was signed off as being completed. Clear directions for medication were pre-printed and hand written with the exception of some medications where timings had been changed as opposed to being rewritten and the use of latin abbreviations. The manager said medication audits had been introduced in recent weeks. Although the current emphasis was getting people to join in the organised social activities, there were some personalised elements as well. The homes activities coordinator was drawing up detailed and highly individualised social histories for each person living in the home. These are described as celebrations of the persons lives, and include information on their personal history, education, family tree, significant events, with photographs. The manager stated that all staff had been instructed to respect the individual rising and retiring patterns of the people living in the home, and that any issues with individual staff were now being discussed in supervision. She stated that there was now a much wider spread of sleeping/rising behaviour, and a far more relaxed atmosphere in the home. The usual bedtime/waking time of each individual is recorded in the physical and social assessment document on admission. Care plans had been drawn up for known early risers, who were encouraged to use the alarm call to tell staff when they want to get up. The manager stated that staff had also been instructed to offer people a hot drink if they rise before breakfast. Peoples nutritional needs were assessed and care planned and weights were monitored. Care Homes for Older People Page 5 of 12 Catering staff work to the homes menus and daily preference sheets indicating individuals choice of meals. They are informed about those people who are losing weight and said they provide milkshakes and smoothies, but do not routinely provide calorific snacks between meals. Food was being fortified with cream, full fat milk and butter. Some special diets were catered for and soft diets were well presented. No staff have undertaken nutrition training to date. Jugs of water and juice were still not being made available in the lounges for people to help themselves. This was also confirmed by the report of a monthly external managers audit of the home. A more flexible approach was being taken to asking people about their meal choices preferences, though there was evidence at the meal time on the unit for people with dementia that such choices were not being respected. Fresh fruit was not being routinely prepared and offered to people in the home, though was on offer at the lunch meal. A number of differences were noted between the meal time practices on the residential and dementia care units. Lunch time on the residential unit was a pleasant experience and people were offered appropriate support and choices of food and drinks including alternatives to the menu. Menus were not displayed. The meals were nicely presented and of good portion size and people spoken with said they enjoyed the food. On the dementia care unit people were all given the same meal, even though at least one had requested the vegetarian alternative, and this had been sent up on the hot trolley. All appeared to be given the same portion size. Similarly, no choice was offered for dessert. Tables lacked salt and pepper cruets and paper napkins were offered at the dessert stage only. Staff interrupted people eating their lunch to give them their medications and the serving of the meal and clearing of tables was not well organised. The meal experience was not enhanced by loud pop music being played on the radio, or by the domestic hoovering the carpet just outside the open doors of the dining room. Six complaints had been recorded in the past year. These included complaints about care issues, staff attitude to relatives, missing belongings, and lack of fresh fruit. Although complaints records were now kept in better order and were clearly sectioned, the actual recording of the complaints was unclear. One recent complaint did not have any detail of the investigation or findings. Other complaints had all the sections completed, but were so vaguely recorded that they lacked even basic details such as the names of persons involved and whether or not the complaint was substantiated or upheld. Only one of the six recorded the complainants degree of satisfaction with the outcome of the investigation. The manager is a safeguarding facilitator, and provides safeguarding training, in-house, for her staff. To date, three-quarters of the staff team had received this training. The manager estimated that the other staff will have received this training within the month. A number of staff have also had external training with the Gateshead Local Authority Safeguarding Unit. The manager agreed to submit a plan for the rest of the care team to receive this training. One safeguarding alert had been made shortly before this inspection, with staff instigating the homes whistle-blowing policy to report an allegation of staff misconduct. The manager responded appropriately in suspending the staff in question and reporting the allegations to the local authority safeguarding team, the Police and the Care Quality Commission. The manager agreed to keep a central record of all safeguarding Care Homes for Older People Page 6 of 12 alerts/issues. Staff rotas were examined and staffing was discussed with management. The home was maintaining levels of nine care workers including seniors across the waking day. Rotas were forward planned and indicated the floors of the home that staff were allocated to work on and where shifts needed to be covered. The manager stated that existing staff work extra hours, staff from other homes within the company are used, and, where necessary, external agency staff to make sure that all staff sickness and holiday absences are covered. There was evidence that she had reported to the Commission the occasional shift that had not been able to be covered in this way. It was confirmed that the minimum number of staff on night shift was six, and the manager said that this level would be maintained at all times. Details of staff training were provided. These showed that there have been updates of core training including fire safety, moving and handling, infection control and safe handling of medication. However, there had been a lack of training provision specific to the needs of service users needs, such as dementia awareness, challenging behaviour, nutrition, and pressure area care. The manager had just completed the facilitator course to enable her to give staff the training course Tomorrow is another day for working with people with dementia. She said that this training would be rolled out for all staff in the near future. The home has a Registered Manager. At the time of the inspection the deputy manager was absent and temporary cover was being organised from within the company. All staff had received a minimum of two formal supervision sessions since the last inspection. An annual staff supervision planner was in place, but it was not being kept up to date. Annual appraisal is staggered over the year. Quality assurance methods were examined and discussed with the manager. Resident committee meetings were held monthly and Friends of Hadrian House meetings were starting next month, to get the views of people living at the home and their relatives and advocates. Surveys about the service were sent out the previous week to relatives and visiting professionals. A monthly newsletter was produced with information about what is happening in the home. The manager was continuing to set dates for a managers surgery to enable people to meet with her in private. The home had recently been subject to a quality audit, Key Outcome Inspection Tool, that is based on the National Minimum Standards for Care Homes for Older People. It specifically looks at previous inspections carried out by regulatory agencies and crossreferences to the requirements and recommendations of these. The audits were carried out and recorded in good detail, and included action plans to achieve compliance. Separate catering audits were also carried out. An area manager visits the home monthly and reports on the conduct of the service. These visits include observations, talking to residents, visitors and staff, reviews of accidents/incidents, complaints, records and premises and also reviewing the existing action plan. The manager stated that she had started to hold Head of Department meetings with staff responsible for maintenance, catering, housekeeping and senior carers. Care Homes for Older People Page 7 of 12 The manager had requested clarification from Tyne and Wear Fire and Rescue Service as to the required frequency of in-house fire instruction and said that she is following that advice. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 12 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 16 22 All complaints and concerns 31/12/2009 expressed to the manager or staff must be fully recorded, with details of any investigations, outcomes, and degree of satisfaction of the complainant clearly set out. Any lessons learnt from such complaints or concerns must be considered, recorded and fed back into the quality assurance system. This is to improve the overall quality of the service being delivered. Care Homes for Older People Page 9 of 12 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Staff who administer 26/06/2010 medication must complete the Medication Adminstration Record for each service user at the time of administration. All medication must be administered as directed by the prescriber to the service user it was prescribed, labelled and supplied for. To ensure that an accurate record of medication administration is maintained and to safeguard the health and welfare of service users. 2 30 18 All staff must be provided 26/08/2010 with opportunities to receive training that is appropriate to the work they perform, including caring for people with dementia, challenging behaviour, pressure area care and nutrition of older people. To ensure that service users are cared for by suitably skilled and trained staff. Care Homes for Older People Page 10 of 12 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 All service users with dementia should have a mental health assessment carried out to identify and monitor their psychological needs. Each new service user should have a full assessment of their needs carried out prior to admission. Care plans should be further developed to ensure they are to a consistently good standard of recording. All service users should have care plans addressing their social and spiritual needs. Records of service users support with personal hygiene and continence should be consistently completed to show all assistance provided. Care plans should be evaulated in greater detail to demonstrate whether the plans are achieving or working towards the stated goals. The correct codes should be entered to medication administration records to verify the reason(s) why medication has not been given. Service users nutritional and fluid intake should be enhanced by providing calorific snacks between meals, regularly offering prepared fresh fruit and providing jugs of water and juice in lounge areas. A review of meal time practices should be carried out to ensure that: Service users with dementia receive appropriate support with choice of meals and drinks. Meal times are protected from interruption such as giving out medication. Menus are displayed. Condiments are provided and use offered. 2 3 3 7 4 7 5 7 6 9 7 15 8 15 Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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