Care Home: Hardwick Dene

What the care home does well There are photo`s of the meals provided to assist the residents` when they are choosing what they would like to eat. A new menu has been devised taken into account the likes and dislikes of the residents`. The manager has sent out quality assurance questionnaires to the families of resident`s so that the home can take their views into consideration. The acting manager told us that the management team carry out direct observations of the care that is provided so that they can ensure it is of a good level. The staff ensured that the correct instructions are followed for a person taking warfarin. All people medicines where available on a ongoing basis. The home would ensure that two staff who have been trained appropriately would give out medicines that are classed as controlled drugs. What the care home could do better: The care plans must be up to date with the current information clearly available. This will ensure that the staff have the information they require to meet the residents` needs. When health issues are identified such as loss of weight or a problem with eating then the resident must be referred to the relevant health professionals. This will ensure that the residents receive appropriate health care and support. The care plans for people must reflect all their health care needs that also relate to medication and need to be updated regularly ie changes in medication used for behaviour/ mood control. The home must ensure that changes in dosage regimes are supported by a GP prescription as soon as possible. Verbal or faxed changes can be followed up but then they do require a signed prescription within 72 hours. This procedure should be covered in the medication policy. The home must ensure that all prescribed creams and ointments are applied as prescribed and that this is recorded. Any changes in a person skin integrity should be recorded and cross referenced to this person`s care plan. Random inspection report Care homes for older people Name: Address: Hardwick Dene Hardwick Lane Buckden Cambridgeshire PE19 5UN two star good service 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: Joanne Pawson Date: 1 0 0 3 2 0 1 0 Information about the care home Name of care home: Address: Hardwick Dene Hardwick Lane Buckden Cambridgeshire PE19 5UN 01480811322 01480819120 hardwickdene12@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Krishan Parkash Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 38 Number of places (if applicable): Under 65 Over 65 33 38 dementia old age, not falling within any other category Conditions of registration: Date of last inspection Brief description of the care home 0 0 Hardwick Dene is a registered care home for 38 older people that includes 33 places for people with dementia related care needs. The home is set in large, attractive, wellkept gardens overlooking farmland, on the opposite side of the A1 to the village of Buckden. The market towns of Huntingdon and St Neots are within a 10-minute drive. The cities of Cambridge and Peterborough can each be reached within half an hour, and London is fifty miles to the south. Originally a family home, Hardwick Dene has been extended three times. A ground floor self-contained unit of 12 single bedrooms, all with en-suite facilities, 2 lounge/dining rooms, a shower room and a bathroom has Care Homes for Older People Page 2 of 10 Brief description of the care home been added to offer care to people who need safe, constantly supervised, accommodation due to problems with their mental health. Accommodation in the older part of the home is on two floors and consists of 22 single bedrooms, 2 double bedrooms, and 2 large lounge/dining rooms. The home has adequate bathroom and toilet facilities, a well-equipped kitchen, an office, a treatment room and laundry. The home has a large open and plain garden at the front of the property. The homes separate extra care unit leads onto an enclosed part of the garden. The home has wellmaintained lawns that are home to two peacocks. The fees at the last key inspection to reside at Hardwick Dene cost from £351 to £560 per person per week. Care Homes for Older People Page 3 of 10 What we found: We carried out this inspection in response to information that had been passed onto the commission. Staffing On the day of the inspection there was 36 residents, 20 of which have dementia. The acting manager confirmed that since she had been in post the staffing levels had increased to ensure that there is six members of staff on the early and late shift at the busiest times. Some of the staff spoken to felt that a further increase in the staffing levels would reduce time that residents have to wait for assistance and allow them to spend more time with each resident. The home must ensure that the staffing levels meet the assessed needs of the residents. Food We checked the stock levels of food, recent invoices for food purchased,looked at the portion sizes when lunch was served and talked to the cook about the ordering of food. There was evidence that the stock of food and portion sizes were appropriate. We also looked at the record of what residents had to eat over the last month. It was clear to see if the residents didnt like one of the main options they could request something different. The acting manager stated that the activities coordinator has spent two days discussing food preferences with each resident so that a new menu could be devised. Care Plans We looked at the care plans for three residents. The majority of the care plans had been reviewed monthly. However where the review had identified a change the care plan was not updated with this information. The care plans must clearly state the current information that the staff need to know so that the staff do not have to read through all of the reviews to ensure they are up to date. The care plans showed where concerns had been highlighted about a residents health e.g. problems with swallowing or weight loss, but the relevant specialist had not been involved. Although residents are weighed regularly the weights are not always monitored or the necessary action taken. Medication Staff had been provided with medication handling training. This training covered legal and policy aspects, safe handling, hygiene, ordering , administration, recording , disposal and practice dilemmas. This was confirmed by checking one persons training file. The acting manager confirmed they had recently changed the supplying Pharmacy to ensure medication is delivered to the home more easily out of hours. Medicines are available on a on going basis. Medication is administered safely and according to the prescribers instructions. Issues were seen when a prescribers instructions had changed in the middle of a medication cycle. Not all medication changes had been clearly documented in a persons care plan. This could increase the risk of medication not given as intended. Care Homes for Older People Page 4 of 10 A person had been repeatly refusing to take their prescribed medication. There was lack of recorded interventions seen to assist in understanding how the home was managing this issue. The acting manager did explain about how some medication had been changed to liquid to aid compliance. It was not always clear if people who had been prescribed steroid creams/ointment or other external preparations that these had been applied. Creams had been supplied into the home and been used but the administration sheets had not been signed. What the care home does well: What they could do better: The care plans must be up to date with the current information clearly available. This will ensure that the staff have the information they require to meet the residents needs. When health issues are identified such as loss of weight or a problem with eating then the resident must be referred to the relevant health professionals. This will ensure that the residents receive appropriate health care and support. The care plans for people must reflect all their health care needs that also relate to medication and need to be updated regularly ie changes in medication used for behaviour/ mood control. The home must ensure that changes in dosage regimes are supported by a GP prescription as soon as possible. Verbal or faxed changes can be followed up but then they do require a signed prescription within 72 hours. This procedure should be covered in the medication policy. The home must ensure that all prescribed creams and ointments are applied as prescribed and that this is recorded. Any changes in a person skin integrity should be recorded and cross referenced to this persons care plan. Care Homes for Older People Page 5 of 10 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 6 of 10 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 7 of 10 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 7 15 Care plans must be kept up to date with the changing needs of the residents. This will ensure that the care staff have the information they require to meet the residents needs. 15/04/2010 2 8 13 Where appropriate residents 15/04/2010 must be referred to the relevant health care professional. This will ensure that the residents receive any health care that they need. 3 9 13 Any changes made to a persons dosage regeime must be confirmed with a signed prescription as soon as possible. This is to safeguard the health and welfare of people living in the home. 15/04/2010 4 9 13 All precribed creams and 15/04/2010 ointments need to be applied as instructed by the GP and Page 8 of 10 Care Homes for Older People 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 recorded. This is to safeguard the health and welfare of people living at the home. 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 9 A Controlled drugs cupboard that conforms to the Misuse use of Drugs act (safe custody ) 1973 could be used to store all controlled drugs. The fridge maximum and minimum temperature readings could be carried out daily and recorded. Medication profiles could be added to everyones care plan to ensure medicines are given out correctly. Medication audits could be carried out by the management of the home to ensure the prescribers instructions are being followed for all medicines. 2 3 4 9 9 9 Care Homes for Older People Page 9 of 10 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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