Care Home: Hartsholme House

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What the care home does well The home provides a pleasant, homely and clean environment for people who live there. Residents and visitors spoke highly about the care provided and praised staff for the way they delivered care. Visitors said that they are made very welcome when they visit. Their comments included, `they are so accommodating we can`t praise them enough`, `it`s very good, nothing is too much trouble for them` and `they are respectful and polite and answer bells quickly`. The activities organiser provides a varied programme of stimulation that people said they enjoyed. They told us, `the activities lady works really hard to keep residents occupied` and `I like to do activities in the mornings and spend the afternoon in my room reading`. Leadership in the home is good and quality assurance systems are in place to ensure the home is run for the benefit of the people who live at the home. This includes a robust complaints procedure and quality assurance system. The training programme offers staff a variety of courses and most staff have completed an N.V.Q (National Vocational Qualification) in care. The home has detailed policies and procedures to inform residents and instruct and guide staff. What has improved since the last inspection? The home has amended the terms and conditions of residency to include all the necessary information such as fee rates. Improvements have been made to the courtyard areas with new furniture and planting. The home has purchased a large flat screen television for one of the lounges. This has a loop system so that people with hearing difficulties can enjoy watching the programmes. What the care home could do better: Care plans could be improved further by including the action staff need to take to show that the mental capacity of people has been considered. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hartsholme House Ashby Avenue Hartsholme Lincoln Lincs LN6 0ED     The quality rating for this care home is:   three star excellent service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elisabeth Pinder     Date: 1 0 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Hartsholme House Ashby Avenue Hartsholme Lincoln Lincs LN6 0ED 01522683583 01522694287 manager.hartsholme@osjctlincs.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Jacqueline Luke Type of registration: Number of places registered: The Orders Of St John Care Trust care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The home is registered to provide personal care for service users of both sexes whose primary needs fall within the following category:- Old age, not falling within any other category (OP) - 37 and Dementia - over 65 years of age (DE(E) - 7 The maximum number of service users to be accommodated is 44. Date of last inspection Brief description of the care home Hartsholme House cares for older people needing personal care with seven places specifically registered to care for people with dementia. The home is a detached property surrounded by gardens and is situated in a residential area to the south of the historic city of Lincoln. Car parking is available at the front of the building and local facilities include shops, library, post office and church. Transport is required to access the main city and is provided at no extra cost. The home has two floors and there is a Care Homes for Older People Page 4 of 25 Over 65 7 37 0 0 Brief description of the care home passenger lift to the bedrooms on the first floor. There are a variety of aids and adaptations around the building to allow residents to move around the home more independently. All of the bedrooms are single but none have ensuite facilities. The home is one of 16 operated by the Orders of St John Care Trust, which is a Registered Charity. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means that people who use this service experience excellent quality outcomes. This was an unannounced visit and it formed part of a key inspection, focusing on key standards, which have the potential to affect the health, safety and welfare of people who use the service. Throughout this report the terms we and us refer to The Commission for Social Care Inspection (CSCI). The visit lasted just over five hours and we took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since the last inspection. Before we made our visit the manager had returned the Annual Quality Assurance Care Homes for Older People Page 6 of 25 Assessment (AQAA). This gave us information about their own assessment of how well they are meeting standards and their plans to improve aspects of the service. We sent out surveys to people before we visited the service and these are mentioned throughout the report. The main method used to carry out the inspection is called case tracking, this includes following the care of a sample of four people through their records and assessing their care. We spoke to people who use the service and saw rooms of those people who said we could and to two staff members. The registered manager was on annual leave and the Head of Care assisted with our inspection and the general outcomes of the visit were discussed with her. What the care home does well: What has improved since the last inspection? 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 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People coming into this service have access to a range of information to help them make a decision about moving into the home and procedures are in place to ensure people are only admitted after a full needs assessment has been carried out. Evidence: Information sent to us prior to the inspection told us that people have access to a range of information about the service and this was confirmed during the visit. The Statement of Purpose and Resident Guide have recently been updated and include information to tell people how they can access our reports and lists the current fee rates. They also tell people how differing needs, such as religion and culture will be met and how the service considers the Mental Capacity Act. Both documents can be produced in different formats if needed and the Residents Guide is written in an easy read format. Residents living in the home also receive a copy of the Trust magazine. Care Homes for Older People Page 10 of 25 Evidence: Care records examined showed that a full needs assessment had been carried out prior to admission. Prospective residents are written to by the manager after their assessment confirming that they can or cannot meet their needs. Three residents surveys returned to us confirmed that they had received enough information about the home before moving in and all had been given a contract of residency. People spoken to told us they were very happy living here and its great here. The service does not cater for people with intermediate care needs. However, there is a day centre within the building where up to seven people do come to the home for day care Monday to Friday. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are well written identifying needs of residents and the action staff need to take to meet these needs. There are satisfactory policies and procedures in place about the administration of medication and the privacy and dignity of residents is respected. Evidence: Four peoples records were checked and these gave clear information to enable staff to know about their individual needs and how to meet them. Since the last inspection care plans have been revised and are now person centred. Care plans have been written as if the resident had completed them themselves and were easy to follow. However, these must show that the person has written their plan. They included medical profiles, life histories including hobbies and interests, detailed risk assessments, personal preferences and appointments with healthcare professionals. Various assessments have been completed on subjects such as, manual handling, pressure risk and nutrition. Monthly care plan evaluations have taken place to ensure needs are being met and daily notes are written and these show that people receive Care Homes for Older People Page 12 of 25 Evidence: the correct level of care and support. Although care plans clearly record if a person is not always able to make decisions they do not always state the action staff must take to ensure consideration to the Mental Capacity Act has been given and a discussion was held with the head of care who agreed to address this. Information taken from the AQAA told us that policies and procedures concerning the receipt, storage, administration and disposal of medications were available. We looked at medication records of the people whose care was being followed and observed medications being administered at lunchtime, these showed that the people were receiving their medications correctly. People were happy with the level of support given and told us they felt their needs were being met. Staff spoken to had a good knowledge of the needs of people who use the service and how to meet them and were observed to be responsive to residents needs, respectful and kind. There is a key worker system giving staff some responsibilities for specific people who use the service and information was available about advocacy services should people who use the service need it. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to take part in various recreational activities and maintain contact with family and friends as they wish. Meals provided are well balanced and take into account personal preferences and special dietary requirements. Evidence: Information sent to us prior to the visit indicated that a range of activities are provided to meet individual needs and an activities co-ordinator is employed who keeps a diary of events and activities held. This was confirmed in the surveys received, during the visit and from comments and observation held on the day. We observed people taking part in movement to music and a religious service to mark remembrance day. People living in Bluebell which accommodates people with dementia were observed doing art and crafts and looking at reminisence books on Lincoln. Photographs and paintings were displayed and records available showed a wide range of activities is offered both within the home and local community, for example, the home have their own bowling and curling team and residents living in Bluebell had recently visited a nearby country park. The activity co-ordinator told us she had recently attended a training course specifically tailored for people with dementia and plans to implement some of the ideas learnt from this, including a garden allotment. Care Homes for Older People Page 14 of 25 Evidence: People said they were able to keep in touch with family and friends and have visitors whenever they choose and this was evident throughout our visit. Since the last inspection dining arrangements have changed and flexi dining has been introduced. This gives people the option of having meals at different times, for example people can come for lunch anytime between 12:30 and 14:30. The dining area was calm and relaxed and people chattered casually as they ate. They said that the menus were varied with several choices. Specialist diets, such as a diabetic diet were also available. The meal on the day looked appetising, tables were nicely laid with placemats/napkins and condiments. We spoke to approximately 10 people in the dining room who told us they were happy with the food provided and the new arrangements. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the homes procedures for handling complaints and allegations of abuse and they are confident that their complaints or concerns will be taken seriously. Evidence: Information taken from the AQAA tells us that people are given the complaints procedure on admission and it was on display on one of the corridors. However, it does not include the correct contact details for us and the head of care agreed to ensure this was changed. People told us they feel able to raise issues with their key worker, care leader, head of care or manager. They said they had more confidence in the older staff but were confident their concerns would be taken seriously. Surveys received prior to the visit all indicated residents know how to make a complaint and who to speak to if they were unhappy. Staff told us they know what to do should a complaint be made and have undertaken training in relation to safeguarding adults. Four staff surveys were returned to us and these also indicated they would follow correct procedures. No complaints or safeguarding referrals have been received since the previous inspection. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well-maintained, clean, comfortable and homely environment, which offers a good standard of decor and furnishings. Signs and pictures help people find their way around the home and bedrooms are well personalised. Evidence: We took a partial tour of the home which included looking at the bedrooms of the residents whose care was being followed and some communal areas. Bedrooms had been personalised by the residents or their families with photographs, mementos and small items of furniture. There were no unpleasant odours detected in the home. Three surveys completed by residents told us that the home is always fresh and clean. Since the last inspection windows on the first floor have been secured to prevent them from opening too wide and additional safety measures have been taken to enable people to walk around the gardens independently. Information provided in the AQAA told us there continues to be a rolling programme of redecoration and during the visit we saw some bedrooms being redecorated. The lounge in Bluebell has been redecorated and refurbished and we were told that the main dining room is due to be redecorated before Christmas, with new tables being ordered. At the side of each bedroom door in the Bluebell unit a memory box has been secured on the wall and these contain a memorable picture of the individual person. Care Homes for Older People Page 17 of 25 Evidence: Various pieces of equipment were in use during the visit including hoists, specialist mattresses, raised toilet seats and grab rails. The service has received a 4 star award for food safety from the Environmental Health Officer. Staff told us protective aprons and gloves are always available to use when needed. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff numbers are in sufficient quantity for them to be able to care for people living in this home. The service recognises the importance of training to ensure staff are knowledgeable and equipped to meet the needs of people living here. Evidence: On the day of the visit 43 people were living at the home, 1 of whom was in hospital. Duty rotas showed that there are normally four care staff on duty rising to five during the busy times. In addition to this there is a care leader on duty, a head of care, a registered manager and an administrator. Two wakeful night care staff and one night support are on duty each night. People told us that staff were always available and were very kind and caring and surveys received from staff prior to the visit confirmed that a robust recruitment system is in place. The records of two staff recently employed were checked and these showed that staff were being recruited safely with essential checks such as written references and C.R.B. (Criminal Records Bureau) checks being undertaken. All staff are given copies of the General Social Care Council Codes of Practice, which sets out responsibilities as care workers looking after vulnerable adults. Information received told us that over 50 of staff have achieved a nationally Care Homes for Older People Page 19 of 25 Evidence: recognised vocational award in care and the service is now using E-Learning induction training and this was confirmed during the visit. One member of staff spoken to confirmed they had received training including induction, moving and handling, health and safety, equality and diversity and fire. Awareness of the Mental Capacity Act training had been provided using a computer and staff spoken with had a basic knowledge of the Act. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home is well managed and the staff are supported and supervised in carrying out their roles. The audit and policy systems ensure that peoples views are listened to and acted upon. Evidence: The registered manager is suitably qualified and experienced to run this home. Surveys received raised no concerns regarding the current management arrangements. Discussion and records showed that there are various systems in place to monitor the quality of the service being provided. This includes seeking the views of people through meetings and questionnaires. Information provided in the AQAA told us that there are a range of policies and procedures in place and these included health and safety, infection control and fire Care Homes for Older People Page 21 of 25 Evidence: safety. All policies were reviewed in May 2008. We were also told of equipment maintenance and service dates. Building risk assessments are in place and monthly health and safety audits are completed. There are satisfactory arrangements in place to ensure any valuables or monies held on behalf of people living in the home are kept safe and we looked at records held for the people whose care was being followed and these were all up to date and accurate. Generally records required by law to be kept about the operation of the service were up-to-date and well maintained. Staff told us they felt supported and valued by the manager and felt she is available for advice and is very approachable. Someone from the Company had visited the home at least once a month and completed a report on their findings as well as what people told them. This had enabled them to evaluate how the home was operating. The home has attained the ISO9000/2000, which is awarded by an independent company who audit the homes systems against expected standards. Care Homes for Older People Page 22 of 25 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, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 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, Care Homes 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 7 Care plans should clearly state the action staff must take to ensure they show that consideration to the Mental Capacity Act has been given. Care Homes for Older People Page 24 of 25 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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