Care Home: Hassingham House Care Centre

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What the care home does well The service provides a range of excellent activities for residents to participate in. The service is keen to ensure that it complies with the requirements made by us. The service continues to have a core of trained nurses who are committed to caring for the people they look after. The service offers a variety of good nutritional food. The residents made positive comments about the food and how the care had improved. A resident told us "the care is much better and I am now getting up every day and I have a bath every day". Another resident said "I am happy with the care the girlsare lovely". One other resident remarked to us "there is always something going on, even at weekends". What has improved since the last inspection? Many areas have been improved internally to include better provision of accommodation for the residents in the communal areas; some changes have also been made such as re citing of office accommodation and the clinical room to make a better working environment for the staff. The assessment process used to assess prospective residents has greatly improved and no one is admitted to the home that does not comply with its registration. The system for handling and administration of medicines has improved, as has the overall management of the home. Staff made comments such as "things are on the up and we have better management", "there is a better atmosphere now", "everyone knows where they stand and things get done and you can talk to the manager". A relative told us "I can talk to the manager and we see her around the home a lot". There have been improvements in the care planning for each resident, however more improvements need to take place to ensure that all assessed needs are met and every resident`s care is evaluated on a regular basis and changed when needs have changed. Good records are kept now of all incidents that happen in the home and we are kept informed of these. Complaints are now handled appropriately. Training has improved and all new staff are given an induction. What the care home could do better: Ensure that the system for monitoring the quality of the service is extended. Ensure that all the staff are supervised at least every six weeks. Make sure that areas of the home where there are unpleasant odours are dealt with. Ensure that all care plans are kept up to date and reviewed on a regular basis as needs change. CARE HOMES FOR OLDER PEOPLE Forest Healthcare Hingham Norfolk Hardingham Street Hingham Norfolk NR9 4JB Lead Inspector Mrs Marilyn Fellingham Unannounced Inspection 4th February 2009 10:00 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 Forest Healthcare Hingham Norfolk DS0000066011.V374013.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Forest Healthcare Hingham Norfolk DS0000066011.V374013.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Forest Healthcare Hingham Norfolk Address Hardingham Street Hingham Norfolk NR9 4JB 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) 01953 851890 01953 852458 hassinghamhouse@btconnect.com Hassingham Limited Jacquelyn Foran Care Home 46 Category(ies) of Old age, not falling within any other category registration, with number (46), Physical disability (46) of places Forest Healthcare Hingham Norfolk DS0000066011.V374013.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users should be aged 30 years and over. Date of last inspection 14th August 2008 Brief Description of the Service: Hassingham House is a purpose built home circa 1997, situated in the small Norfolk town of Hingham. It is approximately 15 miles west of Norwich. The local amenities consist of a post office, a public house, a convenience store, hairdresser and facilities for bed and breakfast. Hassingham House is registered to provide nursing care to 46 elderly service users or those with a physical disability under the age of 65 years. All the accommodation is on the ground floor and it comprises of a large reception area, two spacious day rooms, two dining rooms and a quiet room. The grounds have laid out gardens that can be accessed by the Service Users. All rooms have a door to access the grounds and some Service Users have personalised these areas with bird tables and garden chairs. Each room has a hospital designed bed to ensure safe handling of the Service Users. Chiropody and hairdressing services visit the Home on a regular basis. The fees are currently between £660 and £3,500 per week. Forest Healthcare Hingham Norfolk DS0000066011.V374013.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. the service experience good outcomes. This means that people who use This was an unannounced inspection that took place over nine and a quarter hours. The focus of the inspection was to assess all the key standards follow up requirements made during the previous visit in August 2008. Care services are judged against outcome groups that assess how well a service delivers outcomes for people using the service. The key inspection for this service has been carried out using information from previous inspections, information from some residents, relatives and visitors to the home and people who work in the home. The main method of inspection used was ‘case tracking’. This involved selecting five individual care plans and information available about people who live in the home and tracking the experience of people and speaking to them about the outcomes they experience as a result of the support provided. During our visit a tour of the premises was undertaken and resident’s records and staff files were looked at. What the service does well: The service provides a range of excellent activities for residents to participate in. The service is keen to ensure that it complies with the requirements made by us. The service continues to have a core of trained nurses who are committed to caring for the people they look after. The service offers a variety of good nutritional food. The residents made positive comments about the food and how the care had improved. A resident told us “the care is much better and I am now getting up every day and I have a bath every day”. Another resident said “I am happy with the care the girls Forest Healthcare Hingham Norfolk DS0000066011.V374013.R01.S.doc Version 5.2 Page 6 are lovely”. One other resident remarked to us “there is always something going on, even at weekends”. What has improved since the last inspection? What they could do better: Forest Healthcare Hingham Norfolk DS0000066011.V374013.R01.S.doc Version 5.2 Page 7 Ensure that the system for monitoring the quality of the service is extended. Ensure that all the staff are supervised at least every six weeks. Make sure that areas of the home where there are unpleasant odours are dealt with. Ensure that all care plans are kept up to date and reviewed on a regular basis as needs change. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Forest Healthcare Hingham Norfolk DS0000066011.V374013.R01.S.doc Version 5.2 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 Forest Healthcare Hingham Norfolk DS0000066011.V374013.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personalised needs assessment means that people’s needs are identified and planned for before they move into the home. EVIDENCE: The service has only admitted one new resident since the last inspection. We looked at the records for this resident; we noted that a full assessment of needs had been carried out. The assessment was very detailed and contained relevant information about the resident and what care needs there were if admitted. The service after having completed the assessment sent a letter to confirm that these needs could be met; we saw a copy of this letter. Prospective residents are given the opportunity to visit the home prior to admission. Forest Healthcare Hingham Norfolk DS0000066011.V374013.R01.S.doc Version 5.2 Page 10 Forest Healthcare Hingham Norfolk DS0000066011.V374013.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The practice regarding the delivery of care means that the residents can be confident that their care needs will be met. EVIDENCE: We spoke with five residents who were living in the home and three visitors/relatives. They all commented about the improvements that had taken place since our last visit. One resident remarked, “the girls are very good and we are treated with dignity”, we also observed this to be so. One visitor said, “overall the care has improved but still could be better”. One resident told us “things overall have improved, very good carers, just a couple of bad apples”. A relative said that their relative’s care was discussed with the manager on a regular basis. Forest Healthcare Hingham Norfolk DS0000066011.V374013.R01.S.doc Version 5.2 Page 12 One relative felt that sometimes the care was not consistent although they stated that overall there has been improvements. We looked at the care plans for these five residents; four of these plans of care were very detailed and covered all areas of assessed needs. Each of these four care plans had records for manual handling, risk assessments for skin integrity and assessment documentation for nutritional status. We also noted that these residents’ weights were monitored regularly. These care plans had evidence of regular review and we noted care had been changed according to changing needs. The fifth care plan we looked at had four areas of care that had not been reviewed since September or updated when needs had changed. The daily notes for this resident had had no entries since the 25th January 2009; however the other resident’s files we looked at had good and detailed daily notes. The acting manager was aware that there was a problem with a nurse who was responsible for auditing this person’s care plan and was addressing this concern. We noted that one resident’s wheelchair had a broken footrest; we spoke with two physiotherapists who visit the home twice a week about this. They were aware of this had had been trying to find an other alternative for this resident and explained how the carers had been shown how to manually handle this gentleman. This was also confirmed by the trained nurses on duty and the carers that we spoke with. One trained nurse told us “the physiotherapists have made a vast difference in the home and spend quite a lot of time with the carers to ensure that all residents are being handled in an appropriate way that meets their needs”. There were care plans in place for the administration of p.r.n. (as required) medication and these were closely monitored so that continued use could be rationalised. We noted that spot audits are now carried out of all medicines in use and that the receipt, handling and administration of medicines is managed more effectively. This has been enabled using the expertise of the pharmacist who supplies the home with all medicines. We saw records for auditing the medicines along with the policies and procedures for the administration and handling of medicines. The staff we spoke with had an overall understanding of the care planning process and knew how to use the care plans to give the prescribed care. We were able to speak with a visiting professional to the home who felt that there had been significant changes in the home for the better and that the home was being managed in a more appropriate way. Forest Healthcare Hingham Norfolk DS0000066011.V374013.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The residents have many opportunities to participate in stimulating and motivating activities. Meals and mealtimes are managed well. EVIDENCE: We were able to discuss with a number of residents, staff and visitors to the home about activities within the home; we were also able to observe some social interactions and activities taking place. On the day of our visit four residents were joining in a beetle drive, there was a lot of laughter and all the residents in the lounge appeared very relaxed and happy. We spoke with the lifestyle manager who told us all about the arrangements for activities. A questionnaire has been given to all the residents to ascertain what they enjoy doing, they have also organised more one to one activities as a result of the surveys. A young man has been engaged who now takes the younger male residents out for socialising and activities. There were excellent records in place to substantiate those activities that have taken place and also a Forest Healthcare Hingham Norfolk DS0000066011.V374013.R01.S.doc Version 5.2 Page 14 programme for further events. Those events that have taken place include, quiz nights, social evenings with relatives, movie afternoons, nostalgic games for those older residents such as beetle drives; the list is exhaustive and impressive. The lifestyle manager told us that about twenty residents join in activities every week and we saw daily notes for this. We noted from these notes that there is always provision of some sort of activity in the mornings and afternoons. One resident told us “I have the opportunity to do something every day if I wish”, another said “the activities have really improved and I get out more now”. We noted that mealtimes are better managed and there are now two sittings, this is to allow those that need assistance can be given more attention and time to eat their meals in a dignified manner. Those that were requiring help were given it in an empathetic way and the whole session seemed to be relaxed. One resident told us she did not like the food very much, but was happy with what she was offered and that she was always given choices. We looked at a sample of menus, these were varied and nutritional; one resident does not eat vegetables and we noted that this was always accommodated for. There are always choices for all residents and three residents we spoke with confirmed this. The dining room is very pleasant, each table had flowers and fruit and the tables were arranged to accommodate those residents in wheelchairs. Forest Healthcare Hingham Norfolk DS0000066011.V374013.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents feel safe and listened to and are protected from abuse. EVIDENCE: A complaints procedure is in place and is made available to all residents and other significant people. We spoke with some residents and relatives who told us they knew how to air their concerns and who to go to. One relative told us “I can now talk to the new manager and she is always around”; a resident said “I can talk to the manager if I want to and things are always sorted now”. We noted that the service has now started keeping records for all concerns and complaints and keeps us up to date of any complaints that they receive. A relative told us that they feel quite happy to approach the manager with any concerns. Most of the staff now have had training in relation to safeguarding adults, those staff we spoke with confirmed this and we also saw records to substantiate this. The staff we spoke with were also very aware of the whistle blowing procedure and had a good basic understanding of all issues relating to abuse. Forest Healthcare Hingham Norfolk DS0000066011.V374013.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The refurbishment of a number of areas and the provision of new facilities means that the residents live in a safe and comfortable environment. EVIDENCE: A tour of the premises took place and it was evident that the necessary refurbishment of the home had started. The reception area has been improved to allow more easy access for wheelchair users; coffee tables have been placed in all sitting areas, the dining room has been enhanced and the tables made more attractive. The sister’s station has been re located as has the medicine room. The younger client group have been given an area that is apart from the other residents with a wide screen television and a pool table; we noted this being used as we walked round the home. We spoke with one Forest Healthcare Hingham Norfolk DS0000066011.V374013.R01.S.doc Version 5.2 Page 17 of the residents in this area who said “I like being here and this lounge is nice for us to use and I can help myself to snacks as well”. We did notice one area by a resident’s room that smelt strongly of urine, the manager told us that they were aware of this and taking steps to eliminate the problem. Forest Healthcare Hingham Norfolk DS0000066011.V374013.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents are supported by a caring cohesive staff team. The residents are protected by the home’s recruitment practices. At certain times more staff could be deployed. EVIDENCE: The duty rosters were examined and showed that although the home was adequately staffed there were periods when there could have been more staff on duty in relation the assessed needs of the residents. This was particularly in evidence when care was being provided for those who had been allocated specific one to one care. The service has started to ensure that staff are given the opportunity to attend training sessions and we noted that this had already been instigated and some mandatory training sessions for everyone had already taken place. The manager told us that the training sessions would be increased as soon as everyone had completed the mandatory training. We noted whilst we were visiting that two physiotherapists were giving sessions with regard to manual handling and with specific relation to certain residents. Two members of staff we spoke with commented that the physiotherapists were “great” and have already taught them such a lot. Forest Healthcare Hingham Norfolk DS0000066011.V374013.R01.S.doc Version 5.2 Page 19 Four carers have NVQ 4, 3 carers have NVQ 3 and the rest of the carers are doing NVQ 2 training or NVQ 3. One member of staff is doing NVQ 3 in customer service. The service is gradually introducing other training that is related to certain conditions that are associated with the residents in the home. The home’s administrator is doing NVQ 3 in business administration. All new staff are given an induction and we saw records for this; one new member of staff informed us that they had an induction and had worked with a senior carer for two weeks at the beginning of their employment. Two members of staff we spoke with said “the training is excellent now” and “we are doing such a lot”. We looked at the recruitment records for new staff and found there to be robust system in place with all appropriate checks being carried out before employment. Forest Healthcare Hingham Norfolk DS0000066011.V374013.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management arrangements are meeting the needs of the residents and their health and safety is being protected. EVIDENCE: We spoke with six relatives who all said that it was nice to see the manager around the home and that they knew that they could speak with her any time and that she would listen; this was also expressed by the residents we spoke with. Whilst we were visiting we noted the manager engaging with both residents and visitors. One relative told us that they felt that “there had been great improvements in the home” and that all their concerns had been listened Forest Healthcare Hingham Norfolk DS0000066011.V374013.R01.S.doc Version 5.2 Page 21 to and dealt with. The staff members that we spoke with said that the acting manager was easy to approach and one trained nurse said “issues are sorted quickly, things are on the up and we have better management now”. We noted all records we needed to see were readily available and in good order. Formal supervision has commenced and records were seen for this. The manager is aware that the monitoring of quality needs to be extended and is hoping to do this very shortly. We looked at health and safety related information this showed that there are servicing arrangements for all equipment these included the hoists. Fire safety records were in place and we saw records for fire training. The service has on numerous occasions since the last key inspection held meeting with the residents, staff and relatives, we saw minutes of these meetings and were able to assess that all concerns had been addressed. We also noted that the staff, residents and relatives were continually updated as to the status of the home. Forest Healthcare Hingham Norfolk DS0000066011.V374013.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 3 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 x 3 x 3 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 3 3 Forest Healthcare Hingham Norfolk DS0000066011.V374013.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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. Standard OP7 Regulation 15.1 Requirement All people using the service must have their care plans updated on a regular basis, this will ensure all their care needs will be met. Timescale for action 24/04/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP19 Good Practice Recommendations All parts of the home must be kept free from unpleasant odours. Forest Healthcare Hingham Norfolk DS0000066011.V374013.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Forest Healthcare Hingham Norfolk DS0000066011.V374013.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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