Care Home: Hatchmoor Nursing Home Ltd

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What the care home does well The home was cleaned to a very high standard and there were no malodorous smells. People we spoke to spoke highly about the environment. One person told us that they were able to personalise their room and that they liked the fact that they could lock their bedroom door. The home provides a good range and choice of meals, that are served in small dinning areas on each wing of the home, so that there is no more than 8 people sharing the communal lounge/dinning area. People we saw appeared well groomed and clean. People we spoke to said that staff were available to assist them with their personal and nursing care needs and that this was done in a kind and respectful way. We did not find that people were at any risk and overall peoples needs were being well met by a staff group who understood their needs. What the care home could do better: Care plans and daily records are recorded electronically in this home. We saw that both nursing and care staff have access to these records, and we were assured that all staff have had comprehensive training to use and record on these electronic records. What was less clear is how people who live at the home have direct access to their care plans and records. We have asked that the home make it very clear in their written information such as service user guide, how care plans can be made available to people. We have asked that they also clearly record in their monthly reviews of individuals care plans, where and how the individual and/or their family has been consulted as part of that review. We saw that although the electronic system had separate sections for care plans in respect of pressure care and wound care, that trained staff had not always completed these. There was no rationale for why a particular dressing had been used, or reviewed.There were records within the daily notes on individuals that dressing had been dressed and attended to but improvement or deterioration is less easy to track within these daily notes. We have asked that the home ensure that all nursing staff fully complete pressure care and wound care plans and that they are reviewed on a regular basis so that they can refer onto specialist support if no improvement is being seen. We found that staff supervision is not well recorded, although staff said that they felt well supported. It is important to ensure that regular supervision is recorded to enable the home to demonstrate how they are monitoring competencies and meeting training needs of staff. We have also asked that staff have updated training in pressure care, as their was no record of when this last occurred. The home has people who have both residential and nursing needs. We have asked that the plan of care clearly show on the front page what type of need each individual has been admitted as. This is because for those people who are residential, any nursing needs should be referred to the community nurse team, and not be dealt with by the nursing staff at the home. Random inspection report Care homes for older people Name: Address: Hatchmoor Nursing Home Ltd Hatchmoor Common Lane Great Torrington Devon Devon EX38 7HP two star good service 10/12/2009 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: Joanne Walsh Date: 0 9 0 9 2 0 1 0 Information about the care home Name of care home: Address: Hatchmoor Nursing Home Ltd Hatchmoor Common Lane Great Torrington Devon Devon EX38 7HP 01805625721 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Margaret Myers Type of registration: Number of places registered: Conditions of registration: Category(ies) : Hatchmoor Nursing Home Ltd care home 48 Number of places (if applicable): Under 65 Over 65 16 16 32 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Conditions of registration: 0 0 0 The maximum number of service users who can be accommodated is 48 The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) - maximum of 32 places Dementia (code DE) maximum of 16 places Mental Disorder (code MD) - maximum of 16 Places Date of last inspection 1 0 1 2 2 0 0 9 Care Homes for Older People Page 2 of 10 Brief description of the care home Hatchmoor is a modern, detached two-storied purpose built building situated in Torrington in North Devon that is designed to have the least impact on the environment as possible. It is currently registered to provide care with nursing for up to 32 older people (the Commission is processing an application for the category of dementia to be added to the registration). In time, the provider plans to increase this to a total of 64. The home is owned by Hatchmoor Nursing Home LTD, which is a family business operated by Mr. John Singh (Director), and his son Mr. Solomon Singh (company Secretary). There is level access throughout the home with a passenger lift to the first floor. Hatchmoor has single bedrooms, all with en-suite facilities, double/shared rooms are available if requested. Each group of eight bedrooms has its own lounge/dining room (four on each floor) with quiet areas where people can eat, relax and spend time together. Communal spaces are open plan. Externally there is a garden area, with raised beds that are yet to be planted up. There are also plans to develop a sensory garden that will provide a safe area for people with dementia. The home has a car park and is surrounded by fields and countryside. The home is situated in an area which is served public transport with links to Bideford, Barnstaple and Okehampton. The fees range from £650 - £750 per week for a single room. Chiropody, hairdressing, personal toiletry items and newspapers/magazines are not included in the fees. The home also makes a charge of £10 if any people need a member of staff to escort them anywhere. Care Homes for Older People Page 3 of 10 What we found: This random inspection was completing following receipt of information that indicated that some individuals needs may not be well met. Whilst CQC do not investigate individual complaints, we do as a regulator need to ensure that people are not at risk. We also check that there are no breeches in regulations under the Care Standard Act 2000, which is in force until the 1st October 2010. After this date all registered health and social care will be monitored under the Health and Social Care Act 2008. This random inspection took place during a week day in September and lasted approximately 5 hours. During this time we spoke to the registered provider, the registered manager and two nurses. We also spoke to 5 individuals living in the home. Four of those were able to give an informed decision about what it was like living at Hatchmoor. We found that overall, people we spoke to expressed a high level of satisfaction about the care and support the receive. Comments included The staff are very good. you dont have to wait long for your call bell to be answered. This home is far nicer than the previous one I was at. Love the space, the view from my window and the fact that I can stay in the area where I have always lived and where my friends are. We looked at the plans of care for four individuals including two people who had pressure care needs. We saw that there was good information in the individuals daily notes about what care and support had been delivered. The specific plans of care relating to pressure care and wound care were not so detailed. They had not been fully completed so it was not always clear as to why a particular treatment/dressing had been introduced or how often this was being reviewed. More importantly this record should be used to chart the improvement or otherwise of the individuals wound or pressure area, and this was not being completed always on this record. We spoke with staff about people who had or were at risk of pressure damage and saw that there was in fact two individuals with pressure damage, one person with pressure areas due to wearing of artificial limbs and one person who has been assessed as extremely vulnerable but whose skin is intact at present. We found that although plans of care are reviewed monthly there is no record about how this information or review process is shared with the individual concerned or their family members. As records are electronic individuals do not normally have a printed copy of their plans of care. The registered provider said that this could be made available if people wished and we discussed how people could be given that information. We spoke to the registered manager about how she ensures that clinical and care practices are monitored and competencies checked. She said that she often works along said staff and monitors in this way, but admitted that formal supervision has not occurred as often as it should and that she had not recorded supervisions. She said that she would expect the nursing staff to keep their own learning updated as part of their registration with the Nursing and Midwifery Council, but that she did not always check what learning materials they accessed. They do ensure that professional journals are made available. We agreed that if possible they should get tissue viability specialist nurse in to provide staff with some up to date training on pressure care as this is continually changing. The Care Homes for Older People Page 4 of 10 registered manager has confirmed since this inspection that serveral of the nursing staff did attend tissue viabilty training around 6 months ago. We discussed the fact that there had been two recent deaths at the home and the registered provider had forgotten to send CQC notification of this. The registered manager has been on annual leave so this task got missed. The home are normally good at keeping us notified about incidents affecting the well being of the people who live at the home. We saw that not all plans of care had a mental capacity assessment, although in discussion with management and staff it is obvious that they are continually assessing this. We discussed an individual who asked to leave on a regular basis and we agreed that they should be referred to the deprivation of liberty team for advice, assessment and support. We also discussed individuals who did not lack capacity but who refused personal care. Where this is happening staff record why personal care has not been delivered and when it is offered at different times. What the care home does well: What they could do better: Care plans and daily records are recorded electronically in this home. We saw that both nursing and care staff have access to these records, and we were assured that all staff have had comprehensive training to use and record on these electronic records. What was less clear is how people who live at the home have direct access to their care plans and records. We have asked that the home make it very clear in their written information such as service user guide, how care plans can be made available to people. We have asked that they also clearly record in their monthly reviews of individuals care plans, where and how the individual and/or their family has been consulted as part of that review. We saw that although the electronic system had separate sections for care plans in respect of pressure care and wound care, that trained staff had not always completed these. There was no rationale for why a particular dressing had been used, or reviewed. Care Homes for Older People Page 5 of 10 There were records within the daily notes on individuals that dressing had been dressed and attended to but improvement or deterioration is less easy to track within these daily notes. We have asked that the home ensure that all nursing staff fully complete pressure care and wound care plans and that they are reviewed on a regular basis so that they can refer onto specialist support if no improvement is being seen. We found that staff supervision is not well recorded, although staff said that they felt well supported. It is important to ensure that regular supervision is recorded to enable the home to demonstrate how they are monitoring competencies and meeting training needs of staff. We have also asked that staff have updated training in pressure care, as their was no record of when this last occurred. The home has people who have both residential and nursing needs. We have asked that the plan of care clearly show on the front page what type of need each individual has been admitted as. This is because for those people who are residential, any nursing needs should be referred to the community nurse team, and not be dealt with by the nursing staff at the home. 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 Plans of care must include all 29/09/2010 information about how health care needs should be met, this includes a pressure care or wound care plan with regular reviews to ensure that treatment and care is consistent and reviewed to ensure improvement is occurring 2 36 18 The registered manager must ensure that all staff have training, support and supervision to do their job effectively to enable staff to do their job effectively and to ensure that staff competencies are monitored and reviewed so that good quality care is provided at all times 29/09/2010 Care Homes for Older People Page 8 of 10 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 People who use the service should have access to their plans of care and should be involved in their development and review where possible. 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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