Care Home: Hatt House

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What the care home does well Hatt House has a staff team that is well trained, experienced and committed to providing a quality service to the residents. The three consulted healthcare professionals that provide a service to the home were complimentary about the standard of the care provided. Residents were happy and relaxed and many examples were observed of sensitive care being delivered. One resident said, "I`m well looked after, thank you" and another remarked, "I couldn`t do better". Service users are treated with respect at all times and their privacy and dignity were clearly seen to be a priority for carers. Two visitors were consulted that were visiting their relatives in the home, as part of the inspection process, one described the service as, "Brilliant" and the other one stated "I`ve never known carers so caring". A wholesome diet is provided at the home with meals balanced and varied. Meals are taken in a dedicated dining room at tables that seat up to four persons. A complete tour of the building was undertaken at the time of the inspection and all rooms were seen. The home was well maintained with high standards of hygiene apparent, a comfortable appropriate environment was provided for residents. What has improved since the last inspection? No requirements were raised in the last report, two recommendations were made and both these have been adopted by the home. One called for clearer instructions to be made on `as required` medication and the other one recommended that the supervisor of staff that were awaiting checks was named. The home has a detailed maintenance and redecoration programme in place and this continues. What the care home could do better: No requirements or recommendations are raised in this report. CARE HOMES FOR OLDER PEOPLE Hatt House 14 Park Road St Marychurch Torquay Devon TQ1 4QR Lead Inspector James Rose Unannounced Inspection 7th January 2008 09:00 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 Hatt House DS0000018367.V357197.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. Hatt House DS0000018367.V357197.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hatt House Address 14 Park Road St Marychurch Torquay Devon TQ1 4QR 01803 326316 01803 326316 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) Mr Michael John Oaten Mrs Patricia Anne Oaten Mrs Patricia Anne Oaten Care Home 24 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (24), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (24), Old age, not falling within any other category (24) Hatt House DS0000018367.V357197.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users with the category (DE) aged between 50-65 Date of last inspection 24th January 2007 Brief Description of the Service: Hatt House is a detached property in large grounds in a quiet residential area of Torquay. The home has easy access to the local facilities of St. Marychurch and nearby park. There are three double and seventeen single rooms with a lift available to the upper floor. The garden area is level and has good access for those with poor mobility. There is an enclosed courtyard for anyone who is unable to use the main garden area. The home provides care predominantly for older people with dementia. Aids and equipment include a mobile hoist and bath aids. The communal areas of the home consist of a sitting and dining room. There is a coach house attached by a covered corridor which provides accommodation for more independent service users and which also contains a small sitting room. This is used as a quiet area and a private room for meeting visitors. The home has its own minibus that is used to take service users to local activities. There is a daily programme of activities in the home provided by staff and visiting entertainers. The weekly cost of care at this home is; lowest £325.00 and the highest is £372.00. Hatt House DS0000018367.V357197.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 stars. This means the people who use this service experience good quality outcomes. This unannounced inspection was undertaken over 7 hours on one day in January 2008. Samples of the care records and the administration records of the home were examined. Five residents were consulted about the service provided and two visitors were also asked for their views. Three of the care team were interviewed individually and three healthcare professionals were also consulted. A complete tour of the home and grounds was undertaken and all rooms were seen. The inspection was undertaken with the full assistance of the registered proprietors, one of whom is also the registered manager. What the service does well: What has improved since the last inspection? No requirements were raised in the last report, two recommendations were made and both these have been adopted by the home. One called for clearer instructions to be made on ‘as required’ medication and the other one Hatt House DS0000018367.V357197.R01.S.doc Version 5.2 Page 6 recommended that the supervisor of staff that were awaiting checks was named. The home has a detailed maintenance and redecoration programme in place and this continues. What they could do better: 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. Hatt House DS0000018367.V357197.R01.S.doc Version 5.2 Page 7 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 Hatt House DS0000018367.V357197.R01.S.doc Version 5.2 Page 8 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): 3 and 6. Quality in this outcome area is good. Suitably detailed needs assessments are undertaken on all residents prior to them being admitted to ensure the home can provide an appropriate service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A sample of five assessments were examined at this inspection these covered needs in the areas of health, personal and social. Health and personal needs were well covered, social needs were undertaken and these were discussed at length with the registered manager. It was agreed that this area would be developed further to inform a detailed social element of the care provided. All the residents and the visitors consulted felt that all needs were met by the service provided by the home. Standard 6 refers to a service not provided at Hatt House. Hatt House DS0000018367.V357197.R01.S.doc Version 5.2 Page 9 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): 7, 8, 9 and 10. Quality in this outcome area is good. An individualised plan of care provided is available for each resident. Peoples’ health needs are fully met. The administration of medication undertaken in the home ensures residents are appropriately protected. Residents were treated with respect and their privacy was maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A sample of five care plans were examined at this inspection, these were found to be detailed and developed from the assessments undertaken by the home. Health and personal needs were well covered by the service provided. The social element of the care plan was discussed with the registered manager and it was agreed that this area would be developed further to ensure that a client centred approach was undertaken. A detailed personalised service is provided by the home but at present some of the elements are unrecorded. Consultation was undertaken with three healthcare professionals, a district nurse and two doctors, one from each surgery that provides a service to the home. No concerns were expressed about the service provided and one of the GP’s was particularly complimentary. Hatt House DS0000018367.V357197.R01.S.doc Version 5.2 Page 10 Residents who wish to self medicate are able to do so subject to a risk assessment approach to ensure they have the capacity and are safe. The recordings maintained by the home of the administration of medication were examined in detail and these were found to be clear, complete and up to date. Medication was checked and booked in when received and complete issue records were in place. Unused medication was recorded and returned to the pharmacist. The home has a system in place for the administration of medication subject to the controlled process and appropriate storage and recording was provided at the time of the inspection. No medication that required low temperature storage was currently administered by the home but it was understood that refrigerated storage would be made available if required. All medication in the home is kept safely, in appropriate secure storage. All the residents consulted felt that they were always treated with respect and that their privacy was given priority by their carers and maintained. From observations made during the inspection it was clear that residents were respected, carers knocked on doors before entering a person’s room and time was taken when delivering care. Personal care was only undertaken in conditions that ensured privacy. Hatt House DS0000018367.V357197.R01.S.doc Version 5.2 Page 11 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): 12, 13, 14 and 15. Quality in this outcome area is good. Residents at the home have their expectations and preferences and social needs met by the service provided. The home has a suitable unrestricted visiting policy and procedure. Residents exercise choice and control over their lives and a balanced appealing diet is provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents consulted stated that they felt happy at the home and the service provided matched their expectations. Currently the home has a programme of activities provided and these are displayed on a board in the hall of the home, some of the activities undertaken are taken from the guidance provided by the Alzheimer’s disease society. Residents are then able to take part in what is offered or not. This approach was discussed and it has been agreed with the registered manager that the social elements of residents care plans are going to be developed further to enable a more “client centred” approach to be undertaken. Hatt House DS0000018367.V357197.R01.S.doc Version 5.2 Page 12 The home has arrangements in place to enable resident to have religious observance. Some residents go to local churches and others attend services held in the home held by visiting clergy. The home has an unrestricted visiting policy and procedure and the visitors consulted during the inspection advised that they were always made welcome when they arrived. Visitors are able to partake of a meal with their relative in private in the home and no additional charge is made. Residents are encouraged by the care team to exercise their own choices about matters that affect them. This was observed during the inspection when a resident was deciding what they would like to eat time and care was taken by the carer involved. Clear records are maintained about how the home encourages residents to remain as independent as possible. The residents’ consulted during the inspection advised that they liked the meals provided at the home. One resident said “There is a choice and I like the food I get” another remarked, “This is as good as I could do”. Meals are usually taken in the home’s dedicated dining room at small tables that seat up to four persons or they can be served in residents’ own rooms if preferred. Meals can also be taken in private with visitors in the homes small lounge in the extension to the main building. Hatt House DS0000018367.V357197.R01.S.doc Version 5.2 Page 13 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): 16 and 18. Quality in this outcome area is good. Residents were confident that if they raised as issue with the home it would be dealt with quickly and resolved to their satisfaction. Carers are trained and experienced and ensure residents are appropriately protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When asked about complaints residents were confident that if they raised a matter with the home this would be dealt with quickly and resolved for them to their satisfaction. The home’s complaints procedure is readily available in the home for residents or their visitors. The home has available a complete policy and procedure for the appropriate protection of residents that meets the current legislation. Three carers were interviewed individually during the inspection and they all were able to demonstrate that they were aware of the homes policy and procedure and the different types of abuse known. They also advised the correct action to be undertaken if they discovered abuse taking place in the home. Hatt House DS0000018367.V357197.R01.S.doc Version 5.2 Page 14 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): 19 and 26. Quality in this outcome area is good. Hatt House is a well maintained home that is safe and provides a comfortable environment for residents. The home is clean and pleasant with good standards of hygiene evident throughout. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complete tour of the home was undertaken as part of the inspection processes this including the whole of the grounds. Both the building and the grounds were well maintained and a comfortable, safe environment was provided for residents. Most residents rooms were wallpapered which helped to provide a homely feel that residents said they liked. Two lounges are available and a spacious dedicated dining room. The laundry area of the home was well equipped. Currently clean laundry is placed on open shelving in the laundry area and soiled washing is put into the washing machines in the same area. This was discussed with the proprietors and it has been agreed that a protocol will be introduced to ensure that this Hatt House DS0000018367.V357197.R01.S.doc Version 5.2 Page 15 approach is modified to ensure that there is no contamination between clean and soiled laundry. The grounds of the home are well maintained and have seating areas provided for residents when they use the gardens. All areas of the home were seen during the inspection including the toilets and bathrooms, good standards of hygiene were evident throughout. Residents that were consulted during the inspection advised that they liked their rooms and the lounge areas of the home. Hatt House DS0000018367.V357197.R01.S.doc Version 5.2 Page 16 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): 27, 28, 29 and 30. Quality in this outcome area is good. Residents’ needs are appropriately met by the care team. The homes recruitment practices ensures that residents are always protected and in safe hands. The care team is trained and competent to fulfil their role appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care hours available for the running of Hatt House remain at the same level as at the last inspection, this is sufficient to ensure residents’ needs are appropriately met. There is a core of staff that are experienced and the management of the home ensures that each shift is appropriately managed and that residents are in safe hands. When new staff are recruited the home follows appropriate procedures, which ensures residents are safe. New carers are interviewed and the home undertakes the necessary checks etc. Samples of the personnel care records were examined during the inspection and these demonstrated that all the appropriate documentation was in place that is required by the legislation. The home has an active training programme in place, which helps to ensure that carers are competent and able to fulfil their post appropriately. In addition the management of the home undertakes regular formal supervision. At the Hatt House DS0000018367.V357197.R01.S.doc Version 5.2 Page 17 time of the inspection the supervision processes were a little behind schedule, this was discussed with the registered manager who is going to ensure this is rectified. When residents were consulted they were keen to make positive comments about the care team and this was repeated when visitors were asked for their views. Hatt House DS0000018367.V357197.R01.S.doc Version 5.2 Page 18 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): 31, 33, 35 and 38. Quality in this outcome area is good. Hatt House is managed by a person who is fit to be in charge and the home is run in the best interest of service users. Residents’ financial interests are safeguarded. The health and safety and welfare of residents and staff are given appropriate priority by the management of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager of the home is also one of the proprietors, she is experienced and well qualified to discharge her responsibilities fully. The management of the home ensure that regular consultation takes place to ensure the home is providing the appropriate service. This is undertaken with the use of questionnaires for residents and their families and the healthcare professionals that provide a service to the home. For residents that are unable Hatt House DS0000018367.V357197.R01.S.doc Version 5.2 Page 19 to manage a written response their views are sought verbally on an individual basis. Currently the home does not assist with the administration of residents’ pocket monies. If the home does make a purchase on behalf of a resident a receipt is obtained and an invoice is raised that is settled by the resident’s family. The management of the home takes health and safety issues seriously and gives them appropriate priority. The recordings undertaken of the fire precautions were examined and these were found to be clear and up to date. The regulations concerning the use and storage of harmful chemicals are in place and appropriate reports are made of any dangerous occurrences in the home. All the equipment in the home is regularly serviced and the water supply is tested for unwanted bacteria. The home has a current electrical installation certificate available and the safety of electrical appliances is tested in line with the legislation. This detailed approach to health and safety ensures that residents are safe. Hatt House DS0000018367.V357197.R01.S.doc Version 5.2 Page 20 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Hatt House DS0000018367.V357197.R01.S.doc Version 5.2 Page 21 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hatt House DS0000018367.V357197.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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. 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