Care Home: Hatzfeld House Care Home.

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What the care home does well People who are accepted for care from the community will have a pre-assessment provided for them. This is to ensure that the staff will be able to meet their needs. People are provided with the care support that they need. Staff are trained and new staff will only start work when the required checks have been carried out including a satisfactory Criminal Records Bureau (CRB) or Vulnerable Adults check. People who spoke with the inspector said that they were encouraged to do whatever they could and were able to make choices for themselves and included in any plans about them. Comments on care from three people included: `I find the staff provide me with privacy and treat me with dignity and I am happy at Hazfeld.` Comments about the meals: `I cannot grumble about the choices provided at meal times as I can make suggestions at the residents meetings.` Relatives comments included: `I would like to see people at the home taking part in more activities perhaps quizzes, talks, games and films. I feel that the notice board could provide more information about what goes on at the home`. `I would like to see my visitor in a room separate from their bedroom`. `I am made to feel welcome by the staff and when our family member is ill the staff will inform us.` What has improved since the last inspection? A refurbishment of the communal areas has taken place and the home has been newly decorated with new chairs and tables that suits the different age groups and needs of people at the home. Carpets have been replaced in some bedrooms also to the stairwell area of the home. A designated area has been provided for medication administration. What the care home could do better: Improvements in the recording of information is needed and clarification as to the time when the entries are added to the care records will improve the accuracy of the information. Staff should ensure that they include the individual`s capacity when recording any decisions made about the person. A review of the staffing levels and skill mix at specific times of the day will reduce peoples` perception of staff shortages. People at the care home are adjusting to the changes that have taken place. When the acting manager applies to become the registered manager this will enhance confidence in the service. All health and safety issues should be addressed to ensure the welfare of people at the home at all times. Key inspection report Care homes for older people Name: Address: Hatzfeld House Care Home. 10b Mansfield Road Blidworth Nottinghamshire NG21 0PN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Lesley Allison-White     Date: 1 6 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Hatzfeld House Care Home. 10b Mansfield Road Blidworth Nottinghamshire NG21 0PN 01623464541 01623465508 homecare@hatzfeld.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Roger Willis care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 23 The registered person may provide the following categories of service only:- Care home only - Code PC To the service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Hatzfeld House is a converted property, set in its own grounds in the centre of Blidworth. It is within walking distance of all the local amenities and on a public bus route. Service users are accommodated in one double and twenty-one single bedrooms with a communal lounge, dining room and conservatory. Disability equipment in the home includes a passenger lift, ramped access to the building, grab rails in bathrooms/toilets, handrails in corridors, mobile/bath hoists and raised toilet seats. A call system is available in all the rooms, including communal living space. Written information about the home in the form of a service user guide, and a copy of the most Care Homes for Older People Page 4 of 32 0 3 1 2 2 0 0 8 23 0 Over 65 0 23 Brief description of the care home recent inspection report, are available from the home. Fees at this home range from £366.00 to £750.00 per week. Please contact the home for further details. Care Homes for Older People Page 5 of 32 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: one star adequate 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: This is an over view of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Care Quality Commission (CQC) is on outcomes for people using the service and their views on the service provided. The last key inspection report for this service was on 3rd December 2008. Prior to the visit an analysis of the service was undertaken from information gathered including information from the Annual Quality Assurance Assessment (AQAA) completed by the provider. Due to a shortage of preparation time surveys were not sent out. However all the information received about this home since the last inspection was considered in planning this visit, and this helped decide what areas we Care Homes for Older People Page 6 of 32 looked at. The evidence and judgements that are made are made on behalf of the commission and are written as we although there was one inspector at inspection. The site visit lasted seven hours and the main method of inspection used was case tracking which involved looking at the records of three people in detail and tracking the care they received by checking their records and discussing this with them where possible. Where people have communication difficulties judgements about the quality of service is made through observation, case tracking and talking with relatives and advocates. There were seventeen people in the care home plus one person in hospital. We spoke with three other people also, who received care or were relatives of people who receive care from Hazfeld Care Home. A discussion with the manager and with other staff took place. Care practises were observed at inspection. Although the premises was not looked at in detail we observed that there was evidence of security and that confidential information was protected. The current Registration certificate and the Employers liability certificate were seen and found to be correct. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Improvements in the recording of information is needed and clarification as to the time when the entries are added to the care records will improve the accuracy of the information. Staff should ensure that they include the individuals capacity when recording any decisions made about the person. A review of the staffing levels and skill mix at specific times of the day will reduce peoples perception of staff shortages. Care Homes for Older People Page 8 of 32 People at the care home are adjusting to the changes that have taken place. When the acting manager applies to become the registered manager this will enhance confidence in the service. All health and safety issues should be addressed to ensure the welfare of people at the home at all times. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 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 10 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Hatzfeld have their needs assessed before they move into the home so that staff will be able to meet their needs. However, further consideration should be made to ensure that the people living together will be able to mix well. Evidence: We saw that potential clients are offered a visit to the home and the opportunity to spend time in the home before making a decision. A staff member will do the preassessment and a Social Services assessment is also present. However, staff do not always take into account the different needs (diversity) of all the people who live at the care home and the newer younger people with dementia who will live with older people with dementia do not always live together well. As a result, there have been some concerns expressed by the people who live at the care home and their relatives. At inspection we asked about the people who caused many of the concerns that have been raised during the year. We were told that they have have now left the placement Care Homes for Older People Page 11 of 32 Evidence: at the care home. We saw that peoples care records have evidence of a pre assessment being in place. Pre assessment information included peoples likes and dislikes, diet and nutrition, moving and handling, activities they could do or preferred and how staff should help in support of the younger adults with dementia. For the older people case tracked we saw that there was a record of their past medical histories, medications, moving and handling, falls assessment and nutritional needs. People were offered a choice of Doctor from one of the two local surgeries. The Statement of Purpose and Service User Guide is available. This is information about the service. Both should be revised to clearly state that all adults including younger adults over eighteen years of age must have a primary diagnosis of dementia and need care in this area, or have a primary need that is comparable to that of an older person, and that care and facilities can be provided, to meet both types of needs and say how this will be done each day. The guide is made available in standard format and basic information about the service is provided. We saw that a residency agreement is drawn up and signed by the person staying at the care home or a Representative on their behalf. Care Homes for Older People Page 12 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their health and social needs met however improvements in written communications will improve the care of people at the service and ensure that information can be followed up. This is particularly important as the home changes to accept people from a younger age group. Evidence: Three peoples records were looked at. This included people with different care needs. Assessments included moving and handling, integrity of the skin and any action required. This included treatment by the District Nurses, the need for specialist equipment such as an airwave mattress for prevention and promotion of healing skin. Staff were asked to follow the instructions of the District Nurses by charting when they help to change someones position in bed and make regular two hourly checks on a person during the night. The use of equipment was recorded in their care plan. For example the use of an Oxford hoist to be used by two care staff. A risk assessment for falls was also provided for the two of the older people case tracked. The younger adult had different needs identified that were about prompting with Care Homes for Older People Page 13 of 32 Evidence: personal care as they were physically able to do this for themselves, and there was more information about their daily activities. On one persons bedroom wall there were prompts to remind them to carry out tasks for themself such as have a wash or to make a drink for themself. They had a kettle in their room and a risk assessment in place to show that they were capable and able to use it safely. There was a past history about them and this would help staff to understand their lifestyle and interests. The younger adult was weighed each month as it was identified that they were at risk of not eating without being prompted to do so and they were at risk of dehydration due to not drinking was also noted. However, lacking from the care records was the action to be taken to correct these measures and who to ask as specialists in this area when needed. We saw that one of the older people had not been weighed and the acting manager told us that they were looking to buy new scales for this to happen. It is important to monitor peoples weight and nutrition on a regular basis particuarly as there are now people with the mixed abilities and different age groups. Inadequate nutrition and insuffient fluid intake could be overlooked. The AQAA tells us that this is an area that the home identifies as an area for improvement. We are told: Record sheets to evidence who has eaten a meal and at what time they ate their meal or whether they have a main meal, alternative or vegetarian diet is not recorded well. We saw that one person did not sleep well at night and the recordings around time was difficult to follow as the twenty four hour clock was not used. This was also the case for a person who has since died when their care records contained gaps. It is important for anyone reading the care records to establish the time of the day or night that events take place during the life of a person at the care home. We saw records of visits by health care professionals such as the District Nurses, the Doctor and Chiropodist. People told us that the Doctor visited when they were ill. The Annual Quality Assurance Assessment tells us: That there is no one at the home giving themselves their medication and that policies are in place to ensure that people can be supported for this to happen if they choose to do so. We saw that health needs are identified, medication and health provided in a way that supports the need of people at the home. Policies are in place for the correct management of medications Care Homes for Older People Page 14 of 32 Evidence: including the opportunity for people to self medicate. Sometimes there are gaps in the medicine sheets although staff receive training before they are asked to give out medicines. In general however, people are protected from harm, and there was evidence of medication training in the staff records. The AQAA tells us: We respect peoples privacy by knocking at doors before entering a persons room and by providing people at the home with same sex staff to attend to them when receiving personal care. We observed staff at work and they interacted with people at the home well. At inspection we did not see any male staff and there were no male names on the rota that we saw. Minutes from previous staff minutes also explained that there were no male carers. The acting manager explained that due to the changes that have taken place some care staff have left and that they are actively continuing with the recruitment of suitable staff so that they can better meet the needs of the mixed sexes and age groups at the care home. The wishes of a person in preparation for death have been recorded in one of the care plans and a relatives signature obtained. However, their was no assessment of the persons capacity. It is advised that staff revisit this area of care to ensure that they are complying with current legislation around issues of capacity and deprivation of liberty. Care Homes for Older People Page 15 of 32 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 good 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 have a lifestyle that matches their expectations and preferences and staff continue to encourage activities that are age appropriate. Evidence: At the residents meetings attended by both staff and residents people discussed aspects affecting their lifestyle such as, the banging of doors. To rectify this new fire closures were ordered and fitted. One person said that they wanted to be moved from the dining table soon after eating their meal. It was explained that staff would try to do this but due to helping other residents it was not always possible. However, this may be an area where staffing levels and dependency levels of different people may need to be reviewed to ensure that peoples individual needs and choices are met to ensure that individualised care is practised. Some people commented that they felt that the home was sometimes short of staff. It was explained that the process of recruitment was sometimes lengthy and the correct checking procedures for people to be safe to work in a care home was necessary and the delay was unavoidable. One person requested that the meal breaks were to be better spaced out. The Care Homes for Older People Page 16 of 32 Evidence: manager explained that this could be easily resolved with breakfast starting at 08:00 hours in the morning providing greater choice for when people chose to eat. Menus were to be reviewed and any preferences requested with the help of a key worker. People were observed to be comfortable at the home and encouraged to pursue activities of their choosing. We saw three women playing cards and waiting for bingo in the activities room/ Day centre at the home. We observed other people watching television in the lounge and some people went to rest on their bed after lunch. We noticed that the activities person was out with one of the people at the home and a staff member was to help with activities in her absence. This was not always consistent as staff would be interrupted or asked to help with other tasks. People that we spoke with also confirmed that this happened. The AQAA tells us that: regular non denominational services are held on the premises and religious ministers from the different religions hold services at the home as required. One person goes to the local church to worship escorted by staff. In this way peoples religious and cutural needs are met. People told us that their families were made welcome, we saw relatives present during the day and we saw records kept in the care plans for visits by family, friends and representatives of the people at Hazfeld. We saw that people at the home can go out if they chose to. In a residents meeting staff reminded all residents, to sign the in/out book and inform a staff member when they done so as part of their fire and safety monitoring. We saw that someone requested to help look after the bird at the home. For others a request for more up to date music and dance classes was requested as part of the entertainment to be available at the home. Two people from the home volunteered as resident representatives one older person and one younger person. When we spoke with them they said that the meetings were working well. People are encouraged to choose when they have a bath or shower and are provided with assistance when assessed to need help in this way. People generally felt that they were encouraged to make choices at the home about their lifestyle. We observed a meal time. Staff were present to help anyone who needed assistance. People told us that they liked their meals and enjoyed the pleasant dining area. The food looked pleasant and nutritious. Care Homes for Older People Page 17 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the home are listened to and protected from abuse. Evidence: The Annual Quality Assurance Assessment tells us: The complaints and compliments procedure is in place and displayed on the residents notice board. Complaints are discussed if appropriate in residents meetings as well as with relatives, friends and professionals. Complaints are taken seriously, fully investigated, discussed and explained to the person raising the issue. We looked at the complaints procedure and complaints. They have all been dealt with. People are informed about the Care Quality Commissions (CQC) details however, the e-mail address could also be included. We advise that the contact details for Social Services be included as many people at the home receive funding through them. We spoke with staff briefly and we saw records of staff training including Safeguarding of Adults training. People at the home told us that they felt that staff were able to meet their needs and would be able to assist them if they had a complaint. They knew who the person in charge was, and felt able to approach them if they had any concerns. CQC is aware of complaints and safeguarding issues associated with this care home and all matters have been dealt with. Care Homes for Older People Page 18 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live a clean environment. They will be made safer when the health and safety checks have been completed. Evidence: We looked at three bedrooms and they were satisfactory. Some people had added personal items such as photographs of friends and family and other items to make their bedroom more comfortable for themselves. We saw bedrooms that were kept clean and tidy. We looked at public areas including two downstairs toilets and a bathroom and saw that the room doors could be locked from inside to ensure privacy when being used. We tested the water. It was sometimes too hot. We called the acting manager to test it also, it was found to be too hot. We were shown a copy of the environmental visit report it referred to checks made in October 2009 where excessive hot water temperature readings (above 50 degrees Celsius) in the rooms were found. They left directions as to the corrective measures needed to prevent the risk of scalding and the risks associated with Legionella disease. This was to ensure that the water is safe to use at all times and the risk of scalding and Legionella reduced through water control testing and monitoring. Care Homes for Older People Page 19 of 32 Evidence: At inspection December 2009 this still has not been done. We spoke with the Environmental Officer who said that they would return in the new year to see if these checks had been made by the responsible individual of the home. We saw that window restrictors were in place in the bedrooms where appropriate. Care Homes for Older People Page 20 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Training is provided for staff to ensure that they are able to meet the needs of the people at the home. However, people at the home feel that there are staff shortages when they are kept waiting and this is an area for further consultation. Further improvements in the area of recruitment will ensure that people who live at the home are safe at all times. Evidence: We saw a copy of the staff rota. We saw that care staff are on the rota to cover kitchen shifts. A cook manager, and cook is employed and three house keeping staff are employed. Residents minutes suggested that they felt that there were times in the day when more staff could be available to help them. This is something for the management of the home to consider further to ensure that peoples needs are being met as the rota indicates that more care staff could be available to help at critical times of the day. Three care staff are present at the lunch time meal. We saw a copy of the staff matrix. The staff training programme provides Moving and Handing, Basic Food Hygiene, Safeguarding Adults, Health and Safety at work and Infection Control. We noticed that not all staff had received the training we discussed Care Homes for Older People Page 21 of 32 Evidence: this with the actiing manager who explained that she would stress the importance of training to staff and agreed that this could compomise care provided. Further information is requested with regard to information about specific members of staff. An update of all staff training dates is requested for adult abuse awarenss and fire safety training. Recruitment practises at the home will be satisfactory when information about specific staff checks made by the employer have been sent to the Commission to ensure the safety of the people at the care home. Nine out of twenty two staff have a National Vocational Qualification (NVQ). Out of Fourteen care staff seven staff have an NVQ in care and two further staff are in the process of taking a NVQ qualification in care. The acting manger is not included here in any of the numbers. In (Feb 2009) specialist training has been provided for all staff to explain Korsakoff syndrome to them. Many staff have also received training in self defence (Jan 2010) and Mental capacity and Deprivation Of Liberty training is on-going having started in June 2009. Staff appraisals take place on a regular basis to ensure that staff can discuss any personal and care issues. We saw that newer care staff members can be placed on the 3pm to 11pm shift. Management support is available throughout the day time however further consideration could be given to the eveninings to support new staff who are no longer supernumerary on the rota. Two waking staff are provided at night time. An on call senior staff member is available by telephone at weekends. Care Homes for Older People Page 22 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the care home are adjusting to the changes that have taken place within the age ranges of people at the home. Confidence in the service will be enhanced when the acting manager applies to become the registered manager. The provider will use quaity assurance survey comments to furhter improve the lifestyle for people at Hazfeld and when the health and safety issues are addressed the welfare of people at the home will be fully met. Evidence: People told us that: they felt that staff provide them with privacy and treated them with dignity and that they were happy at Hazfeld. We saw copies of resident meetings, and people at the meeting thanked all the staff for encouraging them to have their say. Comments about the meals included: I cannot grumble about the choices provided at Care Homes for Older People Page 23 of 32 Evidence: meal times as I can make suggestions at the residents meetings. Visitors comments included: Please review meal times as the gap between 1pm to 5pm seems a long time, perhaps an earlier teatime may be better. This has since changed and an earlier tea time of 4.30pm is provided with snacks available again before bedtime. Other comments included: I would like to see people at the home taking part in more activities perhaps quizzes, talks, games and films and I feel that the notice board could provide more information about what goes on at the home. I would like to see my visitor in a room separate from their bedroom. The activities/ day centre room is provided and can be used when no formal activities are taking place. Further comments from the providers questionnaire included people who said: I am made to feel welcome by the staff and when our family member at the home is ill the staff will inform them. These comments will help the provider to provide a better service for the people who live at Hazfeld. However, when we checked the records for accidents and Regulation 37 notifications about incidents affecting the well-being of people at Hatzfeld we noticed that the Commission had not been informed of the an admission of someone at the home to the hospital. The acting manager explained that this had been accidentally overlooked. The registered person holds money for some people at the care home. When we checked two peoples monies we found that one persons money was not accurate. Improvements in the management of peoples money is essential with more accurate record keeping and clearer lines of authority as to access. In this way people will know that their money is kept safe and secure at all times. Money held at the home is kept in secure lockable facilities. Since the last inspection there have been changes at the care home these include a change in the manager. We looked at information about the acting manager to ensure that she is safe to be in charge of the home, this was satisfactory. We advised that Care Homes for Older People Page 24 of 32 Evidence: she become registered with the Commission as soon as possible to provide leadership and maintain stability for the people who live at the home and for the staff who work there. Another important change has been the change of admissions as the home now accepts people from a younger age group with a primary need for dementia care. This has caused upset to some of the staff and to the older people at the home and their relatives however changes have been implemented and people at the home appear to have settled. We saw copies of certificates for fire safety, electrical safety and gas safety at the home.They were satisfactory. We saw a copy of the registration certificate and the Employers liability certificate and they were in date. We saw that there were still some radiators in the corridoor without protective covers on them and that the water temperatures could reach over 50 degrees Celsius in areas used by people who live at the home. We spoke with the Environmental Officer at inspection by telephone who was aware of these issues and agreed to follow them up. An immediate requirement was not issued on this occasion. We spoke with people at the care home and they said that they were satisfied by the management of the care home, and that staff were kind to them. In this way they felt comfortable with the changes including the admission of younger people at the care home and said that it was not a problem to them at the moment. Care Homes for Older People Page 25 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 25 13 All radiators must be risk assessed and appropriate action taken to eliminate risk 28/02/2009 Care Homes for Older People Page 26 of 32 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 1 3 18 Staff must have the appropriate training for the work that they are to perform. This includes the area of pre-assessments. This will ensure that the newer younger people admitted to the home can fit in with existing people at the home more easily. 31/03/2010 2 8 13 The registered person shall ensure that unnecessary risks to health and safety of service users are identified and so far as possible eliminated. Improvements in record keeping will ensure that potential risks are identified and avoided. 31/03/2010 3 9 13 The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal 31/03/2010 Care Homes for Older People Page 27 of 32 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 of medicines received into the care home. Regular checks should be made to ensure that medications are always signed for when given and that old medication sheets are saved should they be needed for any investigations and enquiries. 4 27 18 The registered provider is to 31/03/2010 ensure at all times suitably qualified, competent and experienced people are working at the care home in such numbers as are appropriate for the health and welfare of service users. People at the home have expressed that they are sometimes kept waiting. By reviewing staffing numbers and the skill mix of staff, people at the home will benefit and have their needs met when they ask for assistance. 5 28 13 The registered person shall 31/03/2010 make suitable arrangements by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. Care Homes for Older People Page 28 of 32 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 In this way people at the home will be kept safe. 6 29 19 The registered provider should ensure that full and satisifactory information about staff is available and satisifactory In this way people at the home will be kept safe as full and thorough checks have been made about the staff provided to give them care and support. 7 31 9 A person shall not manage a 31/03/2010 care home unless he is fit to do so. The acting manager should register with the Commission as soon as possible to ensure continuity and confidence within the service. 8 35 16 The registered person shall provide a place where the money and valuables of service users may be deposited for safe keeping and make arangements for service users to acknowledge in writing the return to them of any money or valuables so deposited. 31/03/2010 31/03/2010 Care Homes for Older People Page 29 of 32 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 Peoples money must be kept safe at all times and correct accounting procedures must take place. 9 37 37 The registered person shall give notice to the Commisssion without delay of the occurence of death, illness and other events. The Commission must be informed about any incident that affects the running of the care home. 10 38 13 The registered person shall 31/03/2010 ensure that unecessary risks to the health or safety of service users are identified and so far as possible eliminated. Management should ensure that all heath and safety aspects within the home are be acted on with urgency to ensure the continued well being of all who work and live at Hazfeld. 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 31/03/2010 1 1 A review of the Service User Guide and Statement of Purpose is recommended to ensure that information about Care Homes for Older People Page 30 of 32 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 changes within the service are clearly stated and that an outline of daily life for each of the categories will enable people to make an informed decision as to whether the placement is right for them. The home is registered to take people who are from the older person category or any adult from the ages of eighteen years upward, whose primary need is dementia. 2 14 It is recommended that staff are mindful of the different abilities now at the care home and should continue to make every effort to meet everyones individal needs. It is important that peoples opinions are taken into account in the running the home and that feedback from the questionnaires is acted on and people at the home kept informed of the outcomes. 3 33 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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