Care Home: Hawthorn Green Nursing Home

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What the care home does well We noted that the home provides a friendly and welcoming environment for service users and visitors. The premises benefit from a pleasant location that offers a garden overlooking a park and is close to local amenities. The service has a full time activities co ordinator and there was once again clear evidence of service users being offered a social programme that caters for varying needs, including those who suffer from dementia. What has improved since the last inspection? The service has continued to closely examine all aspects of how it functions and has made further positive changes. For example, the care planning review process has now been completed and information is clearly presented with a focus of ensuring accuracy and relevance to the individual service user. The service has introduced a system for ensuring that medications that are kept are within the expiry date and disposes of those that are no longer needed or have expired. Odour control is also given far greater attention and the issues that were reported at the previous inspection are no longer in evidence. What the care home could do better: It has been recommended that the service train staff about the use of language that is written in reports and display menus with more pictures to aid the understanding of service users who suffer from dementia. Aside from these two areas the service has performed well and no statutory requirements have been made as the result of this inspection. Key inspection report Care homes for older people Name: Address: Hawthorn Green Nursing Home 82 Redmans Road Stepney Green London E1 3AG     The quality rating for this care home is:   two star good 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: James Pitts     Date: 0 1 0 6 2 0 1 0 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 23 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 23 Information about the care home Name of care home: Address: Hawthorn Green Nursing Home 82 Redmans Road Stepney Green London E1 3AG 02077027788 02077028045 zelina.ramdhan@sanctuary-housing.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sanctuary Care Ltd Name of registered manager (if applicable) Joanne Freeman Type of registration: Number of places registered: care home 90 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: MINIMUM STAFFING NOTICE The home can accommodate two (2) named service users under the age of 65 years. Date of last inspection Brief description of the care home Hawthorn Green Care Home is a ninety bedded nursing home situated in Stepney Green, close to Stepney Green and Whitechapel underground stations and accessible by local bus routes. This purpose built care home has a ground, first and second floors, with lifts. The home is divided into six separate units, each with up to fifteen service users. Three of the units provide nursing care for people with dementia and the other three units provide general nursing care. A limited number of the beds have been purchased by the Tower Hamlets Primary Care Trust for the provision of Continuing Care. Care Homes for Older People Page 4 of 23 0 0 Over 65 45 45 Brief description of the care home Care Homes for Older People Page 5 of 23 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: two star good 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 key inspection was conducted over two days, and the first day of this inspection was unannounced. It should be noted that, in error, the Commission had not sent a request for the annual quality assurance assessment for the service and time was given for this to be completed before the second visit took place. Information from the AQAA was also used for the production of this report. Information was gathered through speaking to service users, visitors, the manager and staff. We read a randomly selected sample of the care plans, and checked upon the storage and recording of medication. We also looked at other relevant documents such as policies and procedures and staff files, for recruitment and training details. The premises were toured and staff with specific responsibilities were spoken with. We also provided a sample of questionnaires for people who use the service. At the time of the inspection visits it was too early for any of these to have been returned. Care Homes for Older People Page 6 of 23 However, the Commission will consider any comments that we may subsequently receive. Care Homes for Older People Page 7 of 23 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 8 of 23 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users are offered suitable information about the service and assessments of their unique individual needs that promote their proper admission to the home. Evidence: The statement of purpose was updated in October 2009 and the service user guide in May 2010. Both of these documents are written in plain language and provide the necessary information that people would wish to know. Even so, the documents also encourage people to raise any questions or suggestions that they may have with the staff of the service. We read a randomly selected sample of the care plans. It was noted that the needs of prospective service users are assessed prior to admission. These assessments involve referrals by the placing authority and senior staff from the care home. All residents Care Homes for Older People Page 10 of 23 Evidence: were offered a short trial period, which was followed by a review meeting in order to establish if the placement would become permanent. The manager stated that the service continues to produce specific assessments within the first twenty-four hours for people that were newly admitted. These assessments included moving and handling, tissue viability, nutrition and falls risk. A more comprehensive care plan is then put into place, and checked upon by a senior manager, within five days. The key standard 6 is not generally applicable for assessment as the service does not normally provide intermediate care. Care Homes for Older People Page 11 of 23 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can expect that the planning of care needs has much improved and demonstrates better accuracy. The service also now adheres to its own medication policy regarding how to complete medication charts and the need to safely store/dispose of prescribed medications. Evidence: We read a randomly selected sample of 5 the available care plans. It was acknowledged at the previous inspection that a plan was in place for all of the care plans to be re-written by October 2009. We were in agreement at that time with the views expressed by the Tower Hamlets PCT Clinical Nurse Specialist for Nursing Homes in May 2009, in regard to the need for some form of streamlining of the care plans. It is positive to note that this work has been achieved and that care plans cover all of the necessary areas for consideration and are reviewed. However, it is recommended that staff receive training on how to word entries on care records so that these do not appear at times to be inappropriate. Care Homes for Older People Page 12 of 23 Evidence: The service has also now launched CIRCA. This is a computer based system that helps service users with dementia to communicate and reminisce. This is shared among each of the units and is proving to be a highly popular and useful tool. The system promotes connection with old memories from films, music and everyday life. We also looked at the risk assessments during the reading of the care plans. It was previously felt that there could be more precise information and this is now in place. At the previous inspection we were told by a service user that the night-time carers do not put the incontinence pads on properly and do not change the pads until 6.30am. There were records kept for checking whether people were asleep or awake but no record was kept for pad changing. The manager stated at that time that she felt the form was inadequate and would develop a more detailed one, this has now occurred. We also previously raised the issue of the need for the manager to conduct overnight spot checks. It is positively noted that this is also now occurring and due to matters that have arisen a monthly programme of spot checks at night is currently in use. We checked the storage and recording of medication on three of the units. There were no issues of concern with the management of controlled medications and medication that needed to be refrigerated. The medication that is used is delivered by a local branch of a well known pharmacy. At present the medication is delivered at different times of each month for different units and the manager is attempting to have this coordinated to ensure delivery at the same time across the home. No expired medications were found and the sample of medication administration charts that we viewed had all been correctly completed. The care records of each service user are kept at the nursing station of the particular unit in which they live. During both visits that took place for this inspection it was noted that these were being properly held when not in use. Care Homes for Older People Page 13 of 23 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. The people who use this service are provided with a varied and suitable programme of activities, including opportunities to maintain links with the local community. Evidence: We met with the activities organiser. The service provides a wide ranging activities and entertainments programme, although nurses and care workers also support people with their social needs. The activities organiser provided documented evidence of the activities programme, which include visiting entertainers, outings and shopping trips, bingo, arts and crafts, singing and music. Reminiscence quizzes, visits from school children, exercise and one to one chats with people that do not wish to or are not able to take part in group activities also occur. We were shown the multi-sensory equipment, which residents have found relaxing and soothing. During the course of the inspection we observed examples of activities taking place and planning for forthcoming events. The activities organiser and the manager stated that the home continues to meet individually with all of the nursing and care staff so that each staff member would have their own mini appraisal of their current knowledge and skills in the provision of activities and objectives for future development. The people who live at the home are encouraged to make requests for Care Homes for Older People Page 14 of 23 Evidence: activities that they would enjoy. The service offers very flexible visiting hours for relatives and friends. We met some visitors who came in almost daily and had developed good relationships with other service users and staff. Relatives are allowed free access to the service and are given the key pad entry code for the front door (during office hours when the reception is staffed) and the unit on which their particular loved one lives. The previous inspection noted that lunchtimes were not as relaxed as they could be, for example Music by the Beatles was played quite loudly meaning communication was difficult. Observations at a lunchtime during this inspection showed that a much more relaxed atmosphere exists. We looked around the main kitchen and checked the menus for a four week cycle. It was noted that there continues to be a good choice of cereals, biscuits and cakes (including home baked items) and different conserves. Cooked breakfast was offered daily, which several people on each unit choose to have. It is recommended that pictures be added to the menu to show the meal options available, not least for people who suffer from dementia. Care Homes for Older People Page 15 of 23 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. The people who use this service can expect that their complaints will be listened to and acted upon and that systems are in place to keep them free of avoidable risks to their safety and wellbeing. Evidence: The home has received 14 complaints since the previous inspection. Two of these were upheld, two partially upheld, and the appropriate follow up action was taken. The others were matters that appeared to be more about differences of perception and were resolved through communication and explanation. Each of these complaints is well recorded and the complaints procedure had been followed. The service has an Adult Protection procedure, inclusive of information regarding how to whistle blow. The home has followed its own organisational policy, and that of the local authority, London Borough of Tower Hamlets, for the one safeguarding alert that was raised in the last year. There was no proof of any harm having come to the person in question, but a proper investigation was held and the concern was taken seriously. There is an increase in the level of overall satisfaction with the service. This is noted from comments that were made during the inspection visits and the homes own satisfaction surveys. Care Homes for Older People Page 16 of 23 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can feel confident that the environment of the home is safe, clean, and well maintained. Evidence: The service occupies a purpose built premises within walking distance of a park, and local shops and amenities. There are pleasantly maintained communal areas including an activities room and a rear garden. Many of the bedrooms show that people were supported to personalise their own space. A number of issues were raised at the previous inspection regarding storage of personal care items, for example incontinence pads, and the storage of other items. The home has worked hard to ensure that these matters were attended to and items are now being properly stored in designated areas. Communal parts of the home are now clean and there were no offencive odours detected. The previous odour control problem has been resolved and the unit on which this occurred had significant refurbishment work carried out. The manager stated that at present in the home there was one person with a pressure sore but no MRSA and no C diff infections. Care Homes for Older People Page 17 of 23 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Suitable arrangements are in place for service users to receive their care from safely recruited, appropriately trained and supervised staff. Evidence: We found that the staffing levels continue to be good for each unit. We spoke to the manager regarding current staff vacancies, of which there are not many and those that there are being addressed. The service continues to have an ongoing programme of mandatory training and other training relevant to the needs of the people who use the service. We noted that staff have continued to work with a visiting Primary Care Trust clinical nurse specialist for nursing homes. This was again described as a valuable approach to developing new knowledge and skills. A sample of 10 staff recruitment files was seen and each of these was found to have all of the necessary pre employment background checks in place. Care Homes for Older People Page 18 of 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can feel confident that the home continues to strive for improvement in order to provide a responsive and safe service for those who use it. Evidence: A new manager commenced at Hawthorn Green in early 2009. She is a registered nurse with prior managerial experience in care homes. The manager is now registered with the Care Quality Commission. Service user satisfaction questionnaires from late 2009 show an improved level of satisfaction with the service. Although only 9 per cent of people responded the manager has made a commitment to increasing the level of input from service users and relatives. The home has a health and safety procedure and certain tasks are performed each month to keep health and safety matters up to date. We checked the records for Gas, Electrical and fire safety. All of these checks have occurred within the necessary timescale. Care Homes for Older People Page 19 of 23 Evidence: COSHH items are stored in a locked cupboard and the manager had data sheets and risk assessments for the items. No COSHH items were seen to be stored inappropriately during the inspection visits. The manager stated that the home receives regular monthly Regulation 26 visits from an area manager. They look at files, complaints, the environment and speak to service users, relatives and staff. We note that all visits that were due in the last year have taken place and that action plans for response to each visit are drawn up and are acted upon. Care Homes for Older People Page 20 of 23 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 21 of 23 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 It is recommended that staff receive training on how to word entries on care records so that these do not appear at times to be inappropriate. It is recommended that pictures be added to the menu to show the meal options available, not least for people who suffer from dementia. 2 15 Care Homes for Older People Page 22 of 23 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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