Care Home: Hendford Nursing Home

What the care home does well All people that wish to use the service benefit from a pre-admission assessment and the care plans are then generated from this initial assessment. Prior to admission a meeting takes place between the family, care manager and health care professional if necessary. During this meeting care plans are discussed to ensure that everything is in place prior to admission to the home. Care plans and risk assessments contained enough information about the people using the service to allow staff to care for them appropriately. The staff spoken to on the day were knowledgeable about the care needs of the people using the service.They were observed to be interacting and speaking appropriately to the people in a calm manner. Regular training takes place and this includes the NVQ (National Vocational Qualification) which all staff have access to. The registered manager and staff have a clear understanding of safeguarding policies and procedures. Documentation evidenced that complaints that are received by the manager are investigated appropriately. There are clear lines of managerial responsibility within the home. What has improved since the last inspection? Following the inspection in August 2007 five requirements were made. These were discussed during this visit and the manager told us that they have now been met. Contracts are in place for all people using the service and the type of accommodation and amount of fees payable are included within this document. Blinds have now been fitted to the doors in the West Wing and this now ensures the privacy and dignity of the people in those rooms. The bedrooms in the West Wing identified in the report have now had the walls repaired and repainted. Two written references for staff are now obtained prior to them being employed. Regulation 37 notifications are now sent regularly by the home to CQC. What the care home could do better: Two requirements were made and can be seen at the end of this report. The home`s internal safeguarding adults policy should be written to ensure that it follows the local authority`s procedures. All recruitment application forms should contain a full employment history and an explanation for any gap in employment history. Key inspection report Care homes for older people Name: Address: Hendford Nursing Home Howell Hill Grove East Ewell Epsom Surrey KT17 3ER     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: Lesley Garrett     Date: 2 7 0 8 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 27 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 27 Information about the care home Name of care home: Address: Hendford Nursing Home Howell Hill Grove East Ewell Epsom Surrey KT17 3ER 02083937891 02083932886 HQ@limje.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Jesyem Medicare Limited care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 34 The registered person may provide the following category of service : Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home Hendford is a large detached house in the village of East Ewell. It offers accommodation with nursing for thirty-four older people with dementia and mental health needs. There are two large lounges for service users use. Accommodation is arranged over two floors with twenty single en-suite bedrooms and seven shared bedrooms. There is an enclosed garden at the rear of the house, which is accessible to the service users, and patio furniture is available in the good weather. Car parking is Care Homes for Older People Page 4 of 27 Over 65 0 0 34 34 Brief description of the care home available at the front of the house. Care Homes for Older People Page 5 of 27 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 inspection of the care home was an unannounced Key Inspection. Mrs Lesley Garrett, Regulation Inspector, carried out the inspection and the registered manager and clinical manager represented the home. We arrived at the service at 10:00 and were in the home for four hours. It was a thorough look at how well the home is doing. It took into account information provided by the home and any information that Care Quality Commission (CQC) has received about the service. The registered manager for the service supplied CQC with an AQAA (Annual Quality Assurance Assessment) and this document was used to assist with the inspection. The inspector also spent time talking and observing some of the people using the service and staff members. We looked at how well the service was meeting the key national minimum standards and complying with the regulations and have in this report made judgements about the Care Homes for Older People Page 6 of 27 standard of the service. Documents sampled during the inspection included the homes care plans, daily records and risk assessments, staff files, training records, and the homes safeguarding and complaints policies and procedures. From the evidence seen by us and comments received, we consider that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: Two requirements were made and can be seen at the end of this report. The homes internal safeguarding adults policy should be written to ensure that it follows the local authoritys procedures. All recruitment application forms should contain a full employment history and an explanation for any gap in employment history. Care Homes for Older People Page 8 of 27 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 27 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 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who wish to use the service benefit from a thorough pre-admission assessment to ensure that the home has the staff and facilities to meet their care needs. Evidence: The statement of purpose and service user guide is available to all people who wish to use the service. It has been recently updated and a copy was shown to us. Copies of these documents are also held at reception. The manager told us that prior to accepting anyone into the home a pre-admission assessment takes place. They often receive an assessment from the referring authority first and arrangements are then made for the clinical manager or senior staff nurse to visit the person prior to admission. The manager told us this is to ensure that the home can meet the needs of the person wishing to use the service. The manager told us that prior to admission there is a pre-admission meeting and this Care Homes for Older People Page 11 of 27 Evidence: is attended by the health care professionals, manager and clinical manager and the family. The manager said this gives the families an opportunity to discuss the care plans and discuss any specific needs of their family member. The home does not offer intermediate care. Care Homes for Older People Page 12 of 27 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 health and personal care of people using the service is a good quality. Care plans contained sufficient information to allow staff to care appropriately for the people using the service. Evidence: Three care plans were sampled and all contained detailed information about each person using the service. This allowed the staff to deliver care using the supplied information. Risk assessments were also in place and these were clear and there was evidence that all had been reviewed and evaluated monthly. People who use the service and their relative or representative are involved in the writing and reviewing of all care plans. A discussion took place with the registered manager and clinical manager about the filing of the individual care plans. Currently they are all kept in large folders. It was suggested for ease of use and to protect the privacy of each person using the service that the care plans be kept in individual folders. The registered manager told us that they are considering using a computer system for the care plans. Care Homes for Older People Page 13 of 27 Evidence: Aids and equipment are provided to encourage maximum independence for people using the service and these are reviewed and replaced to accommodate peoples changing needs. The manager said that people who use the service are registered with a local GP surgery. The GP visits every week but also visits in between if necessary. Other health care professionals support the home and include chiropodist, opticians and dentist. The home is also supported by the psychiatrist who visits regularly and reviews the medication that have been prescribed by them. There are medication policies and procedures in place. It was observed that when it was necessary for staff to handwrite a medication administration record (MAR) chart these were not being signed by the person writing them nor were they being checked by a second person for accuracy. Whilst the charts are checked and signed by the GP when they visit the charts can be unsigned for up to a week before the GP visits. In order to reduce the chance of a mistake being made when the chart is first written it is accepted best practise for the person writing the chart to sign for their action and for a second person to check that the chart has been correctly written. The MAR chart must also contain all of the information that is contained on the bottle or packet supplied by the pharmacy. During a tour of the building it was observed that staff were speaking appropriately to the people using the service by their preferred name which had been documented in their care plan. All people were dressed in clothes appropriate for the weather with hair well groomed and nails clean. Care Homes for Older People Page 14 of 27 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 who use the service are able to take part in social and recreational activities and are able to exercise some choice in their daily lives. The standard and quality of the meals are good, which means nutritional needs should be met. Evidence: Activities within the home are provided by an activity company who visit the home every week. This is the basis of the activity provision within the home. The AQAA tells us that the activities are planned to meet the needs of people in the home with dementia and cognitive impairments. During the inspection we observed in the care plans that social plans are now written by the staff taking into account peoples interest and hobbies prior to admission. The manager told us that musical entertainment takes place regularly and parties are also arranged for the people using the service. During the summer some people have been taken out accompanied by a member of staff. They have visited Richmond Park and Epsom Racecourse. Pictures of these visits are kept at the home and one of the nurses told us that these outings have been very successful and will be repeated regularly. Spiritual needs of the people using the service were observed and the Care Homes for Older People Page 15 of 27 Evidence: manager told us that two local clergy visit and talk to the people on a one to one basis. A church service takes place at Christmas. The manager told us that she has the contact details for many other denominations so that any faith could be catered for a the home if needed. The manager told us that the staff offer people using the service choices in their daily lives. All have capacity to make choices at mealtimes, activities and elements of personal care. The AQAA told us that the people who use the service who have no mental capacity in decision making and choice have an advocate or relative actively involved. The AQAA also states that care plans are devised in accordance with the Mental Capacity Act. It was observed in the care plans that all people using the service have a nutritional risk assessment in place which is reviewed every month and all people are weighed monthly. If problems are identified this is reported to the GP and referrals maybe made to the dietitian or speech and language therapist. The manager told us that menus at the home are planned by the manager and chef and that people who use the service are consulted. Meals are cooked on site and we were told these are nutritious. On the day of the inspection lunchtime service was observed. People using the service requiring assistance were being supported appropriately. On one table people were helping themselves to potatoes and vegetables that had been placed in serving dishes. The manager told us that these people had been identified as able to help themselves without assistance from staff. People that we spoke to told us that they enjoyed the food. Drinks were also available on the table. The manager told us that between meals hot and cold drinks are always available along with a selection of fruit which can also be prepared for those people that need the fruit cut. During a tour of the building it was observed that all people using the service had drinks available to them. Care Homes for Older People Page 16 of 27 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 who use the service can be confident that their complaints are listened to and that they should be protected from abuse as the staff team have received training in safeguarding adults. Evidence: The manager said that during the last year they had received one verbal complaint that had now been resolved. A log book is kept by the home for all verbal concerns to be documented by the staff and this is kept in the nurses office. Formal complaints that are received are investigated according to the homes policy. The manger told us that they had received no formal complaints during the past year. The home has a clear complaints policy and this is available to all people and is clearly displayed. The home has the local authoritys safeguarding procedures and the manager told us that these are the procedures that are followed and staff receive training. The homes internal policy was sampled and this is not in line with the local authoritys policy. A requirement will be made at the end of the report. Documents sampled during the day demonstrated that safeguarding training has taken place for all staff. The staff that we spoke to on the day had knowledge of the procedures followed in the home. The AQAA stated that staff have also received training in the Mental Capacity Act and Deprivation of Liberty and have access to the homes whistle blowing policy. Care Homes for Older People Page 17 of 27 Evidence: Care Homes for Older People Page 18 of 27 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 home enables people who use the service to live in a safe, well maintained and comfortable environment. Evidence: A tour of the home took place and the premises were seen to be well maintained and people who use the service able to access all parts of the home and grounds. The home on the day of inspection was seen to be clean and tidy and free from offensive odours. Most of the bedrooms are single with a few still remaining as shared occupancy. All bedrooms visited on the day had been personalised. The AQAA told us that during the last year the home has benefited from a new roof and double glazing throughout. A new downstairs bathroom has been installed together with new bedroom furniture. The manager told us that they are always looking to improve the accommodation provided and planning permission has been applied for to build an extension to the home to increase the communal space available and to provide more single rooms. The laundry facilities are suitable to accomodate the needs of the people using the service. There is an infection control policy in place and records confirmed that staff have received training in infection control procedures. Care Homes for Older People Page 19 of 27 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. Staff numbers at the home on the day of inspection were sufficient to meet the assessed needs of the people using the service. NVQ training for the care staff continues to ensure a good skill mix of staff on duty. Evidence: The home benefits from an experienced staff team and when sampling the staff rota it was observed that staffing levels are consistent. The manager told us that when writing the rotas skill mix, gender and cultural mix are always taken into account. The numbers of staff can be increased if dependency levels increase significantly. The manager also told us that the home does not need to use agency staff that any gaps in the rota will often be filled by existing staff. The home has a programme of national vocational qualification training which all staff are entitled to enrol in following their induction training. Currently ten members of staff have the qualification at level 2 and one member of staff has achieved NVQ at level 3. Three employment folders of newly recruited staff were sampled and all were found to have most of the necessary paper work to enable the home to safely employ those people. Two recruitment folders were found to lack a full employment history with explanations for gaps in employment, therefore, this will be a requirement at the end Care Homes for Older People Page 20 of 27 Evidence: of the report. Individual training files for the staff were viewed. This showed us that staff at the home have access to a variety of training to meet the needs of the people using the service. Mandatory training by the home is carried out yearly or when the certificate has expired. This includes Safeguarding adults, moving and handling, fire awareness, infection control and food hygiene. The manager told us that specialist training is also available depending on the needs of the people using the service. This has included some dementia courses. The manager also told us that the home has been classified as a learning environment with Kingston and St Georges hospitals. Care Homes for Older People Page 21 of 27 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. Management arrangements at the home ensures the staff team is adequately supported and there are clear lines of managerial accountability. Quality assurance systems are in place which improve the quality of care offered to the people who use the service. Evidence: The registered manager of the home is not a nurse so has a clinical manager available. The clinical manager has achieved the registered managers award and his registered mental nurse qualification. There are clear lines of managerial support and responsibilities within the home. The manager says in the AQAA that the home benefits from a pro-active and cohesive team of staff adapting to the changing requirements of the current group of people using the service. The manager showed us the results of the recently completed questionnaires that have been returned to the home. the quality of the service is monitored every year with questionnaires being sent to all relatives or representatives and health care Care Homes for Older People Page 22 of 27 Evidence: professionals. This years results were very complimentary about the quality of the service provided by the staff. The home has the assistance of a recently recruited secretary to assist the manager in her every day administrative role.No person using the service manages their own finances and valuables are not kept at the home. Any money that a person using the service wishes to spend is then invoiced to the relative or representative monthly. The home also employs a full time maintenance person who has some health and safety responsibilities. An external body is also employed to carry out health and safety audits. No health and safety issues were identified during this inspection and records confirmed that the appropriate certificates were in place and current. Health and safety in the home is promoted and the AQAA advises that there are generic risk assessments in place to promote safe working practises.The AQAA also showed us that the maintenance of equipment and services is up to date Care Homes for Older People Page 23 of 27 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 24 of 27 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 18 13 To ensure that the internal policy for the protection of vulnerable adults matches that of the local authority. This ensures that staff are trained and have access to the procedures followed in their local authority. 18/10/2009 2 29 19 To ensure that all new staff complete an application form that details a full employment history with an explanation for any gaps in their employment. This ensures that people who use the service are fully protected by the employment practises of the home. 18/10/2009 Care Homes for Older People Page 25 of 27 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 Care Homes for Older People Page 26 of 27 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. 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