Care Home: Henford House Nursing Home

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What the care home does well Henford House is able to provide a wide range of activities for residents. Activities are provided by dedicated staff, who are on duty seven days a week. One relative commented, "The activity programme is unusually varied and well run" another "entertainment of the residents is good, & treated as a priority". Care staff are also involved in activities provision. A relative commented that when their relative "first went there she was quite depressed, and many times staff had their coffee break in her room with her to try and cheer her up."The home tries to ensure that they maintain links with the local community and encourage visitors to come into the home. The home environment is well maintained, with equipment to meet the needs of residents, including residents with a disability. The provider has an established quality audit system. This ensures that quality of the service is regularly reviewed and action taken to improve areas when they are identified. The manager is experienced and this inspection shows that she is able to take action, within the providers established procedures, to improve staff performance and to improve service provision to residents when needed. People expressed their appreciation of the service provided. One person reported "Henford has a friendly and homely atmosphere in the nicest possible way", another "Henford looks after everyone with great care. They provide a nice homely feel and a fun atmosphere" and another "there is a tremendous feel of welcome in Henford House". People also commented on their staff, one person reported "I have nothing but admiration and gratitude for all the staff at Henford House Nursing Home, and would like to congratulate them on their positive, caring attitudes", another "the staff, at all levels, at the home are very caring in their attitude" and another "All the staff cannot be more helpful, cheerful or more caring". What has improved since the last inspection? Four requirements and nine good practice recommendations have been met since the last inspection. Of these, three requirements have been met in full and one showed progress. Seven of the good practice recommendations had been met in full and two showed progress. The home have also identified issues relating to provision of meals and were in the process of working through an action plan to improve meals provision, at the time of the inspection. Care plans are now more comprehensive. Residents who need support in taking in fluids have monitoring charts, which are totalled daily so that the home can assess how much fluids frail people are able to take in. All staff have been trained in safeguarding adults and one of the senior staff takes a lead in the area. The home how fully documents concerns raised informally with staff and records include actions taken to address matters raised. Moneys and valuables held on behalf of residents are now regularly audited. Staff recruitment processes are regularly audited within the company, to ensure compliance with guidelines and the company`s policy. All records relating to induction and training are now completed in full. There are full written records of staff supervision. CARE HOMES FOR OLDER PEOPLE Henford House Nursing Home Lower Marsh Road Warminster Wiltshire BA12 9PB Lead Inspector Susie Stratton Key Unannounced Inspection 22nd May & 3rd June 2008 09:25 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Henford House Nursing Home Address Lower Marsh Road Warminster Wiltshire BA12 9PB Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01985 212430 01985 219789 gill.rocker@barchester.com www.barchester.com/oulton Barchester Healthcare Homes Ltd Gill Rocker Care Home 58 Category(ies) of Old age, not falling within any other category registration, with number (58), Physical disability (5) of places Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP). Physical disability (Code PD) - maximum number of places 5 The maximum number of service users who can be accommodated is 58. 6th July 2006 2. Date of last inspection Brief Description of the Service: Henford House is a home which provides nursing care for up to 58 people. It is an extended period property and work was completed on a further extension during the summer and autumn of 2003. There were 48 persons resident on the day of the inspection. Accommodation is provided over two floors and passenger lifts are provided between floors. Fees range from £1,200 to £426.01. The home was acquired during 2002 by Barchester Healthcare, a provider with a number of care homes across the country. The manager of the home is Gill Rocker. She leads a team of nursing, care, activities, administrative and ancillary staff. Henford House is situated in its own grounds in a residential area of the town of Warminster. There is car parking on site. Many parts of the home offer pleasant views over the adjoining area of open countryside. Warminster is a small Wiltshire market town, to the west of Salisbury Plain. It is situated on the A350 and has a main line station. Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included visits to the service and takes into account the views and experiences of people using the service. As part of the inspection, 60 questionnaires were sent out to residents and their relatives and 37 were returned. Comments made by people in questionnaires and to us during the inspection process have been included when drawing up the report. As part of this inspection, the home’s file was reviewed and information provided since the previous inspection was considered. The home also submitted an annual quality assurance assessment prior to the inspection. As Henford House is a larger registration, the site visits took place over two days, on Thursday 22nd May 2008, between 9:25am and 5:10pm and Tuesday 3rd June 2008 between 9:10am and 1:00pm. The Manager, Gill Rocker was on duty during the inspection. Mrs Rocker was available for the feedback at the end of the inspection. During the site visits, we met with fourteen residents, three visitors and observed care for seven residents for whom communication was difficult, in different parts of the home. We reviewed care provision and documentation in detail for eight residents across all three areas of the home, two of whom had been admitted recently. As well as meeting with residents, we met with five registered nurses, six carers, the training manager, a cook, the senior activities coordinator, the laundress, the maintenance man and the administrator. We toured all the building and observed practice, including a lunchtime meal. We observed systems for storage of medicines and observed medicines administration rounds. A range of records were reviewed, including staff training records, staff employment records, maintenance records and financial records. What the service does well: Henford House is able to provide a wide range of activities for residents. Activities are provided by dedicated staff, who are on duty seven days a week. One relative commented, “The activity programme is unusually varied and well run” another “entertainment of the residents is good, & treated as a priority”. Care staff are also involved in activities provision. A relative commented that when their relative “first went there she was quite depressed, and many times staff had their coffee break in her room with her to try and cheer her up.” Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 6 The home tries to ensure that they maintain links with the local community and encourage visitors to come into the home. The home environment is well maintained, with equipment to meet the needs of residents, including residents with a disability. The provider has an established quality audit system. This ensures that quality of the service is regularly reviewed and action taken to improve areas when they are identified. The manager is experienced and this inspection shows that she is able to take action, within the providers established procedures, to improve staff performance and to improve service provision to residents when needed. People expressed their appreciation of the service provided. One person reported “Henford has a friendly and homely atmosphere in the nicest possible way”, another “Henford looks after everyone with great care. They provide a nice homely feel and a fun atmosphere” and another “there is a tremendous feel of welcome in Henford House”. People also commented on their staff, one person reported “I have nothing but admiration and gratitude for all the staff at Henford House Nursing Home, and would like to congratulate them on their positive, caring attitudes”, another “the staff, at all levels, at the home are very caring in their attitude” and another “All the staff cannot be more helpful, cheerful or more caring”. What has improved since the last inspection? Four requirements and nine good practice recommendations have been met since the last inspection. Of these, three requirements have been met in full and one showed progress. Seven of the good practice recommendations had been met in full and two showed progress. The home have also identified issues relating to provision of meals and were in the process of working through an action plan to improve meals provision, at the time of the inspection. Care plans are now more comprehensive. Residents who need support in taking in fluids have monitoring charts, which are totalled daily so that the home can assess how much fluids frail people are able to take in. All staff have been trained in safeguarding adults and one of the senior staff takes a lead in the area. The home how fully documents concerns raised informally with staff and records include actions taken to address matters raised. Moneys and valuables held on behalf of residents are now regularly audited. Staff recruitment processes are regularly audited within the company, to ensure compliance with guidelines and the company’s policy. All records relating to induction and training are now completed in full. There are full written records of staff supervision. Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3: Henford House does not provide intermediate care, so 6 is N/A Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents have full assessments before admission so that they can be assured that the home can meet their nursing and care needs. EVIDENCE: During the inspection, we met with several residents, some of whom had been admitted recently to the home. Some residents were too frail to recall much of the admission process and reported that they had been supported by their relations who had visited the home on their behalf, prior to admission. However other people reported that they had been actively involved in the decision to be admitted. One person reported on how they had had “a good look around” prior to admission. Another person reported that they chose the home through “local knowledge and reputation”. One person reported, “I came without knowing too much but I have enjoyed each new week as it comes along”. Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 10 All residents have clear and detailed assessment of need drawn up prior to admission. Assessments are performed by the manager or her delegate, all of who are registered nurses. Where additional assessments are needed, for example from the Macmillan Nurses, copies of these assessments are obtained. Staff reported that they are informed of residents’ needs prior to admission, so that they can plan for the person’s admission. On admission, staff complete checklists to ensure that residents are informed of the range of services provided. It was recommended that how to use the emergency call bell be included in this checklist so that people know on admission how to urgently contact staff. After admission further assessments of need are completed, to ensure that the home can meet the resident’s needs. All residents are admitted on the basis of one month’s trial either way. Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents at Henford House will have their health and personal care needs met. The home seeks to improve standards of care and documentation as part of their quality audit process. EVIDENCE: All residents have regular assessments of need completed. Where a resident is assessed as having a need or a risk, care plans are put in place to direct staff on actions to take to meet the need or reduce the risk. Care plans were highly individualised and generally reflected what residents and staff reported and reflected the care observed to be given. Care plans are regularly evaluated and up-dated when indicated. For example a resident who had complex communication needs had a clear care plan about how they were to be supported as they could not use their call bell. Staff were observed to follow this care plan during the site visits. Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 12 One resident who was experiencing changes in their weight had clear evaluations relating to these changes, directing staff on further actions to take to meet the person’s specific changing needs. Where residents had wounds there were very clear care plans, and these were evaluated regularly to assess the wound’s response to treatment. Care plans are regularly audited as part of the provider’s quality audit system. Of the 37 people who responded to this section of the questionnaire, 16 reported that the home always and 21 usually gave the person the care and support that they needed. One person reported “I can’t fault the staff at all”, another “I’ve not been felling very well today & they’ve come and checked on me, they DO care” and another “[My relative] finds it hard to communicate and they work hard to support her needs”. One person commented on how supportive staff were with their continence needs and another person commented on how good staff were with confused people. Where the home cares for frail residents who were unable to change their position independently, the home uses turn charts to ensure that these peoples’ positions are changed regularly, according to need. The standards of completion of these charts continue to need improvement. On the first day, many of the charts did not indicate that people were having their positions changed at the frequency indicated by their condition or in accordance with their care plan. One person’s chart had been finished the previous day but a new chart had not been put out by the end of the first day of the inspection. This was discussed with staff at all levels, who reported that they considered that frail people were having their positions changed regularly but that staff who provided the care did not remember to document this on their records. By the second day of the inspection, some improvements were noted, but several frail residents continued not to have evidence in their records that their positions had been changed regularly. Some records did not state the actual care given, with records stating “checked” without documenting what was checked or if the person had their position changed. Where residents spent some or most of their day in the sitting rooms their charts did not record how often their positions were changed when they were not in their own room. Where people are frail, there needs to be full evidence that their have had their positions changed regularly, to prevent risk of pressure damage. To ensure that the home can demonstrate that they are fully meeting individual resident’s nursing and care needs, some improvements in documentation are recommended. While some care plans documented how often frail individuals needed their positions changing, not all did. Some residents had care plans which documented the equipment to be used to prevent pressure damage when they were in bed but not the equipment to be used when they were sitting out in a chair. Some people who were sitting out in a chair were provided with a lower specification of pressure relieving equipment than indicated by their condition. Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 13 Where this is the case, the reasons why a lower specification of equipment is appropriate should be documented in their records. One person had a risk assessment which indicated that, due to a range of factors they were at high risk of pressure damage. They did not have a care plan about this. This person was at the time of the site visits able to move independently, however as they were at risk they still needed a care plan to direct staff on how their individual needs were to be met currently or if their condition changed, as they were assessed as being at high risk of pressure damage. Where residents had additional mental health care needs, care plans were put in place to direct how these needs were to be met. Some of these care plans need development. One resident’s daily record indicated that they had having specific needs in relation to their mental health; this was not noted in their care plan, which was generalisitc in tone. Another resident’s care plan did not direct staff on what actions to take to meet a specific mental health need. Records and discussions with staff indicated that the home ensures that the advice of external healthcare professionals, including GPs is sought when indicated. One relative reported, “They are in contact with her GP to monitor her pain relief”. One person’s records showed that the tissue viability nurse had been regularly consulted about a person’s complex wound. Another person’s record showed that the community psychiatric nurse’s advice had been sought about their mental health care needs. One resident met with had dental health needs. The registered nurse in charge of the floor was aware of contacts made with the person’s dentist. This had not been documented in their records and this is advised so that all people who may be involved in this person’s care were made aware of the situation and progress. The home has three medicine trolleys and three medicine cupboards for each area of the home. Medicine rounds were observed and all were carried out in accordance with the home’s policies and procedures. All medicines were safely stored and there was a full audit trail of medicines received by the home, given to residents and disposed of. Some residents were prescribed medicines “as required”, such as inhalers or painkillers. Where this is the case, the home needs to develop care plans to direct staff on when and why these medicines are to be administered, to ensure that such medicines are being given by staff in a consistent manner, in accordance with the individual resident’s needs. Some residents are prescribed medicines which can affect their daily lives, such as aperients or mood altering drugs. Where this is the case, it is advisable for care plans to be drawn up so that the effectiveness of such interventions can be regularly evaluated. Residents were prescribed, or chose to use, a range of skin applications and ointments. Where this was the case, some residents had care plans to document their use and records were maintained of their application. Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 14 However this was not the case for all people and one person had a range of at least three different skin preparations in their en-suite, only one of which was documented but the other two were clearly being used. Where residents need such applications, care plans are needed to direct staff on when and where the application is to be used and a be record made of its application in all cases. Staff worked to ensure that residents’ privacy and dignity were maintained. All personal care was provided behind closed doors. Frail residents had well brushed hair and clean fingernails. One resident reported, “I have been treated with courtesy and kindness”. A relative commented on how they appreciated the home “respecting their residents as individuals who, despite their health problems and disabilities, all still can in some way contribute to the whole”. Residents wore their own clothes and a spot check of three residents’ drawers and cupboards in the different areas of the home, showed that all clothes observed had been labelled with the person’s name and returned to them. Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence, including visits to this service. Residents are supported in choosing how they spend their daily lives. The home regularly reviews services to residents and makes improvements where needed. EVIDENCE: Henford House employs activities coordinators seven days a week. These people are also prepared to work flexibly. They are led by a very enthusiastic person, who reported that she and her team regularly review activities provision and change as needed. This was because, she reported, “we don’t want to stagnate”. The home has an activities room and activities are also provided in the lounges or individually in peoples’ rooms. Activities are flexible, providing large group, small group and individual activities. One person reported, “The people here, they all enjoy it” about the activities, another “We’re doing all different things” and another “The activities organised are the best and certainly keep minds active!” Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 16 Several people commented particularly on the pottery classes and they showed us the range of ornaments that they had made themselves and decorated. One person reported, “I love the potting – I really enjoy that, I never thought I could do such things”. Relatives reported that the activities had made a real difference to people. One person reported “the staff have been wonderful in as much as my relative wouldn’t partake of any of the activities to one who now looks forward to them.” All residents have a care plan about their social needs, which is regularly reviewed. Activities records provided evidence of the range of activities each person had decided to be involved in. Activities staff had a good knowledge of individual peoples’ needs. Care staff are also involved. All care staff work with activities staff as part of their induction. Care and nursing staff regarded resident interaction as part of their roles. One care assistant was observed during the afternoon sitting with one very frail resident, holding their hand and talking quietly with them. Another carer described one resident who preferred not to leave their room, but who very much enjoyed people popping in for a chat and how she tried to do this as much as she could, around her other duties. The senior activities coordinator reported that she worked at establishing close links with the local community, including the churches, the library and schools. One relative reported that their relative’s “spiritual needs are being met now e.g. Alpha course, Bible study, services, discussions with [one of the activities organisers]. She has been able to explore and deepen her faith and has gained comfort and support through that.” The manager reported that it is planned that the home will have a minibus to take people out in the next financial year. A mobile shop is now provided where residents can purchase sundries. One person reported on how they appreciated that “Visitors can come here and have a cup of tea – I think it’s very good – makes it more homely and friendly”. Staff reported that they supported people in choosing how they spent their lives. One person reported “you may participate or not”, another “there’s plenty of entertainment and I can stay in my room” and another on how it was up to them when they got up and went to bed. One registered nurse was observed to spend some time with a resident discussing whether they wanted a bath that day or would prefer to wait for another day. The resident was allowed to come to their own decision about this matter and not put under any pressure to make a decision quickly. The manager reported that the issue of meals provision had been a matter of concern for some time and that, together with her line manager, they had developed a range of action plans to address concerns. At the time of the inspection, a new chef and assistant chef had been appointed, training had been provided to kitchen staff and menus were planned to be reviewed. Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 17 One person reported, “The recent appointment of a new lady chef is pointing in the right direction. Meals have definitely improved and residents are feeling quite optimistic.” The assistant chef was met with and he had a good understanding of his role and responsibilities. A mealtime was observed. The meal was largely well organised, particularly by the care staff. Catering staff may need more supervision at mealtimes to ensure that the meal is not delayed by a lack of menu sheets for care staff and implements needed to serve the meals. Many residents chose to eat in the dining room but they could also eat in their own rooms if preferred. Staff were available to support residents during the mealtime. It was observed that two residents did not wish the menu choice, one asked for an omelette and another for bacon, eggs and chips. These were freshly cooked at the time of the meal. Where residents ate in their own rooms, these were delivered promptly to them, with senior staff supervising more junior staff. It was noted as very good practice that despite the frailty of many residents in the home, that very few people needed liquidised diets. Staff reported that they tried to encourage residents to eat normal diets for as long as possible, providing soft alternatives if indicated. It was also observed that very few residents needed assistance to eat their meals, with relevant aids being provided where needed and staff encouraging residents to be independent in feeding themselves. It was noted that if residents did feed themselves in an untidy manner, this was allowed and that resident’s clothing was discretely and promptly changed after the meal. Staff are to be congratulated on all their efforts to ensure that frail residents retain their independence at eating. Residents were offered a choice of drinks at their meal, including wine and beer. Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents will be protected by the home’s polices and procedures on safeguarding people, have their complaints listened to and action taken when needed. EVIDENCE: Henford House has a complaints procedure, which is available in the home’s service users’ guide and is displayed in the entrance area. Of the 36 people who responded to this section of the questionnaire, 32 reported that they knew how to make a complaint. One person reported, “I feel I would be able to go and sit down and discuss the situation with them”, another “There is always someone to talk to” and another “I tell whoever is looking after me at the time it applies”. One resident reported on a particular issue that they had had and that they had spoken to the manager and this it was resolved. Relatives also reported that they complained if they needed to and that they felt listened to. Three complaints have been received by us in the two years since the last inspection, all were passed back to the provider, who investigated the matters and took action to address matters where relevant. Compliance with the home’s own policy and procedure on complaints investigation is part of their quality audit process. Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 19 The home has a safeguarding policy. Staff spoken with were aware of this policy. All staff are trained on the procedure at induction and regularly following this. One member of staff leads on this issue and supports staff in developing their understanding of the area, to ensure that residents are fully supported. All staff are safely recruited. Six referrals relating to safeguarding elderly people have been made since the last inspection, two years ago. All had been made by the home itself in support of different vulnerable people. Some matters were referred back to the home for investigation and action; others were taken up by relevant professionals to support people. The number of referrals by the home to relevant persons indicates that staff and management are fully aware of the policy and how vulnerable people need to be safeguarded. As noted in standard 7 above, areas relating to records of how the home protects vulnerable people from risk of pressure damage needs to be improved. Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence, including visits to this service. Residents are provided with an environment which is well maintained, clean and where equipment needed to meet their needs is provided. EVIDENCE: Henford House is a large home. Care is provided over two floors, with passenger lifts in-between. Parts of the home are in an older building, with a large purpose-built extension, which has been further extended to the side. All rooms are large and exceed minimum standards. The home employs a permanent maintenance man who knows the building well and who responds quickly when issues are identified. One resident reported “My toilet was blocked and the man has unplugged it already”. There is a system for reviewing the home environment and plans are put in place for up-grading when indicated. Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 21 There are a wide range of different communal rooms, which support larger or smaller group activities. There are wheelchair-accessible, well-kept gardens. One resident reported on the “very nice view” from one of the sitting rooms. Some rooms have direct access to the garden areas; other rooms have access to their own balcony. One relative reported, “Henford House Care Home is of a good standard set in lovely surroundings”. A wide range of equipment is provided to meet the disability needs of residents. All beds are variable height and many of them are profiling. A wide range of hoists and slings are provided for residents who need assistance to move and staff were observed to be competent in their use. Where residents are at risk of pressure damage, equipment is provided to reduce this risk. A range of systems for people to summon staff are provided to meet the needs of individual residents. For example one resident who had limited ability to move had been provided with an aid that they could use by moving the one part of their body which they could move. The home was clean throughout, with no dust or debris observed on low or high surfaces. One resident commented, “Everyone seems to work so hard so the home is always wonderfully sparkling”. The laundry was clean and well organised. The laundress reported that staff work fully within the home’s policies and procedures for prevention of spread on infection. Staff reported that they had a ready supply of gloves and aprons and were observed to use them correctly. Registered nurses reported that they had a fully supply of sterile gloves to perform wound dressings. Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents are supported by a mix of staff who are safely recruited and trained in areas relating to the needs of residents. EVIDENCE: Henford House employs a range of staff to meet residents’ needs; this includes care staff, registered nurses, catering staff, ancillary staff, activities staff and administrative staff. Registered nurses and care staff work throughout the 24hour period. One person reported, “there are staff at every kind of level” and a visitor reported, “there are several levels of staff with the required expertise”. As the home is large, it is divided into three areas for allocation of staff, so that residents are cared for by people who they can become familiar with. The manager reported that they had recently moved staff around and were reestablishing the key worker system. This was commented on by some residents and relatives. As would be anticipated in any larger home, some people felt that the home was short of staff. The manger reported that staffing is regularly reviewed. She was advised that in order to ensure that all people are informed of the current staffing levels, including staff, residents and relatives, she should inform them of the numbers and skill mix anticipated to be on duty each shift. Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 23 She agreed to consider including this in the service users’ guide. Many people felt that response when the nurse call was used was slow or that staff said that they would come back when they had rung their bell and then did not do so. One person reported, “they don’t always respond to the call bell quickly enough, especially when I need the toilet” another person “you ring your bell and you wait” and another “one of my biggest complaints is about the bell, they can be very slow in answering the bell”. One call bell was used during the inspection and a member of staff attended in less than two minutes. Printouts of when the call bells were used were reviewed and whilst most responses were under two minutes, a few were much in excess of this. There was evidence that the manager was investigating reasons for this. The manager agreed to include response times to the call bell and staff performance when call balls were rung, in their regular quality audits. The files of three recently employed staff were reviewed. All staff provided an employment history and proof of identity. All staff had police checks and completed a health questionnaire. All staff provided two references and if a reference was not informative, a third reference was obtained. Staff from abroad had their employment status verified. Staff are generally interviewed using an interview assessment tool. However for one person, this was not the case and this is advisable that this takes place for all staff. Staff records are regularly audited as part of the provider’s ongoing quality audit systems. The home employs a part-time training manager. This person performs inductions and coordinates training for all staff. She also works alongside staff as a member of the team and in support of staff. The home’s induction complies in full with current guidelines. National Vocational Qualifications are supported. The training manager maintains a matrix of training provided and follows up attendance at mandatory training with staff. Other areas of training are supported, for example training has recently been provided in dementia care, prevention of pressure damage and diabetes. Care staff spoken with all reported on how training was supported by the home. Several members of staff had been delegated to lead in different areas, they attended external training and cascaded training on to other staff. Nursing and care staff knew about the nursing and care needs of their residents and how they could be met from within the home. Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents benefit from a well managed home, quality of service provision is regularly assessed and the principals of health and safety are up-held. EVIDENCE: The manager of the home, Mrs Rocker has come into post since the last inspection two years ago. She has been approved by us to be the manager. Mrs Rocker is an experienced manager who had held similar posts for other homes owned by the provider and elsewhere. She holds the Manager’s Award and is a registered nurse. Mrs Rocker is aware of her responsibilities towards resident care and evidence from records showed that she is able to take effective action to improve performance when indicated. Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 25 The provider, Barchester Healthcare has established systems for measuring quality and regular audits are held relating to a wide range of areas. Regular visits take place to the home by a senior manager; these are unannounced and can take place at any time during the 24-hour period. Managers’ reports of visits are objective and include matters which need to be addressed as well as areas of good practice. As part of the audits, “mystery” callers contact the home throughout the 24-hour period, to assess response times to external calls. The manager completed a comprehensive annual quality assurance assessment to inform this inspection. As part of their quality audits, the home needs to ensure that it complies in full with requirements and acts on good practice recommendations from previous inspection. The home does not look after any money for residents. All payments for items such as newspapers, hairdressing and sundries are dealt with via a monthly invoicing system. There is an audit trail of items handed in to the office for safekeeping. It was identified that one item of value had temporarily been handed in to the nursing staff, this had been stored in the controlled drugs cupboard and there was no audit trail relating to this item, although staff did know about it. Where this takes place, items must be securely stored in a cupboard away from the controlled drugs cupboard and a full documentary system must be in place to state when the item was handed in, given back and any other relevant particulars relating to the item. There is a system for regular supervision of staff. Senior staff were observed to be supporting more junior staff throughout the inspection, guiding and advising them where necessary. As noted in Standard 7 above, some staff are not completing all documentation required of them in relation to turn charts. It is advised that this be included in daily supervisions, so that responsibility for completion of such charts is clear and ensures that staff do complete necessary records. All staff are regularly trained in matters relating to health and safety, such as manual handling and fire. There are effective systems to ensure that staff do attend mandatory training. Different methods are used to support staff, including distance learning and group training. Some members of staff reported that they found small group training the most effective as they could learn more easily from the trainer and each other. Regular health and safety meetings take place. All equipment and services are regularly maintained and the maintenance man keeps very clear documentation relating to regular servicing of equipment. These records are simple to audit. Where residents need safety rails or lap belts, full assessments are completed, and these are regularly audited. It is recommended that assessments for lap belts include risks of sliding down in a chair, as this has occurred in other homes in the past. Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 X 4 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 3 X 3 Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13(4)(c) Requirement Where a service user has a monitoring chart in place to ensure that they have their position moved regularly to prevent risk of pressure damage, the monitoring charts must be regularly completed at the time care was given. Timescale for action 30/06/08 2. OP9 3. OP35 Requirement IN PROGRESS from the last inspection. Previous compliance date 31/8/06 13(2) Where a person is prescribed a 31/07/08 medication on an “as required” basis, there must always be a care plan drawn up to direct staff on the protocols for use of the drug. 17(2)Sce4 All valuables handed in for 30/06/08 (9) safekeeping must be correctly stored in accordance with legislation and a full written audit trail maintained. Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP7 Good Practice Recommendations The home should set out the numbers and skill mix of staff aimed for at different times of the day in their service users’ guide, to fully inform people. Where a service user has a care plan relating to prevention of risk of pressure damage, the care plan should state how often the service user’s position needs to be changed. If a lower specification of equipment is being used than that indicated by the person’s condition, this should be documented. Parts of this recommendation are in progress from the last inspection. Precise, measurable wording should be used in nursing and care documentation, words like “checked” should be avoided. All matters known about a person should be documented. Parts of this recommendation are in progress from the last inspection. Where a person is assessed or shown to have a need, such as risk of pressure damage or a mental health care need, care plans should take into account all factors and be clear about actions to be taken to meet the person’s need. Where a person is prescribed a drug which can affect their daily lives, a care plan should be put in place, so that the effectiveness of the treatment can be assessed. Catering staff should ensure that care staff have all the information and equipment they need before a meal, to prevent residents from having to wait for a longer period than necessary to commence the meal. People interviewing prospective staff should always use the home’s interview assessment tool for all prospective staff. Staff performance in response to call bells should be included in the homes regular quality audit systems. 3. OP7 4. OP7 5. 6. OP9 OP15 7. 8. OP29 OP33 Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 29 9. 10. OP36 OP38 Staff performance in completing records of daily care should be included in daily supervisions. Risk assessments for use of lap belts should include the risk of a person sliding down the in their chair. Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Henford House Nursing Home DS0000015917.V349133.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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