Care Home: Hook Hall

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What the care home does well The home has an enthusiastic team of people working within the service, who like doing their jobs and learning more about how to do it well. The people working in the home want to make sure that the people who live in the home receive good care. People we spoke to told us that `we get the best care and attention, it is like living in a 5 star hotel`. All of the people spoken to are positive about the home and like living there. People living in the home and relatives expressed their satisfaction during this visit regarding the care given, service received and the living environment of the home. Staff are hard working and do their best to meet the needs of those people living in the home. Relatives told us that `the manager and staff never give up trying to improve the quality of life for those people who live in the home. They don`t just look after people they give them back the will to live`. People being cared for have good access to professional medical staff and are able to access external services such as dentists, opticians, physiotherapists, chiropody and dieticians, so their health is looked after and they are kept well. Individuals told us that `the manager and staff act on any concerns immediately, they do not hesitate to contact medical professionals for help and advice`. People living in the home said they are offered a good choice of meals and they enjoyed the quality of food. Specific wishes are catered for and they have plenty to eat and drink throughout the day. One person told us `the meals are always well presented and hot, the crockery and cutlery are clean and the dining rooms set out nicely`. Relatives of the people living in the home said that they are made to feel welcome by the people working in the home and that they can visit when they please. What has improved since the last inspection? People working in the home are checking and recording the temperature of hot water outlets to ensure people using the service are protected from the risk of scalds or burns. People using the service have been provided with lockable boxes for their bedrooms, in which they can keep medication if they self-medicate or personal possessions/valuables. An up to date electrical wiring certificate has been obtained for the home and appropriate checks carried out. These three issues were requirements in the last report and have now been met. What the care home could do better: The home has no requirements from this report. Two good practise recommendations have been made about medication as a result of this visit. We would like to thank everyone who took the time to complete a survey and/or talk to us during this visit. Your comments and input have been a valuable source of information, which has helped create this report. CARE HOMES FOR OLDER PEOPLE Hook Hall High Street Hook Goole East Yorkshire DN14 5PL Lead Inspector Eileen Engelmann Key Unannounced Inspection 4th August 2008 09:15 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 Hook Hall DS0000019683.V369551.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. Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hook Hall Address High Street Hook Goole East Yorkshire DN14 5PL 01405 767891 F/P01405 767891 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr James Douglas Ford Mrs Margaret Elizabeth Wrightson Care Home 21 Category(ies) of Dementia - over 65 years of age (21), Old age, registration, with number not falling within any other category (21) of places Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th September 2006 Brief Description of the Service: Hook Hall is a privately owned care home that lies within its own grounds on the edge of the quiet village of Hook, and is a listed building. The home is registered to provide care and accommodation for 21 older people, including those with dementia. The property is extremely well maintained both inside and out, and the communal spaces and bedrooms are in keeping with the original features of the hall. All bedrooms are single, and sixteen of these have en-suite facilities. People using the service are able to access all areas of the home via the use of a passenger lift and ramps. There is a car park to the front of the building. Services in the village are limited to a post office/shop and a village pub, but the registered provider frequently transports people into the nearby town of Goole for shopping and for visits to health professionals, family/friends and social events. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home, and copies are on display in the entrance hall of the home. Information given by the manager during this visit (04/08/08) indicates the home charges fees from £370 to £410 per week. The level of fee is dependent on the type of care required. People will pay additional costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Information on the specific charges for these is available from the manager. Hook Hall DS0000019683.V369551.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 3 stars. This means that the people who use this service experience excellent quality outcomes. Information has been gathered from a number of different sources over the past 12 months. This has been analysed and used with information from this visit to reach the outcomes of this report. This unannounced visit was carried out with the registered provider, manager, staff and people using the service. The visit took place over 1 day and included a tour of the premises, examination of staff and people’s files, and records relating to the service. Informal chats with a people living in the home and one relative took place during this visit; their comments have been included in this report. Questionnaires were sent out to a selection of people living in the home and staff. Their written response to these was good. We received 5 back from staff (50 ) and 8 from people using the service (80 ). One relative also asked for a questionnaire to complete during this visit. The manager completed an Annual Quality Assurance Assessment and returned this to the Commission within the given timescale. Since the last visit in September 2006 we completed an Annual Service Review in October 2007. An Annual Service Review is part of our regulatory activity and is an assessment of our current knowledge of a service rather than an inspection. The published review is a result of the assessment and does not come from our power to enter and inspect a service. What the service does well: The home has an enthusiastic team of people working within the service, who like doing their jobs and learning more about how to do it well. The people working in the home want to make sure that the people who live in the home receive good care. People we spoke to told us that ‘we get the best care and attention, it is like living in a 5 star hotel’. All of the people spoken to are positive about the home and like living there. People living in the home and relatives expressed their satisfaction during this visit regarding the care given, service received and the living environment of the home. Staff are hard working and do their best to meet the needs of those Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 6 people living in the home. Relatives told us that ‘the manager and staff never give up trying to improve the quality of life for those people who live in the home. They don’t just look after people they give them back the will to live’. People being cared for have good access to professional medical staff and are able to access external services such as dentists, opticians, physiotherapists, chiropody and dieticians, so their health is looked after and they are kept well. Individuals told us that ‘the manager and staff act on any concerns immediately, they do not hesitate to contact medical professionals for help and advice’. People living in the home said they are offered a good choice of meals and they enjoyed the quality of food. Specific wishes are catered for and they have plenty to eat and drink throughout the day. One person told us ‘the meals are always well presented and hot, the crockery and cutlery are clean and the dining rooms set out nicely’. Relatives of the people living in the home said that they are made to feel welcome by the people working in the home and that they can visit when they please. What has improved since the last inspection? What they could do better: The home has no requirements from this report. Two good practise recommendations have been made about medication as a result of this visit. We would like to thank everyone who took the time to complete a survey and/or talk to us during this visit. Your comments and input have been a valuable source of information, which has helped create this report. Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 7 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. Hook Hall DS0000019683.V369551.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 Hook Hall DS0000019683.V369551.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, 4 and 6. People who use the 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 wanting to use the service undergo a needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met. EVIDENCE: The people and relatives we spoke to said they received sufficient information to make an informed choice about the service before accepting the placement offer. These individuals have also received a contract/statement of terms and conditions from the home and this is updated every year as fee levels change. Each person has his or her own individual file and the funding authority or the home, before a placement is offered to the individual, completes a need assessment. The four files looked at during this visit were for one funded individual and three self-funding people. Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 10 The home develops a care plan from the assessments, identifying the individual’s problems, needs and abilities using the information gathered from each person and their family. Information is gathered during the assessment around issues of equality and diversity, such as age, disability, gender, sexuality, race and religion/beliefs and this is put into the care plan. Discussion with the manager indicated she goes out to assess individuals who have expressed an interest in coming into the home, and each person is given information about the service and life in the home. People using the service and relatives are very pleased with the care and support given by the staff, they said ‘This place is wonderful and I would recommend it to anyone who needs care.’ and ‘my parent came in on an emergency placement after a fall. So we had time to get to know the home and personnel, read literature and reports before my parent made a choice to stay. Luckily there was a vacancy’. Information from the Annual Quality Assurance Assessment and discussion with the manager and people living in the home indicates that all of the people are of white/British nationality, and everyone is currently of Church of England or Catholic faith. The home does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. The manager told us that the home looks after a number of people from the local community, although placements are open to individuals from all areas. Checks of the staffing rotas and observation of the service showed that the majority of the staff are white/British and all the care staff are female. Discussion with the manager indicates that there is no male care staff due to a lack of suitable applicants, and that an equal opportunities policy is used when employing people. Staff members on duty were knowledgeable about the needs of each person they looked after and had a good understanding of the care given on a daily basis. Discussion with three people showed that they were satisfied with the care they receive and have a good relationship with the staff. One person said ‘these girls are great, nothing is too much trouble for them and they take the time to see you are okay and have a laugh with you’. The staff training files and the training matrix show that new staff go through an induction before starting work and that the home has a training programme in place. Information from the training files indicates that the majority of staff are up to date with their basic mandatory safe working practice training, or they are booked onto training in 2008. The home is registered with us to accept placements for people with dementia and the manager is aware of the need for Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 11 robust staff training around dementia and challenging behaviour to ensure the staff are able to meet people’s needs. A number of staff received training on management of challenging behaviour in 2008 and are waiting for their certificates from the training company, they also have undertaken training around sensory deprivation, diabetes and other conditions specific to the group of people living in the home. The home does not have any intermediate care beds and therefore standard six does not apply to this service. Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, personal and social care needs of the people living in the home are clearly documented, and are being met by the service and staff. The staff have a good understanding of people’s support needs. This is evident from the positive relationships, which have been formed between the staff and people using the service. EVIDENCE: Information from this visit indicates that the people who spoke to us are extremely satisfied that the staff give appropriate support and care to those living in the home. People said they are able to make their own decisions about their daily lives most of the time; that staff treat them well and listen and act on what they say. Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 13 One individual said ‘the care we get is excellent, there is no waiting for attention if you need help and my own health has improved tremendously since coming into the home’. Relatives are also very pleased with the service, one person said ‘The manager is on the ball and very knowledgeable. She understands the feelings and needs of the family. We find this especially valuable as we live some way from the home’, and another told us that ‘ when I leave my relative I know they are in good hands and I have peace of mind about their welfare’. The care of four people was looked at in depth during this visit and included checking of their personal care plans. The content of the plans is clearly written, easy to follow and on the whole completed to an acceptable standard. Care staff have been given guidance and support to enable them to use the computer to carry out monthly evaluations, risk assessments and review notes. Positive aspects of the plans include risk assessments for moving and handling, nutrition, pressure sore development, falls and individual choices regarding activities of daily living. Weights are recorded monthly, and evidence was seen that staff are contacting outside health professionals for advice and visits were needed. Peoples’ choices and preferences are clearly recorded and individuals and families are able to input to the care plans during care reviews and the monthly evaluations. The relatives spoken to said that ‘the staff are extremely conscientious about letting us know how our relative is doing and informs us immediately of anything that affects their wellbeing’. People said that they have good access to their GP’s, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Comments from the people and relatives indicate they are satisfied with the level of medical support given to the people living at the home. One relative told us that ‘there is never any hesitation from the staff or manager to call out a GP, District Nurse or dial 999 when needed. Our parent’s health has improved since they came into the home, from being confined to bed they are now able to weight bear and go out in a wheelchair’. Information given to us in the Annual Quality Assurance Assessment indicates that no one at the home has a pressure sore, and discussion with the manager indicates there is a good relationship with the District Nurse team who provide staff with advice and help around this area of care. The home has accessed specialist, profiling beds from the community team, for people who are deemed at risk of developing pressure sores and pressure care mattresses and Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 14 cushions are also in use. Outside agencies have visited the home to provide training for the staff, relating to care of elderly skin, pressure care and oral care. Satisfaction questionnaires about the service have been sent out to local GP’s and other medical professionals who visit the home and input to the care of the people who live there. Their feedback is extremely positive about the way the service is run and the quality of life for those people they visit. Nutritional risk assessments are completed and the staff weighs everyone on a regular basis. Evidence in the plans show that dieticians are called out if the home has particular concerns about an individual. The medication policy for the home says that individuals can self-medicate if they want to and after a risk assessment has been completed and agreed. These were seen in the care plans. One person who we spoke to likes to administer their own inhalers and use their nebuliser independently, when staff have given them the appropriate medication. Staff retain a responsibility to ensure the person is taking medication correctly and appropriately and to keep records to show how this is being monitored, at the moment the medication charts only say the person is self-medicating. It is recommended that the care plan clearly show what medication the person is self-medicating, and include the frequency of checks that staff are doing to monitor that the person is managing their medication successfully. Checks of the medication records show that overall these are well maintained and kept up to date and the controlled drugs and register are monitored carefully, stored correctly and records are accurate. The care plans have a photograph of people in them but not the medication records. It would be good practise to have positive identification (photograph) of each person using the service, in the medication records to ensure agency staff or new staff are clear that medication is being administered to the right person. Discussion with the manager and staff indicated that staff have completed appropriate medication training using a distance learning package and have also had training provided by ‘Boots the Chemist’ who is the pharmacy supplying the home. People and relative comments show they are very satisfied with the care and support offered by the staff. Chats with people using the service revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Individual comments were that ‘the staff are great, they look after us well and couldn’t be more helpful’, and ‘I like to try to be as independent as possible Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 15 and the staff respect this, but when I am struggling to manage they offer assistance and don’t make me feel useless’. One relative told us that ‘the staff are very good, our relative was extremely frail and staff have built him/her up and brought them back to life with love and care’. Observation of the service showed there is good interaction between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives. Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with choice and diversity in the meals and activities provided by the home. Individual wishes and needs are catered for and people have the option of when and how they participate in mealtimes. EVIDENCE: Activities at the home are mainly a low-key affair, with staff carrying out recreational activities on a daily basis. Information about forthcoming events is on display in the home and there is an informal weekly programme that changes depending on peoples’ preferences. Outside entertainers are booked every month and people have a choice of daily quizzes, sing along classes, a reminiscence group and an exercise class. Individuals also attend a motivational group session in the home and go out to craft classes at the local council offices, or attend the HERIB group on a Friday. The mobile library visits every six weeks and this provides reading books and audiotapes for people to enjoy. Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 17 People told us that ‘there are enough things for me to do’, ‘I can join in when I want to’ and ‘I like to spend time on my own and the staff respect this’. One person told us that they were perfectly happy with reading the newspaper, watching television and going out for a walk, they did not wish to join in with the group activities and the staff respected their wishes. Information from people’s files indicates that there are a number of individuals who follow the Church of England and Catholic faiths. The manager said that at the moment there is no in-house service, but people can access the local churches and some people attend on a regular basis. The home helps people celebrate all major Christian festivals such as Easter, Harvest Festival and Christmas. Birthdays in the home are always celebrated in the way that the individual requests, this may be a trip out, a special tea or just quietly with family. Discussion with the people living in the home indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family. Visitors were seen coming and going during the day, staff were observed making them welcome and there clearly was a good relationship between all parties. Relatives and visitors to the home are very positive about the service and the staff. Comments made to us on the day of this visit showed a high level of satisfaction. Individuals said ‘they have created a friendly, kind and clean establishment. The level of care is exceptional. The food is good, nourishing as well as appetising. There is a family atmosphere’ and ‘there is always a welcome and very pleasant feeling when you visit. Everything is very clean – no unpleasant odours and I feel it is well run. My relative is very happy there and I have peace of mind’. One person said ‘the home deserves top star rating, not only for the building but also the staff’, and another commented that ‘this is a well run home, and staff are always helpful and caring’. The home acts positively to promote people’s independence and will offer individuals support to achieve this aim. People spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. There is some information and advice on advocacy and this is on display within the home and within the care plans. Meetings for people using the service and their relatives are held every 3 months; these are used as an opportunity for individuals to express their ideas of what activities they want and to give their feedback on events that have taken place. Satisfaction questionnaires are sent out on a regular basis and Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 18 people feel that their comments are listened to and changes made to the service as needed. The manager has obtained information about the Mental Capacity Act and Disability Discrimination Act, and staff have attend some training around these issues, but the manager feels that this can be improved upon and plans further sessions later on in the year. Comments from the people living in the home and their relatives are on the whole very positive about the meals and kitchen service provided. Individuals said ‘the dining rooms are very clean and the food is excellent’, ‘I love the meals and have a good appetite’ and ‘we get three good meals a day and there are drinks available whenever we want one’. The lunchtime meals were well presented and offered a good choice of food. Staff were organised when serving the meal and they understood the preferences and dislikes of each individual so the meals served suited individuals regarding size of portions and addition of gravy. Additional staff are on duty to assist those who have difficulties eating and drinking and people have a choice of having their meals in the dining rooms or in their own bedroom. Staff have attended Nutritional training provided by the East Riding of Yorkshire Council, and nutritional risk assessments are completed for everyone in the home and reviewed regularly. The speech and language specialists have input into the care of some people in the home and specialist diets for those with swallowing difficulties are in place. Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the 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 has a satisfactory complaints system with some evidence that people’s views are listened to and acted upon. The home has an open culture where individuals feel safe and supported to share any concerns in relation to their protection and safety. EVIDENCE: We received a concern about care practises in the home (January 2008) and this was passed onto the provider to investigate. The provider responded promptly and his investigation showed no evidence of poor care practises. A copy of his investigation is in the complaints file. The home has a complaints policy and procedure that is found within the statement of purpose and service user guide. It is also on display within the home. The policy is available in a standard print or a larger print for those with sight difficulties. People’s responses showed individuals have a clear understanding about how to make their views and opinions heard and those people spoken to said ‘the manager and provider are always on hand and willing to listen’ and ‘I am able to express any issues that I may have, but have never had cause to in this Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 20 home. I am confident that should I raise anything with the manager it would be taken seriously and dealt with quickly’. Relatives are aware of the complaints procedure and are confident of using it if needed. Those who spoke to us said that the manager was efficient and effective in answering queries and they were satisfied with her actions. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of people’s money and financial affairs. The Annual Quality Assurance Assessment says that the manager has recognised the need to carry out further training relating to the safeguarding of adults. Checks of the staff training files show that individuals have attended safeguarding training in the past and are booked onto an update course in September 2008. The outside company, Mulberry House, has delivered challenging behaviour training. Staff have watched DVD’s about this type of behaviour and answered questionnaires relating to the subject. They are currently waiting for their certificates. The staff on duty displayed a good understanding of the safeguarding of adults procedure. In their training files they have copies of the homes policies and procedures around reporting abuse (whistle blowing) and recognising different types of abuse. They are confident about reporting any concerns and certain that any allegations would be followed up promptly and the correct action taken. The manager understands how to make a safeguarding referral to the appropriate authorities and has a copy of the local policies and procedures to follow in the event of an allegation of abuse being made. Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 21 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, 22, 24, 25 and 26. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The living environment within the home is appropriate for the particular lifestyle and needs of the people who use the service, and is homely, clean, safe and comfortable and well maintained. EVIDENCE: Hook Hall is a listed building within the small village of Hook. The provider has worked extremely hard to provide people using the service with comfortable and homely surroundings, whilst retaining the character and elegance of the Hall. We walked around the building and found it satisfactory and suitable to meet the needs of the people using the service. The home has an ongoing Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 22 maintenance and refurbishment programme; the decoration of the home is to a high standard and the furnishings and equipment within the building are of a good quality. The domestic staff do an excellent job of keeping the premises clean and odour free and visitors told us that ‘the home is immaculate’. The two dining rooms are bright and spacious and have suitable chairs and tables that make eating a more enjoyable experience for people using the service. People and visitors have access to a small kitchen area and can prepare their own drinks and snacks if wished. There are two lounges for people to sit in and individuals were seen socialising in these areas during the visit. People have access to a large and well-maintained garden, containing a wide range of fruit trees, lawned areas and planted beds. Staff were seen taking people out for a walk in their wheelchairs along the footpaths and down into the village. The home is not purpose built as a care facility, but provides a lift and stairs for access to the three floors offering accommodation and communal living space. Ramps and flat walkways provide access to the exterior of the home and handrails are provided in the corridors to aid peoples’ mobility inside. There are a number of the people using the service who are independently mobile or can walk with assistance, and they enjoy having the ability to get around the home ‘under their own steam’. Staff told us that there is sufficient moving and handling equipment within the home to meet the needs of the less able people and this includes a bath hoist and a manual hoist. At the last visit in September 2006 a requirement was made that ‘a lockable facility must be provided in each of the residents’ rooms for the storage of medicines, money or valuables’. Checks at this visit show that people are provided with a lockable metal box to keep their medication or personal belongings in. The requirement is met. There are twenty-one single rooms providing accommodation in the home, sixteen rooms have an en-suite facility and ten of these include a bath. Those bedrooms seen were comfortable and well personalised. The people we spoke to are full of praise for their personal rooms, saying ‘the furnishings, bed linens and towels are always lovely and clean’, and ‘the home is beautifully clean and well decorated’. Individuals commented that ‘the toilets and bathrooms are cleaned every day’, ‘I have an en-suite room, a comfortable bed and my sheets are issued and changed whenever needed. My washing is done every day and brought back ironed and well presented’. Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 23 At the last visit in September 2006 a requirement was made that ‘the registered person must review the arrangements for the monitoring of hot water temperatures from water outlets to which residents have access to prevent risks to residents’. Checks at this visit show the staff are recording weekly water temperatures and the requirement is now met. Discussions during this visit indicate that people using the service are satisfied with the laundry service provided by the home. Infection control policies and procedures are put into practice within the home, and communal bathrooms have paper towel and hand wash dispensers in place. Staff have received infection control training and use personal protective equipment (gloves and aprons) when giving care. Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the 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 morale is high resulting in an enthusiastic workforce that works positively with people to improve their whole quality of life. EVIDENCE: Comments from the people using the service and relatives are very positive about the staffing levels within the home, and individuals feel that there is a good standard of care being given to the people living in the home. People we spoke to said’ the staff are wonderful, they are always around if you need them and nothing is too much trouble’. At the time of this visit there were 21 people in residence and the staffing rota showed that the following staffing levels are in use 7:30am to 2:30pm – 4 care staff on duty 2:30pm to 9:30pm – 3 care staff on duty 9:30pm to 7:30am – 2 care staff on duty These hours include the manager and in addition two members of staff come in at 12 noon to help out with lunches. Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 25 Information from the manager and the staffing rota about the number of care hours was used with the Residential Staffing Forum Guidance, and showed that the home is meeting the minimum hours asked for in the recommended guidelines. 63 of care staff at the home have an NVQ 2 or above in care and five more staff are in the process of completing this training. The home has a mandatory staff training programme in place and information from the staff training matrix indicates that the majority of the staff are up to date with this or are booked onto refresher training for 2008. Each staff member has their own training file and evidence from these indicates the home has offered training around safeguarding of adults, chronic obstructive pulmonary disease, sensory deprivation, catheter care, diabetes, skin care, diet and nutrition and customer care in addition to the mandatory subjects of safe working practises. Staff receive regular supervision and appraisals to monitor and discuss work experience, and ensure they have the right skills and knowledge to meet the needs of the people using the service. The home has provided staff with a training room, this offers individuals a quiet environment in which they can watch training video’s/DVD’s, read current literature on the care profession and specific training subjects and complete their NVQ work. The home has recruitment and equal opportunities policies and procedures that the manager understands and uses when taking on new members of staff. We checked four staff files during our visit including two for fairly new members of staff. These were up to date, well kept and easy to follow. All police checks (Criminal records bureau and POVA first) and references were in place and had been obtained before the individuals started work. Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is good and the home regularly reviews aspects of its performance through a robust programme of audits and consultations, which includes seeking the views of people using the service, staff and relatives. EVIDENCE: Mrs Margaret Elizabeth Wrightson is the registered manager for the service and has been in post since the home opened 13 years ago. She has recently completed her registered managers award and is waiting for her certificate. Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 27 Staff told us they feel supported by the manager and there is an open door policy so they can go to her at any time if they need advice or help. Comments from the staff, people using the service and their relatives are all positive about the management approach within the home saying ‘the home is of a high standard. The manager is hard working, easy to talk to and approachable’, and ‘it is a pleasure to work in the home, where good care and quality of life are important’. The home does not have a formal quality assurance system in place, but robust measures are taken to ensure the service is monitored and evaluated on a regular basis. The manager is completing monthly audits of the service and feedback is sought from the people living in the home, relatives and professional individuals (who input to the people’s care) through regular satisfaction questionnaires. The results of the July 2008 surveys are extremely positive about all aspects of the home and facilities. The manager is in the process of combining the information from the surveys for 2008 into an annual development plan: to highlight where the service is going and/or indicate how the management team is addressing any shortfalls in the service. Staff have monthly meetings with the manager and people using the service have meetings every 3 months with more informal group chats and discussions in between. People and staff agreed that they are able to express ideas; criticisms and concerns without prejudice and the management team will take action where necessary to bring about positive change. The home has a policy of not handling personal allowances for people who use the service. Instead individuals either manage their own finances or have a representative who does so. Discussion with the manager indicated where an individual builds up an outstanding balance, such as for the hairdresser or papers, then a bill is sent to the person responsible for their finances at the end of each month. At the last visit in September 2006 a requirement was made that ‘An up to date electrical wiring certificate must be obtained and any necessary risks completed’. Checks completed at this visit show the certificate is in place and the requirement is now met. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and staff are aware that regulation 37 reports must be completed and sent on to the Commission where appropriate. Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 28 The home has an up to date fire risk assessment in place and the handyman and staff are undertaking regular checks of the systems. Staff have received training in safe working practices and risk assessments are in place for fire, bed rails and daily activities of living. Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 29 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 4 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 3 x 3 x 3 x 4 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 4 x N/A x x 3 Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 OP7 Good Practice Recommendations The manager should ensure that the care plan clearly shows what medication the person is self-medicating, and include the frequency of checks that staff are doing to monitor that the person is managing their medication successfully. The manager should ensure that a photograph of each person receiving medication is kept on his or her medication file. This will improve health and safety practises by ensuring that agency staff or new staff are clear that medication is being administered to the right person. 2. OP9 Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Hook Hall DS0000019683.V369551.R01.S.doc Version 5.2 Page 32 - 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. 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