Care Home: The Hawthorns

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What the care home does well A good standard of care is provided for the people who live at the home. People said they enjoyed living there, and that the staff were kind and helpful. Comments received were very positive about the care. Good records of fridge and room temperature kept on most units. People living at the home were comfortable and well cared for and all of them said that the food was good. The environment is decorated to a high standard and well maintained. Staff were motivated and enthusiastic about their work. What has improved since the last inspection? The standard of record keeping for medicines overall has improved since the last inspection and is good on several units. What the care home could do better: Action should be taken to ensure that medication is in stock in the home so that it can be given as prescribed. On one unit the standard of recordkeeping should be improved and audit need to take place to ensure that the MAR chart is an accurate record and people are getting medication as prescribed Key inspection report Care homes for older people Name: Address: The Hawthorns O`Neill Drive North Blunts Peterlee Durham SR8 5UQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Susan Lowther     Date: 0 1 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: The Hawthorns O`Neill Drive North Blunts Peterlee Durham SR8 5UQ 01915871251 01915866779 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.barchester.com Barchester Healthcare Homes Ltd Name of registered manager (if applicable) Julia Mary Atherton Type of registration: Number of places registered: care home 105 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 105 The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 49 Dementia - Code DE, maximum number of places: 30 Mental disorder, excluding learning disability or dementia - Code MD, maximum number of places: 6 Physical disability Code PD, maximum number of places: 75 Care Homes for Older People Page 4 of 26 Over 65 0 0 49 0 30 6 0 75 Date of last inspection Brief description of the care home 2 0 1 0 2 0 0 9 The Hawthorns Care Home was opened in 1996. It is situated on the outskirts of Peterlee, adjacent to the community hospital and is conveniently located for access to all local amenities. Barchester Healthcare became the owners of the home in 2006. The company changed to Barchester Healthcare Limited in February 2007. This is the first inspection since Barchester Healthcare Limited came into being. The home is a two-storey building that is serviced by passenger lifts. There are three separate units within the service. The general unit for older persons, which caters for people with predominantly nursing needs, is located on two floors. The mental health unit is located on the ground floor and caters in the main for people with dementia. The rehabilitation unit is for people between the ages of 18 and 65 years who require help to maximise their independence. This unit is also located on two floors and the people accommodated upstairs generally have intensive nursing needs. There are a mixture of single and double rooms within the home, some of which have en suite facilities. There are sufficient and suitable additional bathrooms and toilets located throughout the home. Each unit also has a range of sitting and dining areas available. The garden areas are accessible and pleasant. Car parking facilities are available at both the front and rear of the building. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection of this home took place over two days. Three inspectors were involved, one is a pharmacist. Records were examined and a tour of the building took place. Time was spent talking to staff, the people who live in the home and their relatives. The inspection focussed on key standard outcomes for people who live in the home and to check whether requirements from the previous report had been met. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 6 of 26 Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient information is available for people to decide whether they would like to live in the home. Assessment procedures are in place to ensure that the home can meet all of the needs of the people who go to live there. Evidence: People are only admitted after a full assessment of need is carried out by an appropriately trained person. This is usually the manager. This is to make sure that the home can meet the care needs of the people who go to live there. The family of one person who had recently gone to live in the home confirmed that they had looked around the home and had been supplied with all of the information they needed to make a decision about whether or not their relative would like to live there. The manager said that the statement of purpose and service user guide have recently Care Homes for Older People Page 10 of 26 Evidence: been updated. Relatives and people who live in the home were involved in the review. Good systems are in place for the provision of intermediate care. A multidisciplinary team of therapists are employed by Barchester Healthcare, or contracted from the local hospital trust. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main good systems are in place to ensure that health care needs of people are met. However medication systems require constant review to ensure they are robust. People can be confident that their privacy and dignity is protected and that they are treated with respect. Evidence: The manager said that all of the people who live in the home have care plans so that staff know how to look after people on an individual basis. Six were examined during the inspection. These were comprehensive and contained individual plans of care. This is to make sure that staff meet all of the needs of the people who live in the home. People spoken to during the inspection said that they are happy with the care received and the level of information given. Records examined showed that people receive visits from other healthcare professionals. These include district nurses, doctors, and care managers. Care Homes for Older People Page 12 of 26 Evidence: At the inspection we looked at the arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the home. Medication is administered by qualified nurses. We looked at service users medication, examined medication administration records (MAR) and observed the medication administration round. Examination of medication records and discussion with staff highlighted the progress has been made since the last inspection of the service, however in some areas insufficient progress has been made. The quantities of medication received into the home all carried forward each month are now recorded making it easy to check whether sufficient quantity is available and to enable the audit of medication. In most of the units the standard of record keeping is now good and when medication was audited no problems were found. More significant gaps were found indicated medicines are mostly given as prescribed. However in one unit when the sample of medication was counted and checked against the MAR records discrepancies when noted. On two units the MAR records showed at the medication had been out of stock on a number of occasions and had to people and same medication had been out of stock for two or three days on consecutive months. It is important to make sure that the quantity of medication is regularly checked so that prescription can be ordered in plenty of time to prevent people being without. Since the inspection CQC have received information to confirm that a robust system is now in place to prevent this happening again. There is less handwritten entries and changes made to medication as some units now use MAR charts prepared by the pharmacy, however on one unit handwritten entries and changes to medication or dosage were not fully documented with the date change, person making the change or quantity of medications supplied or carried forward completed. Medication is stored in the standard lockable medicines trolleys in locked rooms. However on one unit the medication packed in systems supplied from the pharmacy should be rotated. This means that all of the medication for the morning administration round is available on the trolley and this will prevent several trips back to the medication room during administration to collect medicines not stored on the trolley. The controlled record that was small and not large enough to store medication packed in monitored door systems supplied by the pharmacy. The morning medications round was observed on the Seaham unit. People were offered a drink to help with the taking of medicines. Time was spent with each person Care Homes for Older People Page 13 of 26 Evidence: and encouragement given to help them take their medication. The temperature of the medication rooms are now monitored regularly and good records of fridge and room temperature were kept on all units. One unit recorded a room temperature of twenty five degrees centigrade on a number of occasions and action should be taken to correct this. People spoken to said that staff always treat them with dignity and respect. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities are varied and provide recreation for some of the people living in the home. Family and friends can visit the home at any time and are made to feel welcome. The meals are of a good standard. Menus are varied and service users are given a choice. Evidence: Most of the people said that activities are suitable. The activities organiser spends time with people on an individual basis to find out what activities they would like to do. One to one activities take place during the morning and group activities in the afternoon. Regular activities include card and board games, bingo, poetry sessions, board games and arts and crafts. Outside entertainers visit on a regular basis and a church service is held once per month. People are also taken out. In the Seaham unit there were photographs on the wall evidencing activities that have taken place in the unit. The full tours include family members and children. There is a board at the entrance of information about the dates and activities will take place. The lunch was observed. People have a choice about where they wish to eat. The dining room is attractively laid out and a hostess serves the meals. Staff who were helping people were doing this in a discreet and dignified manner. Evidence was seen Care Homes for Older People Page 15 of 26 Evidence: in care plans to confirm that nutritional needs are assessed and other professionals consulted if required. In Seaham unit there is a bar area in the entrance that has nibbles and drinks placed there every day the people to have access to. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their concerns and complaints are dealt with appropriately and that safeguards are in place to protect them from abuse. Evidence: Information about complaints, how and who to make them to, is made available to the people who live in the home and their families through information displayed in the entrance to the home and in the Service Users Guide. There have been eight complaints recorded since the last inspection. All of these were investigated by the home. The home had a comprehensive adult protection procedure. This gives staff the support they need to make a referral should this be required. The staff spoken to during the inspection were asked about abuse and what they would do if they saw or heard anything inappropriate. All said that they would tell someone, for example the manager, or make a referral themselves if this was more appropriate. Training provided for all staff in adult protection. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and well maintained. It is decorated and furnished to a good standard and provides a homely environment for the people who live there. Evidence: During a tour of the building we saw that many of the rooms are decorated to the persons own taste and there was evidence to confirm that people can take in some personal items when they go to live there. This includes pieces of furniture as well as photographs and ornaments. A high standard of decor and furniture is provided throughout the home. In Seaham unit rooms have sensors on the doors to alert staff that one of the people who live in the home may need assistance. Corridors have different themes, pictures and newspaper articles on the wall. Staff decorate the corridors. One is about the seaside and has real shells (tactile) as well as images of the seaside. There is a box in the hall with sports games, dolls, skittles. One area is devoted to mining, another devoted to the forces and one corridor area is an indoor garden with a memory tree. There was a range of equipment seen around the home to support people with bathing and mobility. We found the building to be clean, tidy and free from offensive odours. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are appropriately recruited, trained and in sufficient numbers to meet the needs of the people who live in the home. Evidence: From the rota supplied at the inspection there was sufficient care staff on duty to meet the assessed care needs of the people who were using the service. People said that staff were usually around and answered the call bells quickly. One person said, The staff come quickly when I need them. One relative said, He gets good care here. Just like a home from home. We had and Easter party yesterday. Another relative said, No complaints whatsoever. Both relatives spoke about how staff had supported them and their relatives were first admitted. They help them come to terms with their relatives condition and help them to understand that the care they were receiving. Once said that they thought their relative wasnt getting fed until staff explained that they were getting fed at a different time so that they could receive help. Both relatives said that it took a long time to travel to visit every day but that they would not accept the offer of transferring to a different home which would be nearer, as the care they got at The Hawthorns was too good. The home had staff files in place, which provided evidence that the appointment of a new staff member is made through proper recruitment processes. This includes the vetting of staff through the use of references, POVA first checks and Criminal Record Care Homes for Older People Page 19 of 26 Evidence: Bureau (CRB) checks. There is a commitment at the home to having a trained workforce with most of the staff having an NVQ at level 2 or above. The way training is delivered has recently been reviewed, and more practical training is now in place. As well as mandatory training, recent training has also taken place in adult protection and health and safety. Staff said that they are also supported with regard to personal training needs. Staff comments in this area were positive. Comments included There is always plenty of training going on and you can ask for additional training if you want to. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that the home is well managed and they are given the opportunity to comment on how the home is run. Policies and procedures are in place to safeguard their health, safety and wellbeing. Evidence: The manager is qualified and competent to run the home. There was an open and friendly culture between the management team and staff working at the home. There was evidence in staff files to show that supervision was taking place and that the staff were being appraised. Staff confirmed that supervision takes place on a regular basis and that they are well supported. People living at the home and visitors who were spoken to during the inspection confirmed that the manager is approachable and that they would go to her if they had any concerns. Staff also confirmed this to be the case. Care Homes for Older People Page 21 of 26 Evidence: Regular meetings are held and there are a number of systems in place to consult with people living at the home. Relatives and the people who live in the home can approach the staff at any time. The manager carries out regular audits covering all environmental and care aspects which may result in improvements being made. The home does not hold personal finances. The manager confirmed that all equipment in the home is regularly checked. The maintenance certificates that were seen at this inspection were found to be in order. Health and Safety checks are carried out regularly to safeguard people living and working at the home. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 12 The home must ensure that 31/12/2009 there is an effective system in place to request, obtain and retain adequate supplies of prescribed medicines so that they can be given as and when prscribed This will make sure that people are not without prescribed medication Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The home must ensure that there is an effective system in place to obtain and retain adequate supplies of prescribed medications so that they can be given as prescribed. This will make sure that people are not without prescribed medication. Timescale of the 31/12/2010 not met. 30/06/2010 2 9 13 Regular audit of the medication system must be carried out and an action plan implemented when any discrepancies or concerns are identified. This helps identify any medication issues promptly and health confirm that staff are following the home medicines policy. 30/06/2010 Care Homes for Older People Page 24 of 26 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 Records of administration should be made after medication has been given. This makes sure that there is an accurate record. Hand written entries and changes to MAR charts should be accurately recorded and detailed. This make sure the correct information is recorded and a person receives their medication as prescribed. The temperature of the medication room should be monitored and action taken when it falls outside the temperature recommended by the manufacturer. 2 9 3 9 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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