Hertfordshire LINk Enter & View Overview
Monitoring Visit Report
Reason/stimulus for Visit: The stimulus to carry out this monitoring visit, within the protocol established by Hertfordshire LINk, was to enable the LINk to look at Care of the Elderly at Intermediate Care level, with particular emphasis on factors underlying possible delayed discharge in Health and Social Care within East and West Hertfordshire.
Facilities Visited: St Peters Intermediate Care Ward Hemel Hempstead
Summary Report Section 1 Sopwell Intermediate Care Ward St Albans Hitchin Hospital Intermediate Care Ward Queen Victoria Memorial Hospital Welwyn Garden City
Summary Report Section 2 Stanborough Lodge Care Home, Welwyn Garden City
Bethesda Care Home, Harpenden Lyndon Eventide Care Home, Sandridge, St Albans
Grace Muriel House Care Home, St Albans
Interviewed: 32 patients/residents / 8 staff / 8 venues / 10 visits
Method: Questionnaire and Observation Checklist
Date of Visit: November 2009 – February 2010
Visit Conducted By: Trained Members of Hertfordshire LINk Cleared by the Criminal Records Bureau
Hertfordshire LINk ‘Enter & View’ Visits to NHS Intermediate Care Units (Elderly) 2009/2010
SUMMARY REPORT - SECTION 1
1. ENVIRONMENT
Four visits were carried out between November 2009 and January 2010. Two of these were in West Herts, Sopwell Ward at St. Albans City Hospital and St. Peters Ward at Hemel Hempstead General Hospital. These are wards that were previously used for acute care and are housed in buildings under 40years old within existing ward blocks. The two units in East/North Herts are Hitchin Hospital and the Queen Victoria Memorial Hospital (QVM) in Welwyn. Both these units are around 100 years old with the associated problems of infrastructure and are stand alone units. Hitchin has undergone refurbishment in recent years and we understand that more is planned to improve the provision of bathrooms. QVM is to undergo major refurbishment shortly which will bring it up to modern standards of bed space, toilet and bathing facilities.
Security at QVM will be addressed during the refurbishment as it currently has a multiplicity of entrances; Hitchin has alarmed doors and is very conscious of security/fire issues. No security issues were reported from Sopwell or St Peters.
Staff and patients expressed satisfaction with cleaning within the units but the adjacent area to Sopwell needed attention due to rubbish sacks, damaged signs and a generally rundown air. All units reported some delays with getting repairs done although these mostly did not impact on patient care. All four units could have improved signposting from main roads although it is good when nearer the sites.
2. CARE
In all units the staff was welcoming and friendly. There was a positive attitude towards active rehabilitation as would be expected. Patients were all up and dressed unless unwell and the patients seen expressed a general satisfaction with the level of care. All the units have very clear policies on nutrition and giving help to those unable to eat independently. Physiotherapy, Occupational Therapy and Social Work input was given on a Monday to Friday basis and home visits were carried out prior to discharge if appropriate. Staff had training courses in the statutory subjects and was generally aware of the needs of patients with sensory disabilities or dementia but specific training was not widely undertaken. Hitchin Hospital has a microphone system for patients with hearing problems. All units had information booklets that were given to patients and these contained complaints procedures amongst other matters. Complaints were dealt with at a ward level but the patients interviewed were hazy about procedures.
3. DISCHARGE
Numbers of delayed discharges across the district were very similar (Oct - Dec 2009). there were also common dominant themes, namely waiting times for social work assessment, for placements and for home care packages. The patients seen were aware of discharge plans but were unclear about the detail. Those patients who were asked about medication were generally concerned about managing at home and the staff on Sopwell expressed concern about this issue. The units all had multi disciplinary meetings where discharges were planned and action taken. It was mentioned on Sopwell ward that Discharge Teams undertook much of the planning and organisation.
4. CONCLUSIONS
Care was felt to be of a good standard in all units. As always, more input from physiotherapy, occupational therapy and social work staff would be advantageous but lack of resources (staff and financial) is acknowledged. Some delays in discharge seem inevitable given the financial restrictions on Adult Care Services. It should be pointed out however, that a reduction in the number of delayed discharges has been
achieved in recent years.
5. RECOMMENDATIONS
1. More training opportunities for staff in awareness of sensory disabilities and dementia needs increasing.
2. Allocated social work hours need to be increased.
3. Communication between multidisciplinary teams, discharge planners, patients and relatives needs continuous attention to effectively minimise problems in the discharge process.
4. A clear and concise written guide to medication to be given to patients on discharge, in a large format if necessary. This will entail co-operation with pharmacy staff and needs to be negotiated on a individual unit basis
5. To ensure that the Estates Department (a) is made fully aware of the environmental issues adjacent to Sopwell Ward in respect of rubbish sacks, damaged signs and a general facelift in that area. (b) reduce delays in administering repairs (c) improve signposting from main roads and within hospital grounds where necessary.
Hertfordshire LINk 'Enter & View' Visits to Residential Care Homes (Elderly) 2009/2010
SUMMARY REPORT – SECTION 2
1. ENVIRONMENT
The four homes were chosen at random and are of a similar size, 25 – 32 beds.
Two of these, Grace Muriel House and Bethesda were purpose built units although this was over 40 years ago. Both Lyndon and Stanborough Lodge are converted period houses. Signs from main roads could be improved although three homes were clearly visible when near. Bethesda’s car park sign could usefully be more obvious and the home signpost more prominent when in the car park to avoid disturbing the occupants of the adjacent building. Security was largely satisfactory, the homes had alarmed doors and signing in books although there was no prompting to complete this at one home. The outside environment of the homes was generally satisfactory with disabled access. Interior décor was good or adequate in the homes; one home was about to undergo redecoration of the main lounge and one was noted to have torn wallpaper on the stairs. General housekeeping and cleanliness were good in all homes. There were pictures, plants and ornaments around the common areas. Welcome/information handbooks are given to all residents. These have the complaints procedure amongst other matters in them. Grace Muriel House has these in a holder on the back of every
bedroom door.
2. CARE
The staff in all the homes were welcoming and friendly. Residents appeared to be content with the levels of care, looked well cared for and were very happy to talk to the LINks representatives. All the homes had a separate dining room, there is a choice of menu and resident’s preferences are taken into account when menus are planned. Help at mealtimes and/or special crockery and cutlery is available for those who need it. Lyndon has a small annexe to the dining room for those who need help with eating so that they can be helped without feeling pressure to keep up with the others. All the homes have adapted bathing facilities. One home does not have en suite facilities
for all rooms. Activities and outings appropriate to the client group are provided. Three of the homes stated positively that they try to keep residents for end of life care unless the care becomes too intensive. Community services e.g. Community nursing; chiropody; dentistry; optical services; hairdressing are either provided on a regular basis or called as necessary. Particular attention to spiritual needs is given in the Bethesda home and in Lyndon, in the former it is part of the Strict Baptist ethos of the home, in the latter it is multi faith. The homes are aware of infection control. Lyndon and Grace Muriel House are very proactive in their management of this issue. Staff at Bethesda have satisfactory protocols and compliance, Stanborough has posters around (apparently not near washbasins) but no hand gels. In an isolated occurrence there is a need to ensure the strict application of food hygiene regulations in food preparation.
Training for staff varied, in one home there was reliance on DVDs for more specialised training, Lyndon and Grace Muriel House had a good range of training available and were aware of the need for updating. All homes sent staff for the mandatory training and had staff with, or undergoing, various levels of NVQs.
3. ADMISSION / DISCHARGE
All home managers assess in person those referred for placement prior to admission. There can be a delay in this which may occasionally be a contributory cause to delayed discharge from hospital. The managers have learned to be proactive to get the transfer information that they require and this has improved the admission procedure. Other delays to admission reported were transport and waiting for medication to be ready. If a resident is admitted to hospital, a transfer letter accompanies them and the manager visits before discharge.
4. CONCLUSIONS
The residents were largely happy with the care and services received. There are some issues relating to infection control and also to food hygiene. It was also felt that staff training could also be better provided and focussed on best practice.
5. RECOMMENDATIONS
The following recommendations are being put forward in order to address our primary concerns / observations in the conclusions above:-
(1) That a review of infection control measures currently in place across Residential Care and Nursing Home establishments in Hertfordshire be undertaken with a view to either:- a. implementing no less rigorous requirements for infection control than exists throughout the NHS for both planned and unplanned care, or b. as a minimum standard, to adopt measures which represent best practice within Care and Nursing Home provision to include the use of hand gel dispensers in those homes not currently using them.
(2) That all providers of Care and Nursing Home services be reminded to strictly adhere to Food Standards Agency guidelines for food preparation and that Managers ensure the strict application and enforcement of food hygiene regulations in food preparation.
(3) That all providers of Care and Nursing Home services continue to work in partnership with all stakeholders to reduce the ‘delayed discharge / admission’ transfer cases by improving procedures sufficiently to achieve a seamless service.