Inspection on 16/12/05 for Hay House Nursing Home

This inspection was carried out on 16th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hay House Nursing Home 02/11/09

Hay House Nursing Home 10/08/09

Hay House Nursing Home 24/06/09

Hay House Nursing Home 01/10/08

Hay House Nursing Home 05/11/07

Hay House Nursing Home 21/06/06

Hay House Nursing Home 26/07/05

Hay House Nursing Home 21/10/04

Hay House Nursing Home 22/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hay House Nursing Home Hay House Nursing Home Broadclyst Exeter Devon EX5 3JL Lead Inspector Stephen Spratling Unannounced Inspection 11:55 16 & 22nd December 2005 th 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 Hay House Nursing Home DS0000043065.V264621.R01.S.doc Version 5.0 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. Hay House Nursing Home DS0000043065.V264621.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hay House Nursing Home Address Hay House Nursing Home Broadclyst Exeter Devon EX5 3JL 01392 461779 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) Chartbeech Ltd Rachel Somers Care Home 35 Category(ies) of Dementia - over 65 years of age (35), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (35) Hay House Nursing Home DS0000043065.V264621.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Staffing minimum as agreed with the previous registration authority 29/01/2002 and detailed in the variation of registration report of the same date, is observed. The manager, Ms Rachel Somers, must obtain the Registered Manager`s Award by 2005 There is a named Registered Mental Nurse as a lead for mental health care at the home. To admit one named person outside the categories of registration as detailed in the notice dated 5th November 2004 The maximum number of persons accommodated at the home, including the named service user, will remain at 35 On the termination of the placement of the named service user, the registered person will notify the Commission in writing and the particulars and conditions of this registration will revert to those held on the 8th November 2004. 26th July 2005 2. 3. 4. 5. 6. Date of last inspection Brief Description of the Service: Hay House is registered as a care home for 35 people, over the age of 65, with dementia or mental disorder. The building dates back to Georgian times and has beautiful views of the countryside. It is set in an elevated position between Broadclyst and Killerton. There is a 16 bedded extension attached to the home, which provides ensuite bedrooms. There is one main lounge, one dining room, one smaller lounge, a visitors room and a large entrance hall. Care is provided by Registered Nurses and trained carers. Hay House Nursing Home DS0000043065.V264621.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector, Stephen Spratling, conducted this inspection over two visits. The first visit was unannounced, the second was with a few days notice. During the inspection the inspector spoke with nine residents all of whom had some degree of communication difficulty, one visitor, four care workers, one registered nurse, the manager and one of the homes owners. He also looked around the building and grounds, and looked at a variety of records. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hay House Nursing Home DS0000043065.V264621.R01.S.doc Version 5.0 Page 6 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 Hay House Nursing Home DS0000043065.V264621.R01.S.doc Version 5.0 Page 7 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed during this inspection. Please see the last report for more information. EVIDENCE: Hay House Nursing Home DS0000043065.V264621.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 9 Clear care planning and good liaison with health care professionals helps to ensure residents health care needs are recognised and fully met. The systems for the management of medication are weak in parts potentially placing residents at risk. EVIDENCE: The care plans for three residents were looked at and as seen on the last inspection they contained good description of how residents mental health needs should be met; on this inspection care plans written about residents physical care needs were also detailed and provided useful descriptive information about what care is needed and how it should be delivered. For example one persons file contained clear description of what staff should do to protect their skin from pressure damage and how their diabetes should be managed. One of the registered nurses now takes lead responsibility for “tissue viability” (caring for skin and wounds) and regularly liaises with health service specialists for advice. Nursing staff were heard requesting GP input for residents and a GP visited a resident on the day of inspection. Hay House Nursing Home DS0000043065.V264621.R01.S.doc Version 5.0 Page 9 Medications are securely stored. The inspector looked at the medication records for three residents; all were properly completed, where prescribed medication had been omitted the reason for doing so was clearly recorded. The medication fridge temperatures did contain a thermometer but it was not clear what is done if temperatures are observed to be outside the expected limits. Expired medication was found in the fridge and other medications that needed disposal were being stored. The home has a locked cupboard with a locked cupboard within for storage of controlled medications. The controlled medication recoding system was sampled and accurate. Hay House Nursing Home DS0000043065.V264621.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 Good food and appropriate levels of support are provided to residents to ensure they receive the diet they need. EVIDENCE: The inspector spent time in the dinning room and then in a lounge during lunchtime. Staff were heard offering each resident choice of meal, residents were served individually and given assistance by patient attentive staff. The atmosphere in the dinning room was relaxed and jovial. Some residents wore clothes protectors as required/wanted. Residents told the inspector that the food is usually good. Nutritional needs assessments were seen in residents records and a detailed care plan aimed at ensuring one resident received enough to eat was also seen. Hay House Nursing Home DS0000043065.V264621.R01.S.doc Version 5.0 Page 11 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed during this inspection. Please see the last report for more information. EVIDENCE: Hay House Nursing Home DS0000043065.V264621.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 The standard of the environment around this home is generally good providing a comfortable and homely place for residents to live. EVIDENCE: The inspector looked in 10 residents bedrooms, all of which were clean and suitably equipped. Some upper floor windows were checked and found to be suitably restricted. All shared areas were also visited and found to be clean and comfortably furnished. The laundry area was well organised and clean. Hot water temperatures in one bath were checked and found to be within expected limits. Residents able to comment said they were happy with maintenance and cleanliness around the home. Two members of staff said they felt that cleaning standards at the home had slipped but another said they thought they were better than they had been. The grounds of the home are generally level and accessible for residents, seating is provided and the grounds benefit from attractive views. Hay House Nursing Home DS0000043065.V264621.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 & 30 Staff have the skills to provide residents with a good standard of care however inadequate staffing levels mean that at times residents do not receive care in a timely manner or the individual attention they benefit from. EVIDENCE: The staff duty rota indicated that there are usually two registered nurses plus five carers on duty each morning with some exceptions. All four of the care staff spoken with felt that staffing levels over the past months have often not been enough for them to spend time talking with (“family time”) residents as they used to and they often feel they have to rush. The day of the second visit at 11.50 am staff said they still had three people to get up. Residents did not raise any concerns about staffing levels, those able indicating they get help when they need it. The manager reported that high sickness rates of some staff has meant that levels have dropped at times. Efforts are clearly made to cover staff sickness but short notice often makes this difficult; care staff expressed confidence that the manager does try to cover sickness. The manager reported that six of the care staff have NVQ qualifications in care and two are currently studying for NVQs. Staff reported that training about caring for people with dementia and those who have mental health problems had been provided as well as manual handling, fire training, wound care and recognition of abuse; records confirmed this. Some staff were satisfied with training offered others felt they would like more training opportunities. Residents expressed confidence in staff, and staff were seen working Hay House Nursing Home DS0000043065.V264621.R01.S.doc Version 5.0 Page 14 confidently and professionally with residents, communicating clearly. A relative who briefly spoke with the inspector said they were “very happy” with the care their very frail mother was receiving, describing the home as “extremely good”. Hay House Nursing Home DS0000043065.V264621.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 36 The home is well managed on a day-to-day basis with the interest of residents kept uppermost. Some quality monitoring systems are in place but the lack of a systematic approach staff supervision and to quality assurance means that changes and improvements that should be made may not be noted and acted upon. Clear systems for managing residents money help to protect them from financial abuse. EVIDENCE: The registered manager is an experienced Nurse. She is a Registered General Nurse and Registered Mental Handicap Nurse. Her Deputy is a Registered Mental Nurse. The manager told the inspector that she has started but not yet completed the Registered manager’s award; completion of this qualification by end of 2005 was a condition of her registration and therefore it must be completed as soon as possible. Staff describe the manager as supportive and Hay House Nursing Home DS0000043065.V264621.R01.S.doc Version 5.0 Page 16 approachable. The manager is well supported by the homeowners who work in the home on a day to day basis. Care staff described receiving supportive informal supervision from some senior staff and said that the manager and owner were approachable. None spoken with receive regular formal one to one supervision though all had annual appraisals. The owner and manager described a variety of measures designed to monitor and improve the quality of the service residents receive e.g. monthly audit of residents care records the results of which were shown to the inspector. They also described other planned measures but acknowledge that their quality assurance systems are not yet comprehensive and that an annual development plan for the home has not yet been developed. The inspector was told that nobody at the home acts as appointee for any of the residents. Some money is held securely for residents; the account and money held for two residents was checked by the inspector and was satisfactory, records clearly showed deposits and withdrawals with receipts available for money spent on resident’s behalf. Hay House Nursing Home DS0000043065.V264621.R01.S.doc Version 5.0 Page 17 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 X X 3 2 X X Hay House Nursing Home DS0000043065.V264621.R01.S.doc Version 5.0 Page 18 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 Good Practice Recommendations Expired medications should be properly disposed of. Medication fridge temperatures should be monitored and a clear procedure established for if temperatures fall outside expected norms. 2. 3. OP27 OP33 Staffing levels should be sufficient to meet all the assessed needs of residents at all times. There should be an annual development plan for home, based on a systematic cycle of planning- action- review, reflecting aims and outcomes for the service users. Care staff should receive regular formal one to one supervision covering all aspects of practice, philosophy of care within the home and career development needs. 4. OP36 Hay House Nursing Home DS0000043065.V264621.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 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 Hay House Nursing Home DS0000043065.V264621.R01.S.doc Version 5.0 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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