Random inspection report
Care homes for older people
Name: Address: Hay House Nursing Home Broadclyst Exeter Devon EX5 3JL one star adequate service 06/11/2008 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Teresa Anderson Date: 2 4 0 6 2 0 0 9 Information about the care home
Name of care home: Address: Hay House Nursing Home Broadclyst Exeter Devon EX5 3JL 01392461779 01392460040 info@hayhousecare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Chartbeech Ltd care home 35 Number of places (if applicable): Under 65 Over 65 35 35 dementia mental disorder, excluding learning disability or dementia Conditions of registration: 0 0 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. 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 The maximum number of persons accommodated at the home, including the named service user, will remain at 35 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
Care Homes for Older People Page 2 of 13 notice dated 5th November 2004 Date of last inspection Brief description of the care home Hay House is registered as a care home that provides accomodation with nursing for up to 35 people over the age of 65, with dementia or a mental disorder. The building is Georgian and is set in an elevated position with views to Broadclyst and Killerton. The house has been extended and adapted for use as a care home and provides provides both shared and single bedrooms, 16 of which have en-suite facilities. There is a passenger lift linking the floors aswell as a wide staircase. Communal facilities are made up of a main lounge, a dining room, a smaller lounge and a large entrance hall. There are Registered Nurses on duty throughout the day and night. 0 6 1 1 2 0 0 8 Care Homes for Older People Page 3 of 13 What we found:
We (the commission) carried out this random inspection for two reasons. Concerns had been raised about the care given to one person at the home and we wanted to monitor what progress had been made with the requirements set at the inspection that was carried out in November 2008. We arrived at the home at about 10.00am and left at around 6.30pm. During that time we looked around the home, spoke with staff, observed care given to people and looked at the records relating to three people living here. We also spoke with the manager and with the owners. We did not on this occasion speak at length or in depth with people living here. We were specifically looking at the quality of care given to people who have dementia and who cannot speak up for themselves. Although we looked at three plans of care, we only casetracked two of the people these plans relate to. Casetracking means we looked closely at the care given to these people. We looked at their care plans, the documents designed to provide instructions on what care should be given, what care has been given and the effects of that care. We spoke to staff, both nurses and carers, about these peoples care and we observed some care being given to these people. When we looked at the care plans we found that people have been identified as being at risk of poor health and that sufficient actions have not been taken to manage the risks or to keep people as healthy as they can be. One care plan told us that the person is at medium risk of malnutrition. An accredited tool has been used to make this judgment as is good practice. This tool instructs that because the person is at risk of malnutrition that they should have their food intake monitored and recorded for three days. We looked for this information and could not find it. Staff also looked for this information but they could not find it. They said this meant that it had not been done. We saw in the care plan that there are instructions that this person should be weighed monthly and that staff should report any signs of weight loss. We looked at the record of this persons weight and found that they had lost 2kgs over a period of two months. They have not been weighed again since April (2 months ago). We asked a member of nursing staff about this persons weight and malnutrition risk assessment. They told us they are not concerned about either because both were satisfactory. When we looked in the care plan together we saw the record that this person has lost weight, has not been weighed again for over two months and is at risk of malnutrition. We asked the manager what would trigger a referral to the Doctor in relation to weight loss and risk of malnutrition. She told us that the doctor would be called if someone had gone without eating their usual amount for a period of two or three days, or if they were losing weight. We saw in records that although the doctor had been called to see this person for other reasons, they had not been seen about their weight loss. The manager
Care Homes for Older People Page 4 of 13 also looked at these records and confirmed this. We asked if the cook knows that some people might need extra calories. We were told that staff tell the housekeeper who needs extra calories who then tells the cook. The cook then puts extra cream and butter in these peoples meals. We checked this and were told by the cook that if someone were not eating well on a particular day that staff would tell the cook on that day. Something light would then be prepared for them to eat. We asked if the cook puts extra cream or butter in certain foods for people who need extra calories. We were told that everyone has extra condensed milk in porridge and extra butter in the mash, but not individuals. We were shown a record that confirmed this to be the case. In the care plan, staff have also identified that this person is at risk of choking. As is good practice, they arranged for the Speech and Language Therapist (SALT) to carry out an assessment and to provide advise. Instructions in the care plan say that this person should have a pureed diet, drink from a cup without a beaker (to better manage the flow of liquid) and that consistencies such as flakes and milk should not be mixed. We spoke to a member of staff who showed us that they were going to give this man his supper. This was lasagna that had been mixed and broken up. It was not pureed and we could see lumps of food. We were also told by staff that this person eats cake mixed with cream. We asked if the SALT had said this was safe. Staff told us they did not know and had made this decision themselves. This person is also identified as being at risk of developing a pressure sore. The risk assessment tool used is an accredited one and this is good practice. However, the recommendations associated with the risk assessment were not carried out. The tool says that this person should have been nursed on an air waves mattress. The manager rightly told us that sometimes people can high a high score when they are for example moving and mobile and are not actually at risk of developing pressure sores. She told us that this person was not nursed on an airwaves mattress, but did not know why not. However, she clarified that it was not because they were not at risk. After this person developed a pressure sore, an airwaves mattress was put on the bed. The pressure sore has since healed. Records show that this person has never had, and does not now have, a plan of care which gives instructions on how to prevent this person from getting a pressure sore. We looked at another care plan and found that this person has been assessed at being at high risk of malnutrition. This person is losing weight, nearly 2 kg over two months. This person has not been weighed again since April (2 months ago). The tool used to assess and manage malnutrition recommends an overall increase in nutritional intake, a referral to the dietitian and for staff to monitor and review the care plan monthly. There is no record of what this persons nutritional intake is or if it has been increased. We spoke to staff about what this person eats. They told us that this person doesnt really like proper meals but likes sugary things like spaghetti in tomato sauce. We asked what they were having that day for lunch and were told either lasagne or chicken pie. Records show that a referral has not been made to the dietician. This care plan has been reviewed by a nurse and this states that this persons weight is stable and that their dietary intake is satisfactory, which is contrary to the evidence we found. Whilst looking at these care plans we saw that one person has not received a prescribed
Care Homes for Older People Page 5 of 13 medication on 6 occasions over a two month period. Records show that staff could not find it or that it was out of stock. This means that this person did not get a medicine that they need. We have shared the above information with the local Primary Care Trust and with the Local Authority. We have taken enforcement action and will be issuing a Statutory Requirement Notice requiring this service to take action to address these serious shortfalls. What the care home does well: 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 set out on page 2. Care Homes for Older People Page 6 of 13 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 7 15(2) You must keep each persons 31/12/2007 plan under review and ensure that revisions to the plan are appropriately made. Where possible the person should be involved in planning their own care this will ensure people get the care they want in a way that is acceptable to them. This requirement was not inspected at the compliance inspection undertaken on 10th August 2009. 2 8 12 (1) (a) Each person living 30/01/2009 here must have proper provision made to meet their health and welfare needs. This includes making provision to meet needs relating to tissue viability and preventing skin damage, nutrition, hydration, diabetes and mental health needs. This will help to ensure that people remain healthy for as long as possible. This requirement was not inspected at the compliance inspection undertaken on 10th August 2009. Care Homes for Older People Page 7 of 13 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 3 9 13 (2) Medicines must be 13/02/2009 managed safely. This includes making sure that records are up to date and accurate, that medicines are stored securely and that medicines are in date. This requirement was not inspected during the compliance inspection undertaken on 10th August 2009. This will ensure that people get the medicines they need in a dose that is appropriate to their needs, that all medicines are in date and therefore effective and that all medicines recieved into the home can be accounted for. 4 18 13 (7) (8) All records relating to 13/02/2009 the use of restraint (e.g lapbelts) must relate to the Mental Capacity Act and helping people to make decisions. Where restraint is used there should be clear guidance about the circumstances in which this is to be used and for how long. This requirement was not inspected during the compliance inspection undertaken on 10th August 2009. This will help to ensure that Care Homes for Older People Page 8 of 13 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action restraint is only used in exceptional circumstances and is used appropriately for as short a time as possible. 5 22 23 (2) (n) An assessment of the 13/02/2009 home must be made to determine if the equipment and adaptations available to people (such as toilet raisers, seat raisers and wheelchair foot plates) are sufficient to meet their mobility and comfort needs, and to help them remain independent. This requirement was not inspected during the compliance inspection undertaken on 10th August 2009. This will help in identifying individual and collective adaptation and equipment needs and to meet those needs for the people living here. 6 38 23 (4) Adequate precautions 13/02/2009 must be taken to ensure that if a fire were to break out that it could be contained appropriately. This includes carrying out regular checks to ensure that all fire doors close. This requirement was not inspected during the compliance inspection undertaken on 10th August 2009. Care Homes for Older People Page 9 of 13 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action This will help to ensure that the people living here are kept safe. Care Homes for Older People Page 10 of 13 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, 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 7 15 Peoples plans of care must be reviewed meaningfully using all the information available, and decisions made about care and treatment must be based on this information. In this way people will receive the care and treatment they need to help ensure their needs are met. 09/08/2009 2 7 15 People living at this home 09/08/2009 must have a plan of care that clearly identifies the actions to be taken to meet needs and the actions which need to be taken to detect and prevent deterioration in that persons health or welfare. In this way staff will be able to deliver consistent care that is planned for that person as a way of meeting identified needs. 3 8 13 People must receive appropriate support to meet their nutritional needs. 09/08/2009 Care Homes for Older People Page 11 of 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 This will help to ensure that people remain as healthy as they can for as long as they can. 4 9 13 People must be given the 09/08/2009 medicines they are prescribed. There must be a system in place that ensures this happens. This will help to ensure that people get the medicines they need to keep them as healthy and comfortable as they can be. 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 Care Homes for Older People Page 12 of 13 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 13 of 13 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
