Inspection on 26/07/05 for Hay House Nursing Home

This inspection was carried out on 26th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 16/12/05

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 Broadclyst Exeter Devon EX5 3JL Lead Inspector Stephen Spratling Announced 26 July 2005 09:30hrs 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 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 D54 D06_s43065_hayhouse_v217680_260705 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Hay House Nursing Home Address Broadclyst Exeter Devon EX5 3JL 01392 461779 Telephone number Fax number Email 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 DE(E) Dementia - over 65 (35) registration, with number MD(E) Mental Disorder - over 65 (35) of places Hay House Nursing Home D54 D06_s43065_hayhouse_v217680_260705 stage 4.doc Version 1.40 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. 2 The manager, Ms Rachel Somers, must obtain the Registered Manager`s Award by 2005 3 There is a named Registered Mental Nurse as a lead for mental health care at the home. 4 To admit one named person outside the categories of registration as detailed in the notice dated 5th November 2004 5 The maximum number of persons accommodated at the home, including the named service user, will remain at 35 6 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. Date of last inspection 21 October 2004 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 D54 D06_s43065_hayhouse_v217680_260705 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection carried out by one inspector (Stephen Spratling) from 9.15 am until 3.15 pm on 26th July 2005. During the day the inspector spoke with the registered provider, the manager, five members of staff, eleven of the people living at the home and 1 visitor to the home. The mental frailty of many of the residents who the inspector spoke with prevented them for being able to express clear views about the service they receive. The inspector also received CSCI questionnaires from four of the residents relatives and four CSCI residents questionnaires completed by residents assisted by the owner. Additionally the inspector looked at the assessments and care plans for three residents; some of the policies and other records kept by the home. What the service does well: What has improved since the last inspection? What they could do better: Written plans of care need to be developed to ensure they provide detail of how residents health care needs should be met by staff. Assessments of residents health needs need to be completed in all instances and kept under review. The quality assurance process of the home need further development to help ensure that the home continues to provide good standard of service and improvements are made where needed. Hay House Nursing Home D54 D06_s43065_hayhouse_v217680_260705 stage 4.doc Version 1.40 Page 6 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 D54 D06_s43065_hayhouse_v217680_260705 stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Hay House Nursing Home D54 D06_s43065_hayhouse_v217680_260705 stage 4.doc Version 1.40 Page 8 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 standard(s) 3 Resident’s benefit from good admission and assessment practice, which ensures that the home is able to meet their needs. The home does not offer an intermediate care service. EVIDENCE: The inspector looked at the admission assessments written for three residents. All contained detailed information about their physical, social and mental health needs. Professionally recognised assessment tools had also been used. The relative spoken with said that one of the registered nurses had visited their mother at home and conducted an assessment of her needs, together with family before a decision was made about moving to the home. Hay House Nursing Home D54 D06_s43065_hayhouse_v217680_260705 stage 4.doc Version 1.40 Page 9 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 standard(s) 7, 8 & 10 Resident’s benefit from plans of care, which provide good description of how their mental health needs should be met by staff. However lack of detail in care plans about how physical health care needs should be met and assessments not being used properly means that there is a risk that resident’s physical health care needs may not be recognised and met. Residents are treated kindly and with respect. EVIDENCE: The three care plans seen by the inspector provided detailed descriptions of how the resident’s mental health/social care needs should be met; these plans showed a recognition of the residents unique personal history, strengths and frailties. For example one care plan read recognised that the resident had always preferred their own company and encouraged staff to respect this preference, another described triggers that may lead to the resident becoming distressed and calling out and how staff should respond. One residents notes seen said that they were diagnosed with Diabetes but the care plan did not provide the reader with information about how this persons diabetes should be monitored/managed; another persons assessments indicated that they were at risk of developing pressure sores but the care plan did not provide enough information on what measures should be taken to prevent this person Hay House Nursing Home D54 D06_s43065_hayhouse_v217680_260705 stage 4.doc Version 1.40 Page 10 developing pressure sores. All care plans showed evidence of regular review and involvement of relatives where residents were unable to represent themselves. The inspector saw a variety of professionally recognised health assessment tools in use, including nutritional assessments and mobility/moving and handling assessments. Some of the information from these assessments had been used to develop care plans, but not all were up to date or completed as they should be e.g. two of the manual handling assessments seen had not been completed and the third had not been reviewed for 9 months. Throughout the inspection staff were seen addressing residents kindly, warmly and respectfully. The visitor spoken with said that they always see staff being kind and patient, commenting that this is so even when staff are busy and under pressure. All four of the residents questionnaires returned indicated that residents feel treated well by staff; residents who were able to comment said that staff are kind. One relative responding to a CSCI questionnaire wrote “I know my mum can be difficult and she is treated with kindness and respect”. Hay House Nursing Home D54 D06_s43065_hayhouse_v217680_260705 stage 4.doc Version 1.40 Page 11 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 standard(s) 12, 13 & 14 Social activities are provided at the home and provide daily variation and interest for residents. Residents are encouraged and helped to exercise control and choice over their lives. They benefit from the contact with family and friends which is encouraged by the home. EVIDENCE: Residents were seen moving freely around both floors of their home, some choosing to spend time in the lounges, others in their private rooms. Record of resident’s interests was seen in three files. A visitor spoken with said that their mother was supported to retain her individuality by the staff and that they felt there are sufficient activities for residents laid on. All four of the residents assisted to complete CSCI questionnaires indicated that they think there are suitable activities available. Residents able to comment said they have enough to do. Staff told the inspector that residents can join in with a regular drama group, music and outings; the homes summer fate was advertised for the coming weekend. Four relatives who completed CSCI questionnaires indicated that they are made to feel welcome whenever visiting the home. The relative spoken with said that they feel supported to continue to be closely involved with their mother’s care and welcome at anytime without appointment. Hay House Nursing Home D54 D06_s43065_hayhouse_v217680_260705 stage 4.doc Version 1.40 Page 12 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 standard(s) 16 & 18 Arrangements for responding to concerns are satisfactory and help to improve the quality of care for residents. The open management and training received by staff help to keep residents safe from abuse. EVIDENCE: The homes complaints procedure provides clear information about how to make a complaint and includes contact details for the commission. The procedure was seen on display in the homes entrance hall. The inspector saw the homes complaints recording system which is clear and provides sufficient detail. Where the commission has had contact with this service over the last year about complaints made the provider and manger have responded very positively using them as a means of improving the service. Staff said that an external trainer has recently done three training sessions for care staff to help ensure they would recognise and know how to report abuse. All staff spoken with said that the owners and manager of the home are very approachable and that they would speak with them if they had any concerns about the way residents are treated and be confident that action would be taken. Hay House Nursing Home D54 D06_s43065_hayhouse_v217680_260705 stage 4.doc Version 1.40 Page 13 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 standard(s) None of these standards were assessed during this inspection. EVIDENCE: Hay House Nursing Home D54 D06_s43065_hayhouse_v217680_260705 stage 4.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 Staff are employed in sufficient numbers to meet the needs of residents. Robust recruitment procedures are in place to protect residents from people who should not be working with them. Training is provided which helps ensure staff know how to look after residents properly. EVIDENCE: Residents able to respond said they felt that there are always enough staff around to help them. Five staff asked said that they think there are generally enough staff on duty to properly care for residents. Three relatives completing CSCI questionnaires indicated they think there are always enough staff on duty; one person indicated that there are usually enough staff on. The manager said and staff confirmed that when staff are sick efforts are made to bring in agency staff. The inspector looked at the recruitment files of three members of staff, all contained the required pre-employment checks including references and Criminal Record Bureau checks. Staff told the inspector that training is funded by the home and provided in paid time. All staff spoken to had attended some training over the past year either in house or external to the home. Both the registered nurses spoken with said they had attended training to allow them to take blood from residents Hay House Nursing Home D54 D06_s43065_hayhouse_v217680_260705 stage 4.doc Version 1.40 Page 15 and improve the care they give to terminally ill residents. One of the care staff said they had enrolled on the NVQ 3, the other carer spoken with had done fire and manual handling training and attended a talk about care of people with dementia. Hay House Nursing Home D54 D06_s43065_hayhouse_v217680_260705 stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 & 38 Some quality monitoring systems are in place but the lack of a systematic approach to quality assurance means that improvements needed may not be noticed. The home is managed and maintained so as to protect the health and safety of residents and staff. EVIDENCE: The inspector was shown quality survey questionnaires which were sent to relatives of all service users in April 2005, asking them to comment on the service provided; this information had been collated. Care plans are regularly reviewed to ensure that resident’s needs are identified and met. The home has a very open and proactive approach to complaints using them to help improve the service. The home does not have an annual development plan and the owner indicated that he is looking ways of developing the homes quality assurance work to help them plan improvements to the service. Hay House Nursing Home D54 D06_s43065_hayhouse_v217680_260705 stage 4.doc Version 1.40 Page 17 The inspector looked at the fire equipment maintenance log; this showed that maintenance checks on all fire protection and alarm systems are done as recommended by Devon Fire Officers. Portable electrical tests were recorded as having last been done 09/08/04; a receipt indicating that all gas appliances were serviced 09/08/04 was seen. Records showing that hoists in the home were serviced 11/07/05 and that the passenger lift was serviced 06/06/05 were also seen by the inspector. Hay House Nursing Home D54 D06_s43065_hayhouse_v217680_260705 stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 2 x x x x 3 Hay House Nursing Home D54 D06_s43065_hayhouse_v217680_260705 stage 4.doc Version 1.40 Page 19 yes Are there any outstanding requirements from the last inspection? 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. 1. 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 OP 7 Good Practice Recommendations The service users plans should set out indetail the action which needs to be taken by care staff to ensure that all aspects of health, personal and social care needs of the service user are met. All assessments of service users health needs should be completed and kept under review. There should be an development plan for home, based on a systemastic cycle of planning- action- , reflecting aims and outcomes for the service users. 2. 3. OP 8 OP 33 Hay House Nursing Home D54 D06_s43065_hayhouse_v217680_260705 stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection 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 D54 D06_s43065_hayhouse_v217680_260705 stage 4.doc Version 1.40 Page 21 - 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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