Inspection on 05/11/07 for Hay House Nursing Home

This inspection was carried out on 5th November 2007.

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 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 21/06/06

Hay House Nursing Home 16/12/05

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 Broadclyst Exeter Devon EX5 3JL Lead Inspector Caroline Rowland-Lapwood Unannounced Inspection 5th November 2007 09:15 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.V344662.R01.S.doc Version 5.2 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.V344662.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hay House Nursing Home Address Broadclyst Exeter Devon EX5 3JL 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) 01392 461779 01392 460040 Chartbeech Ltd Ms 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.V344662.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION 1. 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. 2. 3 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. 02/03/2007 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 en-suite bedrooms. There are 11 bedrooms on the ground floor, 1 shared and 19 bedrooms on the first floor, 4 shared. There is a passenger lift and a wide staircase from the hall. There is one main lounge, one dining room, one smaller lounge, which is also used as a dining room, a visitors’ room and a large entrance hall. Care is provided by Registered Nurses and trained carers. The average cost of care is £492-600 per week at the time of inspection. Additional costs, not covered in the fees, include chiropody, hairdressing and personal items such as toiletries and newspapers and personal transport. Current information about the service, including CSCI reports, which are accessible, is given to prospective residents and/or their representatives. Large print format is available on request. Hay House Nursing Home DS0000043065.V344662.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over nine hours over two days. The registered manager was present throughout that time. Some of the people living at Hay House have limited communication skills. Most were therefore unable to contribute verbally to the inspection process. Time was spent with all people at the home and observations were made during the inspection. We took an ‘expert by experience’ to this inspection. An ‘expert by experience’ is a person who, because of their experience of either using services or their ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The ‘expert’ spent time, spoke talking with and observing the people living in the home. Prior to the inspection the manager completed a questionnaire, called an AQAA (Annual quality assurance assessment), which provides information about people living at the home, staffing, fees and confirms that necessary policies and procedures are in place. Before the inspection we also sent out questionnaires to the people living in the home, their families and health care professionals. We received five questionnaires from people who use the service and or their relatives, five from health care professionals and eight from staff. A small number of staff also spoke with us during the inspection. All this information gives us a picture of what it may be like at the inspection and helps focus the inspection on what matters to the people who use the service. On the day of inspection we “case tracked” three people who use the service. This means we spoke with staff about individual care, read the persons records and made observations if the person was unable to speak with us. We looked around the building and other records were inspected. These included, fire safety logbook, maintenance records, staff files, medicine records, complaint records, care plans, communication books and quality assurance records. A random inspection was undertaken on 02/03/07 to follow up on requirements made at the last key inspection. The home has worked hard to improve its standards and as a result all but one of the requirements have now been met (the Registered Manager has not yet completed the Registered Managers Award). Hay House Nursing Home DS0000043065.V344662.R01.S.doc Version 5.2 Page 6 What the service does well: People have the information they need to make an informed choice about their admission to this home. The home has a written statement of purpose; this document sets out the aims and objectives of the home and provides information about the service. The admissions process is safe; an assessment of care needs of people takes place prior to admission to the home. Documents provided evidence that staff use a standard pre admission assessment form; this is used to assess peoples’ ability to undertake their activities of daily living. Other records seen included copies of assessments carried out through care management arrangements and hospital/community health care teams where applicable Care Plans at the home have enough information to identify each person’s needs and highlight any health care needs. Access to a full range of health care is maintained and specialist advice is sought where necessary. People who use the service are encouraged to maintain links with their friends and family and have access to advocacy services. Promotion of the person’s spirituality is respected and supported well by the home. Meals are good at the home with balanced and varied meals being provided. People confirmed that they enjoyed the meals at the home; one said “the foods lovely”. The environment is generally a clean and safe place for people to live and work. The management of fire safety and specialist equipment is managed well at the home. A stable and dedicated staff group care for people who use the service. The induction process is thorough which means that staff are provided with enough information to perform their roles safely. Staff have opportunities to attend formal training (NVQ-National vocational qualification training), which ensures they have the skills and knowledge to perform their roles. Staff have a good knowledge and understanding of the needs of people who use the service. Personal care is provided in a caring way. Verbal and informal communication is very good at the home, which means that information about people in the home is passed on to all staff. The quality of the service is kept under review on a day-to-day basis with the presence of the manager and more formally through questionnaires and audits. This means that the service changes to reflect the changing needs of people in the home. Hay House Nursing Home DS0000043065.V344662.R01.S.doc Version 5.2 Page 7 The home is managed well with an atmosphere that is welcoming and caring. The environment is homely and furnished to a satisfactory standard. The people who were able said they liked living in the home and said staff are caring, helpful, hardworking and kind. This was observed throughout the inspection. What has improved since the last inspection? What they could do better: Not all people living at the home have their care planned or reviewed in a way that co-ordinates their care, promotes choice or which ensures that consistently high standards of care can be delivered (this refers to decisions made about reclining chairs, covert medication and involving people in planning their own care). Staff must be made aware of what restraint is, and understand that inappropriate use of equipment can be classed as restraint. Staff must also be aware that the use of some equipment is discouraged unless an assessment has highlighted this as a need for safety and not just for the convenience of the home. The home must also consider issues about capacity to consent to this decision and show that discussions have been made with health care professionals and care managers. Records and care plans must also be improved to show how decisions have been made and must reflect the care that has been given. Hay House Nursing Home DS0000043065.V344662.R01.S.doc Version 5.2 Page 8 Aspects of the management of medicines must be addressed so that practices are safe and people’s wellbeing is assured. To ensure a pleasant and comfortable environment is available for all people, work to improve the environment needs to continue as per plan. 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. The summary of this inspection report can be made available in other formats on request. Hay House Nursing Home DS0000043065.V344662.R01.S.doc Version 5.2 Page 9 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.V344662.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have enough information about the home before they move in which helps them make an informed choice about whether the service is right for them. The personalised needs assessment means that people’s needs are identified and planned for before they move into the home. The home does not provide intermediate care EVIDENCE: People have the information they need to make an informed choice about their admission to this home. The home gives each new person that enquires about living at the home an information pack. This includes a written statement of purpose, the aims, standards and philosophy of care, a “residents guide” and a Hay House Nursing Home DS0000043065.V344662.R01.S.doc Version 5.2 Page 11 copy of the terms and conditions. A copy of the last inspection report is also included if required. All surveys from people living at the home showed that they had received enough information about the home before moving in so they could decide if it was the right place for them. One relative confirmed he was given plenty of information prior to his wife’s’ admission; he talked positively about her stay and of how he too been made welcome. Three peoples’ files were looked at. The home had obtained comprehensive assessments completed by a health or social care professional, such as community psychiatric nurse, or care manager. Good evidence was seen to show that the home liaises with family and representatives during the assessment and care planning process. The manager will visit people at home or in hospital in order to complete assessments. Three assessments looked at were detailed and contained important information about health and personal care needs as well as individual preferences. All staff responding with surveys said they were not asked to care for people with needs outside of their experience. Hay House Nursing Home DS0000043065.V344662.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The arrangement in place for planning people’s care generally ensures that usually people get the care they need in a way that suits them and they are treated with dignity and respect. Peoples’ health care needs are well met by good practice and monitoring, and close working with other professionals. . There are good systems for managing medications, but some aspects of practice may compromise safety. EVIDENCE: Everyone to whom we spoke appeared very happy and said the staff were kind. Those people that were able to said they receive a good level of care. Personal records held on behalf of 3 people were examined in detail; there were documented assessments which provided information about skin integrity, moving and handling, safety - including risk of falls, nutritional Hay House Nursing Home DS0000043065.V344662.R01.S.doc Version 5.2 Page 13 screening and social needs. The information in the assessments had been used to form the plans of care and provided the basis from which the care was to be delivered. One care plan usefully informed about triggers for adverse changes in one individual’s behaviour, so staff could act to prevent those triggers. For instance one care plan showed an individual who had particular needs with regard to smoking, clear guidance was written on how to care for this person effectively. Information on the Mental Capacity Act was seen in the office. Some reviews were recorded monthly, others were not; there was no evidence to suggest that the individual had been involved in the review that had been completed. Most reviews were usefully detailed, but some entries gave little information to show the success or otherwise of planned care and how the person had been. Care staff said they referred to the care plans, and seemed to know people well. During the inspection a person was seen in a wheelchair, it did not have footplates and the individuals’ feet were unsupported. When asked we were told the home has footplates but that some people could not use them; this was so in the case of one person living in the home but not for most others. There was no reference to this in the care plans. Several other people were sat in reclining chairs to promote their comfort, although there is no inference of inappropriate restraint there was no reference to this practice in the care plans to describe how this decision had been made on behalf of the individual and any associated risks. Specialist nurses were supporting staff in caring for people with pressure sores. The home had ensured people attended hospital appointments. Some people in the home are nursed in bed/chair; all were seen to be comfortable and warm. Personal histories have been developed by the staff and with the relatives that contain important information about the persons’ past life and occupation, which gives a sense of who this person is. Personal histories are particularly important for people with diminished communication. The medication system was looked at; some areas of practice need attention. Some medication seen was not marked with the person’s name (Risperadol and Salbutamol), other medication was found in the fridge which belonged to people no longer living at the home but had not been returned. The home uses a system whereby medication is taken from the original bottle/packet and put into a pot this is then given to the individual person. We were told this is done for each individual person to avoid mistakes. Some people receive their medication covertly (in jam), no record of this was seen in the care plans to show how this decision was made and who was involved. It is best practice to Hay House Nursing Home DS0000043065.V344662.R01.S.doc Version 5.2 Page 14 ensure that this only happens after all other avenues have been explored and only if it is in the best interests of that person. The room in which the medication is kept was very untidy with bottles of medicines left on the side. The returns bin was overflowing with medication waiting to be returned. Generally staff were seen interacting with people in the home in a positive way, however on one occasion we witnessed a person living at the home walking towards the lift to go upstairs, a member of staff was in the lift waiting for the door to close she saw the person coming but yet chose to ignore her leaving the lady quite distressed. On another occasion people were seen waiting in the dining room for their breakfast, two of these people were sat in wheelchairs but had slumped right over, a lady at the table was upset about this and was shouting for someone to help, there were three staff in the room at the time but no-one assisted these people to sit up. Staff were seen and heard knocking on doors before entering bedrooms and were carrying out personal care for people in private. Most staff observed in conversation with people were heard to be courteous and respectful. The home has some double rooms in which privacy screens were seen and staff confirmed they use when undertaking personal care. Hay House Nursing Home DS0000043065.V344662.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is reasonably good provision for activities for people at the home. The people living at the home benefit from the good relationships the home has developed with their relatives and representatives. Some people are enabled to make some choices and have some control over their lives whilst others who lack the capacity to communicate their wishes do not. The people that live in the home enjoy a balanced diet which takes into account the likes and dislikes of most individuals. EVIDENCE: Four people responding to CSCI surveys said there were activities arranged by the home that they could take part in others said there were” sometimes” activities. The home has one dedicated activities organiser, who works Hay House Nursing Home DS0000043065.V344662.R01.S.doc Version 5.2 Page 16 approximately 20 hours per week. Group and individual activities are organised. Outside entertainers visit the home on a frequent basis, every two weeks people are able to participate in drama therapy, some photographs were seen of people joining in and enjoying this. On the day of the inspection a musician was visiting, he was singing in the lounge with people joining in and most enjoying it very much. During the inspection staff were seen spending varying periods of time with the people living at the home. For example staff were seen in the lounge during the morning, one was painting a lady’s nails whilst another was sitting reading a magazine with a person. The Expert by Experience was told that a quarterly newsletter is sent to all families detailing activities in and out of the home. For example, as it was the 5th November there was to be a special supper and then fireworks in the garden. The more mobile people are taken out in cars and for other outings the home hires a minibus. Activities were discussed at length with the homeowner; it is hoped that the person currently responsible for activities would have her hours increased to full time and that she would get some training in how to effectively deliver quality activities especially to those people with dementia. Also the home has had a dementia mapping exercise undertaken by a Psychologist this has also been very useful in identifying what activities would be more appropriate and compatible with peoples’ differing needs. The home has established good relationships relatives and visitors. Those responding to the CSCI survey confirmed that they were always welcome at the home and that they were always informed and consulted with regards to their relative. One relative said, “They really are very good here.” Peoples’ preferences regarding daily routines and choices were not consistently recorded to identify what time people like to get up or go to bed or how and where they spend their day. However, staff did confirm that there is no set routine and for those people that are able to state their preferences and that they choose what to do and when. However, for people that lack capacity and have difficulty expressing their wishes clearly agreed routines and preferences would be useful to guide staff. Positive comments were received from people living at the home regarding the meals. From surveys three people said they “always” like the meals and two said they “sometimes” enjoy the meals. One person said the food was ‘very good indeed, can’t complain’. The home employs a cook. The menus are regularly reviewed and altered; the cook has a list of individual dietary needs, likes and dislikes and these are always catered for. The daily menu is displayed on the board in the dining room of the home. Records are kept of the meals provided to each person. An alternative is always provided if they do not Hay House Nursing Home DS0000043065.V344662.R01.S.doc Version 5.2 Page 17 like the main meal each day. The home works within the environmental guidelines “Safer Food Better Business” which is good practice. Homemade cakes, fresh fruit and vegetables were seen in the kitchen. Staff said breakfast is served from 915am; a cooked breakfast is available everyday people were seen enjoying this. Senior staff said snacks were available in the evening, in case people needed to eat more before settling. Hay House Nursing Home DS0000043065.V344662.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a robust complaints procedure and there are systems in place to ensure that investigations are undertaken, which means that people can be confident that their complaints will be listened to. People are protected from the risk of abuse by well-trained staff and good policies and procedures EVIDENCE: The majority of the people we spoke with told us they like living at Hay House, are well cared for and that staff treat them well. The questionnaires people completed either stated that staff always treated them well. Relative questionnaires stated that staff were very friendly and caring. All relatives said they knew how to make a complaint. All felt confident that it would be dealt with properly. People who were able to told us that they would speak to someone if they were unhappy. All staff spoken to said they knew who to report allegations of abuse to. All staff knew of the different types of abuse and had received training in the protection of vulnerable adults. Hay House Nursing Home DS0000043065.V344662.R01.S.doc Version 5.2 Page 19 The Commission for Social Care Inspection have received one formal complaint regarding Hay House since the last inspection. This was concerning poor staffing levels. The homeowners investigated the complaint, it was dealt with quickly and robustly and there was found to be no evidence to substantiate it. The finances of people at the home are well managed. Some relatives or solicitors maintain appointees and provide the home with monies when necessary. Fees are paid directly to the company and minimal personal monies are managed by the home (see standard 35). Hay House Nursing Home DS0000043065.V344662.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 23,24,25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is safe and improvements to some of the décor and fabric have been made, however there is still work to be done to ensure a pleasant, clean and comfortable environment is available for all people. Specialist equipment does not always meet people’ needs. People have homely bedrooms, which suit their needs. EVIDENCE: Our expert looked around the building, her first impression on entering Hay House was of a relaxed and very friendly atmosphere and this was reinforced during the course of her visit. The house itself is Georgian and very imposing and although the difficulty of maintaining such an old property must be considerable the standard of Hay House Nursing Home DS0000043065.V344662.R01.S.doc Version 5.2 Page 21 decoration and cleanliness was found to be generally very good. A few carpets need replacing as they looked old and worn, but for the most part everything looked fresh and clean. A few areas were malodorous but the domestic staff at the home work hard in keeping this to a minimum. On the ground floor there are two lounges and a dining room. Some bedrooms are also situated on the ground floor. On the first floor there are further bedrooms, a passenger lift is used to access these rooms. All bedrooms visited had been personalised with items such as pictures, photographs and various pieces of furniture. Our expert toured the building she found all the bedroom doors had the name of the occupant displayed which was practical for those who are able – one lady even had a personalised nameplate; consideration should be given to identifying bedrooms with a system which may help those people with dementia, for instance photographs or a familiar object. The environment in general would benefit from being assessed in line with dementia care environmental good practices. A considerable amount of work has been done to the rear garden – paving, raised flowerbeds – to make it attractive and safe for people. Our expert was told there are plans to make an exit from the dining room directly to the patio – at present the only way is to go out through the front door and around the house – and to have a conservatory, but because the house is listed there are restrictions on what can be done. There are gloves, paper towels and liquid soap around the home, to promote good basic hygiene. Staff had knowledge of infection control issues such as MRSA. The laundry is well equipped and appeared to be well organised. The home has a well-maintained environment, which provides aids and equipment to meet the care needs of elderly people. However, people who use a wheelchair were seen sat at the table for their meals in their wheelchairs instead of a more suitable chair to sit in when eating. Also equipment must be made available to meet people needs for example wheelchairs must be safe to use with footplates attached. The front of the property has car parking for staff and visitors. The home is secure with key coded entry. This allows people to freely wander around the home in a safe way. Hay House Nursing Home DS0000043065.V344662.R01.S.doc Version 5.2 Page 22 Hay House Nursing Home DS0000043065.V344662.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are protected by the home’s recruitment practice, which is good. People benefit from having significant numbers of skilled, experienced and friendly staff that has a good understanding of their needs. EVIDENCE: On the morning of inspection there were two trained nurses, five care staff, a cook, a kitchen assistant, two domestic and a maintenance man, to care for thirty four people. The manager and owner was present throughout. Feedback from people found that staff were “usually” available when needed. During the morning call bells were answered fairly quickly and staff were busy, but seemed well organised. In surveys staff say they feel well supported and that they are not asked to care for anyone outside their area of expertise. Training for staff is satisfactory. The manager has developed a training matrix so that it is easy to recognise whom needs training and when. Nearly all staff have had up to date training in infection control, first aid, fire prevention, health & hygiene and the protection of vulnerable adults. We were told that moving & handling training is given to all (records confirmed this), this is Hay House Nursing Home DS0000043065.V344662.R01.S.doc Version 5.2 Page 24 delivered by two trained nurses at the home that have undertaken an intense course and are able to train others. Individual training records provided evidence that training is provided and ongoing. Staff spoken to on the day of the site visit confirmed they received sufficient training to enable them to meet the needs of those living in the home. Of the eight staff that completed and returned surveys to us seven indicated the home provides funding and time for them to receive training, and the other indicated they didn’t know if the home did. The home operates a good recruitment procedure that clearly highlights the processes to be followed. Three staff recruitment files were looked at during the visit. The documentation was consistent with evidence of a safe and robust recruitment process being carried out before a person is employed at the home. All new staff have induction training to enable them to get to know the people living at the home, the philosophy of care, safety procedures, all procedures and the general layout of the home. The Service users were complimentary about the staff team confirming their needs were met 24 hours a day. Comments received from people included; ‘I get everything I need” and ”they are very kind”. Hay House Nursing Home DS0000043065.V344662.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home, relatives and staff benefit from the friendly and open management at the home. There are systems are in place to ensure that peoples’ personal monies are correctly managed. There are arrangements in place to involve people and their representatives in the running of the home, with evidence that their views are sought. Systems are in place to promote the safety and health of people living at the home and staff Hay House Nursing Home DS0000043065.V344662.R01.S.doc Version 5.2 Page 26 EVIDENCE: The manager is a first level registered nurse, and has had considerable management experience. However, she has yet to finish the Registered Managers Award, she told us that this would be completed by December this year. Communication systems are in place, there are regular staff handovers and regular staff meetings; minutes of these were seen and contained positive reassuring messages for the staff team. There is a good quality assurance system in place. This includes people living at the home, friends, relatives and health professionals’ satisfaction surveys being undertaken yearly, the results of which will be analysed and actions taken where issues arise. Also a meeting is held every six months which is chaired by Mr Guest and includes everyone living at the home that would like to be involved and their relatives/representatives whereby any issues can be discussed and plans made. We looked at the personal accounts of three people at the home. Each is kept securely in a locked space. Each account is kept separately and records and receipts are kept. Balances were checked and were found to be in order. Maintenance and associated records provided evidence that the registered provider has a sensible approach towards maintaining the safety of the environment; the fire precautions logbook indicates that the fire alarm is tested weekly and emergency lights monthly. Records and discussion confirmed that the staff have regular training in fire safety. Documentation was seen of maintenance of equipment and water, gas and electrical systems. Window restrictors have been fitted to windows where we looked for them this will reduce the risk of falls, and all radiators were covered which reduces the risk of scalding. People we asked said they did not find any problems or hazards in the home. Staff said they checked the bath water with a thermometer before the person got in. Bath water records in each bathroom and a thermometer were seen. Staff who were asked felt they had a safe working environment, and sufficient equipment to do the job expected of them. Three accidents have been reported to the commission by the home in the past three months these include two fractures and a head injury sustained by people living at the home. The accident records were looked at and the care Hay House Nursing Home DS0000043065.V344662.R01.S.doc Version 5.2 Page 27 plans all were in good order and showed that good procedures had been followed. Risk assessments were in place for the prevention of falls. Hay House Nursing Home DS0000043065.V344662.R01.S.doc Version 5.2 Page 28 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 3 Hay House Nursing Home DS0000043065.V344662.R01.S.doc Version 5.2 Page 29 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. 1 Standard OP7 Regulation 15(2) Timescale for action You must keep each persons 31/12/07 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. Arrangements must be made for 30/11/07 the safe return and storage of medication in the care home. Medicines must not be given to people covertly unless this has been specifically stated by the doctor on the prescription relating to that medicine. When staff administer medicine covertly the reasons for this should be clearly recorded; agreed by the multidisciplinary team and be in the persons best interest. In such cases decisions must be made within the Mental Capacity Act (2005), using the key principles of that act. This will ensure the people living at the home are kept safe from Hay House Nursing Home DS0000043065.V344662.R01.S.doc Version 5.2 Page 30 Requirement 2 OP9 13(2) 3 OP14 12(2)(3) 4 OP31 9 (1)(2) the risk of medication errors occurring. Residents’ preferences regarding daily routines and choices must be considered, planned for and recorded. You must ensure that the manager has the qualifications, skills and experience necessary for managing the Home. (This refers to the completion of the Registered Managers’ Award, which is a condition of registration.) This requirement is repeated from the last key inspection on 25/06/06 30/12/07 28/02/08 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. 2. Refer to Standard OP22 OP7 Good Practice Recommendations Staff should be reminded to ensure that footplates are on wheelchairs when appropriate. This will ensure people can be moved safely and easily. It is recommended that care plans clearly document all identified needs, actions taken and reviews (this includes decisions made about using reclining chairs and covert medication). It is recommended that the garden is made more accessible for residents. In progress. It is recommended that the Home be assessed in relation to dementia care good practice environmental issues and that all service users’ doors are individualised in some way to enable service users to identify their rooms. Appropriate chairs should be available in the dining room to allow people to be comfortable and supported when DS0000043065.V344662.R01.S.doc Version 5.2 Page 31 3. 4. OP12 OP19 5. OP22 Hay House Nursing Home eating. Hay House Nursing Home DS0000043065.V344662.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V344662.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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