Inspection on 15/04/08 for Haye Corner Residential Care Home

This inspection was carried out on 15th April 2008.

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

Haye Corner Residential Care Home 13/04/07

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Haye Corner Residential Care Home 21 Crofton Lane Hill Head Fareham Hampshire PO14 3LP Lead Inspector Jan Everitt Unannounced Inspection 15th April 2008 09:30 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 Haye Corner Residential Care Home DS0000068989.V361312.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. Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Haye Corner Residential Care Home Address 21 Crofton Lane Hill Head Fareham Hampshire PO14 3LP 01329 662175 01329 516970 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) Mrs Maureen Winifred Flanagan Mr John Joseph Flanagan Care Home 20 Category(ies) of Dementia (20), Dementia - over 65 years of age registration, with number (20), Old age, not falling within any other of places category (20) Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in the category DE referred to above are not to be admitted under the age of 55 years. 13th April 2007 Date of last inspection Brief Description of the Service: Haye Corner is a residential care home that is comprised of three bungalows in the seaside village of Hill Head close to the sea front. The village of Stubbington is nearby with a good range of shops and facilities. The home has ten single bedrooms and five twin bedrooms. Each room has a washbasin, television and phone points. Communal areas include two lounges, a conservatory, plus two dining areas. There is one assisted bathroom, one shower/wet room and there are two separate toilets. Externally there is a patio area and a well-kept garden for residents use. The home is registered to provide care for up to twenty residents with old age and mental frailty. The current fees for the home range from £460:20 - £440:00 Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced, inspection visit to Haye Corner Residential Home, took place over a one-day period on the 15th April 2008. The newly appointed manager, was present in the home and assisted throughout the visit. The previous key inspection visit of April 2007 identified an adequate service and an improvement plan was requested by the CSCI. A further random inspection was undertaken in December 2007, following a number of contacts to the CSCI raising concerns with issues such as adequate diet, the environment and insufficient staff on duty. This visit was to monitor the improvements identified on the improvement plan the providers had submitted to the CSCI and to ensure they were completed. The manager had also returned the Annual Quality Assurance Assessment (AQAA) to the CSCI and the focus of this visit was to evidence the information stated in this document and other information received by the CSCI since the last fieldwork visit, which was a random inspection, made to the home in December 2007 and to also assess other key standards and to re- evaluate the overall rating of the service. Documents and records were examined and staff’s working practices were observed. We looked around the building. Due to all the residents having a diagnosis of dementia verbal feedback was sometimes difficult to establish. However feedback was gained verbally, from observations and non-verbal communication. Those spoken to were generally complimentary about the their home and the care they receive. One visiting relative was also spoken with. Surveys had been distributed to service users, relatives, care managers, GP and other visiting professionals. One service user surveys, three staff, two GP and three visiting professional surveys were returned to the CSCI. The surveys did state the home usually manages people with dementia very well. The outcome of the surveys indicated that there was generally a high level of satisfaction with the service and that people were pleased with the care the home provides. There were 13 residents living in the home. None were from an ethnic minority group. The outcome of this visit demonstrated that in the areas identified as being poor, an improvement in the standard has been achieved. Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The home now provides a more varied diet with choices at every mealtime. The home maintains adequate food stocks of wholesome food. The manager and chef have compiled a new menu that is more varied and with choices. The environment has had numerous improvements made to it. A new alarm system has been installed along with alarm mats by beds. All bedroom furniture, curtains and carpets have been replaced. The communal areas have been rearranged to give residents more improved space. The shower room on the ground floor has been completely refurbished. New carpets have been put down throughout the home and general decoration of the communal areas. A visiting relative commented: ‘The environment has improved greatly’. A maintenance man is now employed to undertake the general repairs of the home. The home has an organised training programme and more staff are now undertaking National Vocational Qualifications. Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 7 The home now has a manager in post who is implementing systems within the home to ensure staff are supervised, trained appropriately and able to meet the needs of the service users. Staff spoken with at the time of this visit and surveys received from staff indicate that training is available and the staff feel will supported by the manager who they say ‘Is a good manager and is respected by staff’. The medication administration records (MAR) sheets are now being recorded appropriately and the manager is auditing this every day. Photographs of the service users are now displayed on the MAR sheets for identification. The exit fire doors have been wired to the fire alarm and will unlock automatically if the alarm goes off. The duty rotas are clearly displayed and staffing levels have improved and there is now the appropriate number of staff working on each shift to meet the needs of the current service users and to ensure safe working practices. The recruitment process is now more robust and POVA and CRB checks are received prior to a person commencing employment. The home is fresh and clean with no offensive odours. What they could do better: The registered person must implement a quality assurance system for reviewing and improving the quality of the service to include consultation with service users/representatives, family, friends and stakeholders. The report of any review of the service must be documented and made available for service users and other stakeholders. The registered provider or representative must visit the home to undertake an inspection of the premises, speak to service users, staff and relatives and prepare a report on the conduct of the home which must be maintained in the home and be made available for inspection It is recommended that full fat fresh milk be part of the service users daily diet. It is recommended that the temperature of the new ground floor shower room be monitored to ensure that a comfortable temperature is maintained for service users when showering. It is recommended that the patio doors leading from the lounge into the garden be risk assessed as to service users safety in negotiating them independently. Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 8 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. Haye Corner Residential Care Home DS0000068989.V361312.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 Haye Corner Residential Care Home DS0000068989.V361312.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 Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users needs are always assessed before moving into the home to ensure the home can meet their needs. EVIDENCE: The home has a newly appointed manager who has been in post for the past two months. She was able to show us one pre-admission assessment she had undertaken since being in post and said that she had visited the gentleman in hospital to assess his needs, had gained information from the social care needs assessment and also looked at records at the hospital and communicated with hospital staff. The assessment tool was comprehensive and took into consideration all physical, psychological and emotional needs of the potential service user. Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 11 Three other care plans were viewed and these also evidenced that a preadmission assessment had been done prior to the service user coming to the home to live. The manager said that social services do send through the needs assessment they have undertaken to help inform the decision as to whether the home can meet the needs of the referred client. The manager said that she encourages relatives to bring the potential service user to the home at any time prior to their admission, if this is possible. It is at this time the manager can do a further assessment and involve family members to ensure they are informed and agree with the planned care. It is at this time the manager will give the service user/family a copy of the Service User Guide and the brochure. The home does not provide intermediate care. Haye Corner Residential Care Home DS0000068989.V361312.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 good. This judgement has been made using available evidence including a visit to this service. The home has care plans in place to ensure the personal and healthcare needs of residents are identified and met. The practices and policies of the home ensure that the home manages medication safely and effectively. The home’s ethos and staff working practices ensure that residents’ privacy and dignity is promoted. EVIDENCE: We looked at a sample of four care plans. The manager is currently introducing a new care planning system and therefore both systems were operational at the time of this visit. The care plans are well documented and detailed risk assessments are in place to support the service user’s needs. Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 13 There was evidence in one file of a full risk assessment for the use of bedrails on one service user’s bed and this had been discussed with the son and GP and the son had signed to say this had been discussed and he agreed to their use to ensure his father’s safety. We observed that care plans are reviewed monthly and changed as needs alter. The care plans held comprehensive information about the service users and included a social history of the service user’s past life. The care plans did demonstrated that the health, personal and social care needs of service users are assessed and plans give details of the care to be provided and also gives details on how this care should be given. The manager said that some relatives will participate in the care planning and discuss their relatives care but the majority of the service users do not have regular visitors and service users themselves are unable to participate in the care planning owing to their mental frailty. Staff spoken with at the time of this visit said that the care plans do inform them of how the resident should be cared for and they are confident in writing in the daily notes and care plans. Service users are registered with a number of GP’s and are able to keep their own GP if possible and this benefits service users. The home ensures that all service users have access to all relevant health care professionals. The chiropodist visits six weekly, the optician six monthly but the home has no access to a visiting dentist. The Community Psychiatric Nurse (CPN) does visit the home if the home requests a visit or needs advice on any resident that suffer mental frailty and who is taking medication prescribed by the psychiatrist. The staff training files evidence that staff have had training in Challenging Behaviours. The manager said there were no residents with challenging behaviours at the present time, but described a recent incident where she had informed the psychiatrist that the home could no longer care for a service user, whose needs had become greater and had started to present a risk to other service users and staff. The service user had subsequently needed nursing care. The manager considered that the home could meet the needs of the current residents, most of who were in the later stages of a dementia illness. The records evidence that all visits from health professionals are recorded in the care plans with any outcome from the visit or change of treatment. Surveys returned to the CSCI by visiting health professionals say: ‘The home requests visits and are always helpful and try their best with clients’. ‘The staff appear to respect the privacy of the service users when I have visited’. Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 14 ‘If I have bought anything to their attention they deal with is appropriately’. ‘The staff care for the clients within the limitations of their scope’. ‘Caring homely atmosphere. The home has a good retention of experienced staff and they advocate well for the patients’. ‘Continually give attention to client/family needs and education’. ‘Good activity’s s programme’. ‘The home provides appropriate care for older people with dementia’. ‘The home manages very well with a diverse group of residents who need a lot of intense support and intervention at times’. The policies and procedures of the home guide the home in the management of medication. The new manager has introduced more stringent practices following the requirement from the last inspection where a number of omissions were noted. The manager co-ordinates the ordering, receiving and checking of all medications in the home and is in the process of changing the system over to a blister pack system. We looked at the medication administration records, storage and control of stock. The records evidenced that there was good stock control with adequate supplies. Prescriptions are checked before they are taken to the pharmacy for dispensing, this is considered to be good practice as stated in the Royal Pharmaceutical Society guidelines. The MAR sheets were viewed and these were well recorded. The manager monitors these daily and signs as evidence that she has audited these. There was no residents self-medicating oral medication at the time of this visit. The AQAA states that over the last year refresher training by the pharmacist has been delivered, to reinforce staff knowledge on medication. The manager told the inspector that although most of the staff have been trained to administer medication, further training is planned from the pharmacist on the new system, before it is introduced. The administration of medication was observed for a short period of time. The trolley was taken around the home for this and medication was observed to be being administered as per the stated procedures and MAR sheets recorded appropriately following administration. It was also observed that MAR sheets had photographs of the service users attached to them. The care plans detail the service user’s preferences of when they like to go to bed or get up, what food they like and dislike. Staff were observed to interact well with residents, treating them with respect. Screens were observed to be present in all double rooms to ensure privacy. There was an obvious good rapport between the staff and service users with staff being very familiar with the daily routines and preferences. Haye Corner Residential Care Home DS0000068989.V361312.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. The home provides a range of social activities to meet service users needs although some residents may benefit from additional activities. Service users are able to exercise choice and make decisions about their lives. Visitors are made welcome to the home and they can see service users in private. A varied menu is available and a nutritious food is served to service users. EVIDENCE: The AQAA stated that the home offers various facilities and activities for service users. The new manager said that she is in the process of increasing and arranging various activities and entertainment for the service users. The notice board advertised the monthly attendance of an outside person who attends the home and undertakes physical exercises, quiz games and floor games with the service users, with the anticipated outcome being to motivate the residents mentally and physically. The manager reported that she is arranging for this person to attend more frequently as there is a good response from the service users, most of whom attend these sessions. Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 16 The care staff take on the responsibility of activities and arranging some form of entertainment at other times and with the staffing ratio improved, the manager said this should now be possible. They organise sing-a-longs most days, which the service users enjoy and this was observed at this visit. The AQAA states, and the manager told us that she is anticipating organising more outings on a mini-bus in the finer weather. The home being close to the sea, she is hoping the service users can enjoy being taken out in the summer months. Social histories are recorded in the care plans, but for some service users relatives are not involved and it can be difficult to obtain an accurate past social picture owing to the mental frailty of some of the service users. The visitor’s book evidenced that the home does have visitors most days. The manager said that the home does not get many visitors but the same regular visitors come to the home most days. One regular visitor spoken to at the time of this visit said she is ‘always made most welcome and feels she can visit whenever she and her family want to’. The clergy visit monthly to offer communion and all religious needs are observed. The manager said the hairdresser attends the home fortnightly and this is advertised on the notice board. None of the service users go out into the community independently except for medical appointments, to which they are always escorted. Service users spoken with said they were very happy at the home and felt well cared for. From observation of the day it was evident that the ethos of the home is to promote service user’s independence and choice in their daily activities. They can get up when they wish and sit in whichever communal area they choose. One service user was observed to be constantly wandering around the home quite content within her and without restraint. Following the findings from the key inspection visit of April 2007 and the random visit in December 2007, requirements were made with regards to the quality and quantity of foods being offered to the service users and there being insufficient food available. An improvement plan has been put in place since these visits. The requirements and improvement plan was discussed with the manager, who reports that she orders the food every week herself to ensure that there is sufficient wholesome food in stock. She also has petty cash that she uses to buy in food that is needed to top up the existing stock. Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 17 The kitchen was visited and the chef spoken with. The kitchen was observed to be clean and well organised. The previous cook has left and the newly appointed chef appeared very enthusiastic about his job and has many years experience in catering. He and the manager have compiled a new menu plan over a two-week cycle, which the manager is going to increase to a four-week cycle. The menu offers a variety of home made foods taking into account the service users preferences. The chef has introduced a cooked breakfast on certain days of the week and he says that most residents are choosing to have this. One resident told us that she really enjoys the English breakfast. The menu is displayed on the wall and there is also a picture menu that is used with service users to help them select the food of their choice. Each resident is supported to do this every day. Food records of what service users have eaten throughout the day were evidenced in the kitchen records. The chef was cooking the lunchtime meal, which was a beef hotpot and a variety of fresh vegetables for main course and cheesecake for dessert. He and the manager explained that they are attempting to create menus that are appropriate for the service users whilst taking into account their nutritional needs. The chef said that he provides a number of pureed meals and described how he presents them in separate portions to allow the colour and textures to be enjoyed by that person. Survey received from a staff member commented that they could do with more food and fresh milk, fruit and vegetables. The food store cupboards were seen and these were observed to have a stock of appropriate foods, cakes, biscuits, fresh fruit, vegetables and drinks. The chef said that he does bake cakes on occasions and the residents are served cake every day at teatime. The home continues to use long life milk. This was discussed with the manager and she said that she is attempting to negotiate with the providers to change to fresh full cream milk. Following the lunchtime meal it was observed that there was little wastage and that service users said they had enjoyed their lunch. One gentleman said the meat was a ‘bit tough’, but it was noted that he chose not to wear dentures. There was a poor response from service users to the surveys distributed but one returned said that they ‘ always have good meals’. One visitor spoken to at the time of this visit said she had ‘no complaints my husband is well cared for and he enjoys his food’. Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 18 Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 19 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 complaints procedure, which people felt they would use if necessary. Service users are protected from abuse by the policies and procedures of the home and staff training. EVIDENCE: The home has a complaints procedure and this is documented in the Service Users Guide. A complaints log is maintained and this was seen and evidenced that no complaints have been received since the new manager has been in post. It did evidence the previous complaints that had been recorded with the action taken and outcome from the complaint. The CSCI have received four complaints in the past year, which were addressed at a random visit made on 11th December 2007. This key inspection visit also followed up the issues in the complaints, which have now been resolved. The returned survey and the relatives spoken with at the time of this visit confirmed that they would know to go to the manager or member of staff if they had issues to discuss. The relatives commented ‘I have no complaints whatsoever’. Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 20 The home has a policy and procedure for ‘Safeguarding Vulnerable Adults’, which is available to all staff. The procedures for the reporting of any concerns with regards to abuse were discussed with the manager who was aware of all the reporting procedures. The training files evidenced that staff have received training in abuse awareness and the policies and procedures. When discussing abuse with staff on duty at the time of this visit it was clear they are aware of what constitutes abuse. The surveys returned from staff to CSCI indicate that staff would know to whom and how to report any concerns and were aware of their role in the process of reporting abuse. Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 21 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 &26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a pleasant homely environment that is maintained and clean. EVIDENCE: The AQAA states that there is a continuous maintenance schedule in place and redecoration; replacement of furniture and improvement of dinning room and lounge facilities has taken place over the past twelve months. Furniture that was old has been replaced and all new curtains hung throughout the building. The home has created a new layout for the dining and lounge area to create more space for residents to have more access to other areas of the home. New call bell system has been installed alongside pressure mats. Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 22 The old shower room has been converted into a wet room, a new shower, sink and basin has been installed. All new linen has been purchased. The high water temperature in the two bedrooms identified in the last report have been adjusted. The offensive odours have been addressed with the purchase of a new carpet cleaner and a cleaning schedule introduced to ensure any offensive odours will be dealt with immediately. The building was looked round and most of the rooms visited. There was evidence that the requirements from the previous inspection have been complied with and that required environmental improvements to the home have been undertaken. All bedroom furniture has been replaced and new curtains hung since the last inspection visit. Rooms have been personalised with service users own belongings. The layout of the lounge and dining area has been changed and communal areas redecorated. The communal areas are now spacious and light and service users were observed to be enjoying the lounge area, which was sunny and bright. New carpets have been put down in the corridor areas and the manager said that these are about to be replaced again as they have proved to be inappropriate. The ground floor shower room has been refurbished and is now a ‘wet room’, which the manager reports, is used daily. When this room was visited it was observed to be quite cold with no obvious heating in the room. This was discussed with the manager who said the window had been left open. The manager said that the service users enjoy using this shower, but she would monitor the temperature of the room. The home has the services of a maintenance man twice weekly who undertakes the ongoing small repairs and maintains the pleasant gardens that surround the home. The maintenance book was viewed and evidenced that the manager records all maintenance jobs and when they are completed. The manager said there is a programme of maintenance for larger scale works to be undertaken, which she is consulted on. The issue of the hot water temperatures has now been resolved. A valve was installed in March 08, which thermostatically controls the hot water temperature in the boiler. It was observed that the new nurse alarm system has now been installed and all rooms have call points. Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 23 The home was clean and hygienic. There were no offensive odours detected. The home employs a separate housekeeping staff of one domestic and one laundry person. The manager quality audits the cleanliness of the home and the condition of the fixtures and fittings of the home, on a regular basis and reports any faults. The home has an infection control policy and training files evidence that staff have received training on infection control and are aware of the principles. Gloves and aprons were observed to being worn appropriately and hand washing facilities of soap dispensers and paper towels were placed in all bathrooms and toilets. Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 24 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. Service users are cared for by trained staff that are competent to do their job, in sufficient numbers to meet the needs of the service users currently in residence. Service users are protected by the policies and practices for the recruitment of staff. EVIDENCE: The report of April 2007 made a requirement to ensure staffing levels were maintained to enable service users to use all parts of the home safely. There were further complaints received from a relative in relation to insufficient staff on duty and care staff having to prepare the tea leaving just one staff member to supervise the service users during the afternoon period. A random visit on 11th December 2007 was prompted by further concerns received by the CSCI of there not being sufficient staff on duty. The visit concluded that there were not sufficient staff on duty to ensure the health and welfare of the service users and a letter was written to the providers requiring them to ensure that there was sufficient staff on duty to meet the complex needs of service users. A letter and copies of staff rotas were received from Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 25 the provider saying that there was now sufficient staff on duty throughout the day to reflect the service user’s needs. The key inspection took place on 15th April 2008. The staff rotas were examined at the time of this visit. The home employs 16 staff - 12 carers, 1 manager, 1 chef, 1 laundry lady and one domestic staff. There were thirteen service users in residence. The rotas evidenced that there are three care staff on duty throughout the whole day. There is two waking staff throughout the night. The manager is in attendance five days a week from 07:00 until early evening, there is a cook seven days a week, who does split shifts and returns in the late afternoon to prepare supper, a domestic cleaner four hours per day, seven days a week and a laundry person six days a week. The staff practices were observed and staff were not rushing about and were observed to be giving time to service users and interacting with them in a relaxed familiar way. Staff spoken to say that there are sufficient staff on duty now and that they do have time to spend with service users. Those service users who were either in bed or had a high dependency were observed to look clean and comfortable. A survey comment from one staff member commented that the home could do better by having more staff. At the time of this visit the evidence suggests that there was sufficient staff on duty at the time to ensure service users’ needs were being met appropriately. The home now has over 50 of its workforce with NVQ level 2 or above with two completing the NVQ level 2 and three staff undertaking their NVQ level 3. The manager is researching the various resources who supply this training free which will enable her staff to undertake these qualifications without having to find any funding for themselves. The April 2007 report required the home to ensure that all appropriate checks are in place before commencement of employment. This was to include some form of photographic identification and some other proof of identification by way of an address. The improvement plan identified that all staff had provided photographs for their files together with proof of their ID and address. A sample of three staff recruitment files was viewed. The three viewed were for the most recently recruited staff. The files evidenced all the information required to be obtained as stated on Schedule 2 of the Care Home Regulations, together with a photograph and another form of identification. Two of the three files evidenced only POVA first checks that had been cleared and the home was still awaiting CRB clearance. This was discussed and agreed with the manager as to those people being supervised in their practice until the CRB checks were cleared. Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 26 Staff who had recently commenced employment at the home were spoken with. They described their recruitment process and said they were very happy with the process and felt well supported in their jobs. The manager undertakes to interview all new staff along with a representative from the company. The manager is in the process of organising the training programme. The manager is committed to staff training and has organised an appraisal and supervision programme over the next months to identify staff training needs and wishes. The programme for the supervision timetable was seen displayed on the staff notice board. All staff have individual training files and a training matrix is at the front of the file that gives an analysis of what training that person has received, what training is required, and easily identifies when mandatory training is due. The new staff have received an induction that is signed off by the manager when the element has been achieved. The length of the induction can vary depending on the qualification and past experience of the carer. The induction is usually a short programme as the manager says that most of the people she is now employing have NVQ level 2. For those who do not have this, their induction is longer and is based on the core elements of the Common Induction Standards but is not formally documented as such. The manager says she is putting all newly employed carers without NVQ qualification, forward immediately for the NVQ level 2 programme. This was evidenced by speaking to the two new carers, one saying she had got her NVQ level 2 and the other carer, who had never worked in care before, was being supervised and had been put forward for the NVQ level 2 which was in the process of being organised with a training provider. Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 27 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 adequate This judgement has been made using available evidence including a visit to this service. A person who is experienced to run the home and meet its stated aims and objectives is currently managing the home. The home has no effective quality monitoring and quality assurance systems in place. Service users financial interests are safeguarded. The health and safety of service users and staff are promoted. Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 28 EVIDENCE: The home has a new manager who has been in post since February 2008 and has applied to the CSCI for registration. She has achieved her NVQ level 4 in management and is commencing her Registered Managers Award imminently. The manager has worked with the elderly with dementia for some years and has worked in a care home for the past five years in the local area. The manager says that she does not yet get involved with the business planning but advocates on behalf of the service users and manages the home in their best interests. The manager told us she is working hard to improve the home and implement systems that can be easily audited and quality assured. The obvious improvements in the home are testament to her dedication and work in the short while she has been in post. The home has no quality assurance system in place. The quality manager visits the home weekly, tours the premises and the manager discusses with her what needed doing. The outcome of these visits is not recorded in a monthly Reg 26 report and therefore there was no evidence of this person quality assuring the home. The AQAA indicates that there are up to date policies and procedures that are reviewed regularly. The policies and procedures in place are stored in numerous folders and are unwieldy for staff to refer to. It will be recommended that these are reviewed and personalised to the home. There was no evidence that a service user/relative survey had been sent out to gain opinions and ascertain the level of satisfaction with the service. This was discussed with the manager who said that this is something she will be doing in the future. Service user/relatives meetings are not held to date. Many of the service users would be unable to contribute effectively owing to their mental frailty. It was suggested that relatives be asked for their opinions about the service and this be recorded as part of the quality assurance. The manager is holding two monthly staff meetings. The minutes of these meetings were seen to be recorded. A questionnaire is distributed to all staff at the end of staff meetings for them to evaluate the meeting and give their opinions/suggestions of the meetings and whether their questions were answered to their satisfaction. The manager has introduced her own internal quality assurance system and she checks the MAR sheets most days to ensure they are documented fully. The cleanliness of the home, care plans and she also monitors daily reports. Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 29 The home manages the personal allowance for all service users. A sample of monies and records were checked. It was observed that all monies in and out were recorded with a running total maintained. Receipts were given each time a transaction was made. The monies held were checked against the records for three residents and found to be correct. All monies are stored separately for each resident and kept in a secure environment. The fire logbook was seen, which demonstrated the necessary tests were being carried out in the agreed timescales. Staff were receiving adequate sessions in fire issues in a twelve-month period. Automatic fire closures have been fitted to the two bedrooms of service users who remain in their room at all times. The doors will automatically close when the alarm goes off. The new fire alarm system also releases the locks on the fire exit doors. It had been identified in the previous report that the fire officer had recommended that these doors should be readily opened in the case of fire. A fire risk assessment was evidenced. This was discussed with the manager who has agreed that it needs to be reviewed, and she will undertake this. Risk assessments were seen for each room and area of the home. It was identified that a risk assessment needs to be undertaken for the back patio doors that lead onto the garden. There are varying levels for a service user to negotiate to get out of the doors and this could be a potential risk for those with walking aids and could inhibit service users from using the garden. The manager said that there are other areas of the garden, and in particular the patio area at the front of the home, which is more popular with service users in the finer weather, but that she would risk assess this access. Servicing records were available demonstrating all the necessary equipment had been regularly serviced. The PAT testing for small electrical goods was observed to be out of date. The manager is aware of this and has organised for this to be done in April 2008. Food in the fridge was appropriately stored being covered and dated. The records for staff health and safety training for moving and handling, fire, first aid, infection control were evidenced as being up to date. All cleaning materials and other hazardous substances were observed to be kept in a secure environment and those being used at the time were being supervised by the housekeeper. Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 30 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 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 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 2 X 2 X 3 X X 3 Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 31 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 OP33 Regulation 24 Requirement The registered person must implement a quality assurance system for reviewing and improving the quality of the service to include consultation with service users/representatives, family, friends and stakeholders. The report of any review of the service must be documented and made available for service users and other stakeholders. The registered provider or representative must visit the home to undertake an inspection of the premises, speak to service users, staff and relatives and prepare a report on the conduct of the home which must be maintained in the home and be made available for inspection. Timescale for action 31/08/08 2. OP33 26 30/06/08 Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Haye Corner Residential Care Home DS0000068989.V361312.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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