Inspection on 22/02/06 for Hayes Court

This inspection was carried out on 22nd February 2006.

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

Hayes Court 08/04/08

Hayes Court 29/05/07

Hayes Court 29/06/06

Hayes Court 18/07/05

Hayes Court 14/01/05

Hayes Court 19/07/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Hayes Court Hayes Court Nursing Home 50 Hayes Lane Kenley Surrey CR8 5LA Lead Inspector Mohammad Peerbux Unannounced Inspection 22nd February 2006 11:00a 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 Hayes Court DS0000019027.V262503.R01.S.doc Version 5.1 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. Hayes Court DS0000019027.V262503.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hayes Court Address Hayes Court Nursing Home 50 Hayes Lane Kenley Surrey CR8 5LA 020 8660 3432 020 8668 4522 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) Dr Michael John Sturgess *** Post Vacant *** Care Home 56 Category(ies) of Old age, not falling within any other category registration, with number (56) of places Hayes Court DS0000019027.V262503.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. A variation has been granted to allow one specified resident under the age of 65 to be admitted. 18th July 2005 Date of last inspection Brief Description of the Service: Hayes Court is a 56-bedded care home. It provides both nursing and residential care. The home is set in its own quite substantial grounds about a mile from Kenley railway station. Access for wheelchair users is available. There are three floors with access by stairs or a small passenger lift. The home provides the possibility a double room on each floor, though only one can be occupied doubly at any one time to keep within the registered number. The remaining bedrooms are all single occupancy; all bedrooms have en-suite facilities. The majority of rooms are located on the ground floor, with a small number in the original main building on first and second floors. There are a number of communal areas located throughout the home, and a conservatory for the use of service users. Parts of the garden are also accessible to them. Visitors may be seen in private in users rooms, or in one of the small lounges. Hayes Court DS0000019027.V262503.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the home’s second inspection for the year 2005/06. It was an unannounced inspection and took place over three hours. Some times were spent looking at the policies and procedures, talking to the Registered Provider, staff and to some of the service users. They are all thanked for their time and assistance. A tour of the building was also carried out. Some of the service users spoken to stated that they were happy with the care being provided. Requirements and recommendations from the previous inspection were also discussed with the registered provider. Overall the inspection confirmed that the home provides a good level of care for the service users who live there. What the service does well: What has improved since the last inspection? It was positively noted that the registered provider and his staff team have worked hard in meeting all the requirements and recommendations that were set at the previous inspection. Hayes Court DS0000019027.V262503.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hayes Court DS0000019027.V262503.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hayes Court DS0000019027.V262503.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 The Statement of Purpose, and Service User Guides’ provide prospective service users with details of the services the home offers. This enables them to make an informed decision about admission to the home. EVIDENCE: It was previously required that the Statement of Purpose must be reviewed with regards to the organisational structure of the home and the number, relevant qualifications and experience of the staff working at the home and that the Service User’s Guide includes a copy of the latest inspection report. Both requirements have been met. Hayes Court DS0000019027.V262503.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 and 9 Service users’ personal, physical and emotional health needs are being appropriately met and reviewed. This ensures that the service users’ physical and emotional health is well maintained and therefore the quality of life experienced is also maximised. EVIDENCE: A number of care plans were sampled and they have been reviewed and updated to reflect changing needs and current objectives for health and personal care of service users. This is in line with requirement made at the last inspection. It was previously required that staff must receive training in the support service users with visual (and hearing) impairments. The registered provider stated that it was difficult to find an appropriate course however he has put together a training pack and the training is done in house. The training pack contains very useful information. A number of requirements and recommendations were made at the last inspection regarding medication (standard 9). It was positively noted that all of them have been met. This will be monitored again at the next inspection. Hayes Court DS0000019027.V262503.R01.S.doc Version 5.1 Page 10 Hayes Court DS0000019027.V262503.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 The daily routines and the home’s policies promote the residents’ choice and rights, to ensure equality and that all rights are enjoyed by all service users. EVIDENCE: The service users’ comments and observation confirmed that the home is run in a manner that promotes choice and independence. Service users can bring in their own possessions and furniture if they wish and this was observed in service users’ bedrooms, which had been individualised. Hayes Court DS0000019027.V262503.R01.S.doc Version 5.1 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Service users are protected from abuse and are living in a safe environment as the home has appropriate adult protection policies and procedures in place. EVIDENCE: The home has a copy of London Borough of Croydon adult protection procedures. It was previously required that all staff including ancillary staff must receive training in Adult Protection. Most of the staff have had the training already and this is on going. Hayes Court DS0000019027.V262503.R01.S.doc Version 5.1 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20,22 and 24 The home provides a clean, safe, well-maintained environment with service users having access to safe and comfortable facilities. Service users have sufficient aids and adaptations to ensure safety. EVIDENCE: The home provides a satisfactory amount of communal space. Furnishings of communal rooms are domestic in character and of good quality, and suitable for the range of interests and activities preferred by service users. Service users have access to all parts of service users’ communal and private space, through the provision of a passenger lift. Call systems with an accessible alarm facility are provided in every room. As part of the inspection process, a tour of the premises was carried out and a random sample of bedrooms was viewed with the occupants permission .The majority of rooms seen were decorated to a good standard and were very personalised with photographs, pictures and other personal affects, including a wide variety of ornaments, noted. All the bedrooms viewed contained curtains, Hayes Court DS0000019027.V262503.R01.S.doc Version 5.1 Page 14 a mirror, comfortable seating, and sufficient storage space for service users to hang their clothes. All the rooms were comfortably warm and bright at the time of the inspection. Hayes Court DS0000019027.V262503.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 and 30 The home’s recruitment procedures protect the service users through vigorous staff vetting. EVIDENCE: It was previously required that the Registered Provider must ensure that staff records contain all the details listed in schedule 2 of The Care Homes Regulations 2001. This has been met. Staff records were examined and were seen to contain references, criminal record checks, and original application forms copies of identification and other details listed in schedule 2. All staff now have an individual training and development assessment and profile in place in order for them to fulfil the aims of the home and meet the changing needs of service users. This was a requirement made at the last inspection. The Registered Provider stated that staff training in ongoing. This will check in depth at the next inspection. Hayes Court DS0000019027.V262503.R01.S.doc Version 5.1 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,36,37 and 38 The home is managed well and run efficiently providing a safe and stable environment for the people living there. EVIDENCE: Since the last inspection the registered provider stated that he has not found a suitable candidate to be the manager of the home. However he is still actively recruiting for a manager. In the meantime he is managing the home with the assistance of his son. It was positively noted that the quality assurance surveys now include visiting professionals, voluntary workers and any other stakeholders. There were evidence in place at the times of inspection where other professionals have written in with their comments about the home and the care it offers.The home has a development plan in place however this needs to be further developed to show how the home is meeting its aims and objectives and is being run in the best interests of service users. Hayes Court DS0000019027.V262503.R01.S.doc Version 5.1 Page 17 It was previously required that the registered provider must ensure that formal supervision sessions are held with all care staff at least six times a year, and that these sessions are recorded and signed by both the supervisor and supervisee. From staff files sampled at random there were evidence that staff are being supervised on a regular basis. The registered provider stated that all staff would be having their annual appraisal soon in line with a recommendation made at the last inspection. This will be checked at the next inspection. It was previously required that the home must have a policies and procedures checklist. This should list all of the home’s policies and procedures, indicating when each policy was last reviewed. A copy should be included in each staff file, and should evidence that staff have read and understood each policy developed and reviewed. There was evidence that this requirement has been met. Two requirements were issued regarding health and safety at the last inspection,both of them have been met. Hayes Court DS0000019027.V262503.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X 3 X 3 X 3 X X STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 3 3 Hayes Court DS0000019027.V262503.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hayes Court DS0000019027.V262503.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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