Inspection on 19/06/08 for Haylands

This inspection was carried out on 19th June 2008.

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

Haylands 15/03/10

Haylands 26/08/09

Haylands 12/06/09

Haylands 19/07/06

Haylands 22/02/06

Haylands 29/09/05

Haylands 18/01/05

Haylands 06/07/04

Haylands 23/02/04

Haylands 23/10/03

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Haylands 93 Crofts Bank Road Urmston Manchester M41 0US Lead Inspector Sylvia Brown Unannounced Inspection 19th June 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 Haylands DS0000005610.V366237.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. Haylands DS0000005610.V366237.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Haylands Address 93 Crofts Bank Road Urmston Manchester M41 0US 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) 0161 748 3185 Haylands Stacey Jayne Niven Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Haylands DS0000005610.V366237.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. All service users fall within the category of old age. The maximum number of service users requiring personal care shall be 24. All service users accommodated are male. The home must at all times employ a manager who is registered with the Commission for Social Care Inspection. 19th July 2006 Date of last inspection Brief Description of the Service: Haylands home for retired gentlemen is registered to accommodate a maximum of twenty-four residents who require personal care by reason of old age. The home is situated within walking distance of Urmston town centre. Public transport routes are close by. The building is a large detached Victorian house with well-maintained enclosed gardens. There is off road parking at the front of the property. There are fourteen single rooms and five twin bedded rooms. Two of the single rooms have en-suite facilities and there are toilets and bathrooms on each floor. A stairlift provides access to all floors and there are additional toilet facilities on the ground floor with disabled access. The fees for accommodation are £250 per week and for those residents who are privately funded their attendance allowance is paid towards their fees. The fees include all meals, laundry, domiciliary chiropody and entertainment. Additional costs include hairdressing, dry cleaning and telephone calls. Haylands DS0000005610.V366237.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service would experience adequate quality outcomes. The inspection report is based on information and evidence gathered by the Commission for Social Care Inspection (CSCI) since the last key inspection, which was completed on the 19th July 2006. This was a key inspection which included a site visit to the service. The site visit was unannounced, which means the registered manager and staff were not told that we would be visiting. The registered manager was on duty throughout the site visit. We gathered information from a number of people, which included talking with and seeking the views of service users. We sent out surveys to service users, relatives and members of staff. This gave them an opportunity to talk with us about their opinions on the services provided at Haylands. At the time of writing the report we have no received any surveys from service users or relatives. Comments received from staff are, where appropriate included within the report. We looked in depth at records and the care support of two people living at the home. We also spent time sitting with service users and observing their dayto-day routines as they received care support from care staff. This helped us get a better view about how people living at home are looked after and supported. In May 2008 the registered manager of Haylands completed a self-assessment form, which is called an Annual Quality Assessment Audit (AQAA). This told us what the home had been doing since the last key inspection to meet and maintain the National Minimum Standards. It also told us what they felt they were doing well, how they had improved within the past 12 months and their plans to develop in the next 12 months. We also gathered information through general contact with the home; through their reporting procedures, which are called ‘Notifications’, and through information we received from other people, such as the general public, including concerns and complaints procedures. We had received information from one person about dissatisfaction with the service. We have received one anonymous complaint about Haylands, which related to the deterioration of standards within the home. We considered comments what Haylands DS0000005610.V366237.R01.S.doc Version 5.2 Page 6 the complainant said when we conducted the key inspection and evaluated the standards. Since the last inspection the manager has successfully completed the registration process with us and is now the registered manager of Haylands. What the service does well: What has improved since the last inspection? We do not feel that the home has made any major improvements since the last inspection. Although we think there is a further opportunity to improve the menu, the registered manager states within the AQAA that the Menu has been improved within the last twelve moths as a consequence of listening to service users. We are told that the registered manager now has a team of “bank “ staff who cover when permanent staff are on leave or off sick. This means service users continue to receive support from people they know. The registered manager has improved administration systems, with computerised equipment enabling a more efficient administration system to operate. The manager has improved the frequency of staff meetings and has developed individual supervision sessions for staff and staff appraisals. Haylands DS0000005610.V366237.R01.S.doc Version 5.2 Page 7 What they could do better: To ensure that the needs and preferences of service users are recognised, their records should be developed to include all their support requirements and personal preferences for how care should be provided. Food and fluid intake charts should be completed in detailed to ensure that accurate assessments can be carried out. Information provided to service users should be clearly written in a format they can understand. Currently contracts signed by service users for accommodation do not detail services provided or the cost of the service. Furthermore the contracts are lengthy and difficult to understand. To make sure service users receive their prescribed medication, the registered manager must ensure staff complete administration medication administration duties correctly. Staff should observe service users taking their medication and sign medication records each time, rather than leaving medication by service users and signing records collectively. They should also ensure that they never leave the medication trolley unlocked when leaving the room during administration. Robust recruitment and selection procedures should be developed and followed at all time. This will as far as possibly reduce the risk of service users being cared for by people who may do them harm. To ensure that staff are aware of what to do in a fire emergency, unannounced practical fire drill training should be incorporated in to fire safety training at the home at appropriate frequency. Although the manager does consult with service users, we think that management systems can be further developed to ensure that service users are encouraged to make comments on the services they receive and are able to contribute to the homes continued development. A review of mealtimes and the menu is recommended. We feel that service users independence is restricted because they are not able to have opportunities to serve themselves at meal times. The menu needs to include additional options and more fresh foods and quality meals, that ensure service users are receiving the nutrition they require to sustain good health. Despite the registered manager and staff having NVQ training in place, there continues to be gaps in their training programmes. To ensure they have the correct knowledge base and skills, we have recommended that a review of training requirements is undertaken. Where gaps are evident training should be secured and planned for. Parts of the home need upgrading to make sure all parts offer service users comfort, security and homely surrounding. We have asked for a full audit of all rooms, fixtures and fitting, and an action plan which details what action the registered manager is going to take to improve the environment. Haylands DS0000005610.V366237.R01.S.doc Version 5.2 Page 8 In order to ensure we can evaluate staffing levels, duties and care support time to service users the rota of hours needs to contain the correct details. We could not determine who completed domestic and cooking duties when ancillary staff were not on duty. A full quality assurance audit should be undertaken, which includes seeking the views of service users, relatives, staff, and other professionals and visitors to the home. The outcome of which should be made public and provided to service users and ourselves. This will enable service users to see that the home has taken seriously what they have said and assist them to see how the registered manager intends to develop the services offered to them. 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. Haylands DS0000005610.V366237.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 Haylands DS0000005610.V366237.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): 1,2,3 & 4 Standard 6 is not applicable to this service. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. The arrangements in place for assessment of service users needs, and the provision of information available were insufficient for service users to be sure that they understood what living in the home would be like, or that their needs would be met. EVIDENCE: We have looked at the service users guide and statement of purpose and found that the service users guide does not contain the required information. To support service users to understand information provided to them, both documents should be reviewed and amended to make sure information is relevant and in a user friendly format. Haylands DS0000005610.V366237.R01.S.doc Version 5.2 Page 11 Once the decision has been made to become permanent, service users are provided with and sign a contract of accommodation. We found the contracts inappropriate and confusing. They did not state the fees required or detail the services provided. Furthermore they were lengthy, legalistic, confusing documents. They use the term “warden” when referring to the manager and they also indicate that Haylands is a place which restricts service users from making their own decisions and choices. Such statements as “ to ensure control over our residents diet, all visitors at most inform the warden if they bring food into her home.” “All medication must be held under the control of the warden.” “Except in cases of illness all meals will be served only in the dining room.” and “Residents are expected to maintain an acceptable standard of dress” are inappropriate. They do not promote the independence and individuality of the service users, who may well be able to administer their own medication or may wish to take their meals in their own room. We have made a good practice recommendation for a review of all service users contracts. Service users should have contracts which state the required information and be in a format they can understand. Time and consideration should be given to supporting service users to understand what they are signing for. Prior to moving into the home service user have their needs assessed. The assessments looked at during the site visit, did not detail sufficient information. There was no information about who the assessment was conducted by, and with whom they consulted which should include the service user and other relevant people. Haylands DS0000005610.V366237.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. Staff practice ensured that the health and personal care needs of service users were met. Service users are placed at risk of not receiving their medication due to some of the medication practice in place. EVIDENCE: All service users had written care plans in place. Although the two care plans look at contained all the required elements, they had not been fully completed, we found that optical, hearing and dental checks were not evident. Nutritional screening had taken place but practices of recording were inconsistent and vague, making it impossible to evaluate if one service users who was required to have a to have a “ well balanced and nutritional diet.” And have their “ Intake” monitored was receiving the support required. Food and fluid intake charts were mainly copies of the menu. Portion sizes and some food contents were not noted, neither was there any indication about what was eaten. Haylands DS0000005610.V366237.R01.S.doc Version 5.2 Page 13 Care records detailed additional medical services such as GP and district nurse services. Routine chiropody treatments were also provided routinely. Risk assessments were in place, but they needed more detailed information in order to fully identify individual risks, what was required to minimise the risk and how the service user should be supported. When we observed the medication routine we found that staff left the medication trolley unlocked and unattended during administration. We also observed at least one service user’s medication on the table without staff ensuring it was taken. Medication records were then signed for collectively at the end of the administration process rather than after each administration. Such practices place service users at an increased risk of not receiving their own prescribed medications and without observation of service users taking their medication, staff cannot be confident that medication has been taken appropriately. When looking around the home, we found a number of prescribed creams belonging to service users in bathrooms. We also found prescribed medications in service users room which did not belong to them. . Throughout the inspection staff were in the main attentive and polite when supporting service users. Haylands DS0000005610.V366237.R01.S.doc Version 5.2 Page 14 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 adequate. This judgement has been made using available evidence including a visit to this service. Service users are not fully supported to make choices for themselves and their independence was not promoted at mealtimes. EVIDENCE: Care plans detailed service users social preferences and hobbies, however of the two files looked at, nether had sufficient information. We could not tell what social interests the service users had or if they had been consulted about what their hobbies and interests were or how they wished to be supported to continue with their chosen hobbies or develop new ones. Some service users had recently been taken out of the home on a trip and a further trip was planned for in July. During the inspection one member of staff attempted to engage some gentlemen in a game of darts. Another member of staff provided a service users with a writing pad and some pens, so they could occupy themselves. This member of staff did not speak to the service user or interact in anyway when providing the materials. Haylands DS0000005610.V366237.R01.S.doc Version 5.2 Page 15 The registered manager has developed activities programme, however it is repetitive and did not state what daily opportunities service users had for joining in activities. Furthermore we do not consider “hairdressing services “an activity, rather it is part of the systems in place to promote self worth and respect to service users. The registered manager makes comment within the AQAA that she recognises that the she has to develop a more stimulating activities programme. The registered manager told us that she had recently obtained a catalogue that that includes a wide variety of care activities for older people. We advise that service users are consulted about future activities and are able to influence how the social programme at Haylands develops. When asked what they home did well, one staff member told us “The social evenings and events in the home are good and enjoyed by both staff and residents.” Throughout the inspection we observed a number of visitors arriving at the home and spending time with service users. When spoken with they told us they thought the care provided at the home was of a good standard and that the service users were generally well looked after. The registered manager told us within the AQAA that “Although we offer a varied, wholesome and nutritious diets there is room for more varied choice. On arrival at the home we observed service users receiving their breakfasts. Hot food items are available everyday at breakfast which include, egg, bacon, sausage, tomatoes etc. We shared a lunchtime meal with service users and found that the mealtime experience could be improved for the benefit of service users. Tables were laid in a basic manner. Service users were not provided with items which enabled them to serve themselves with drinks. There was no milk, sugar, juice, salt or pepper on the tables. Tea was served from a communal pot which was also contained milk; furthermore the large teapot was without a lid. Serviettes were not available and one service user who was observed looking for something to wipe his hands on after eating a chicken leg. We found that whilst service users enjoyed the chicken leg salad, some had difficulty using their knifes and forks with the chicken. When asked how their meal was, one said “enjoyable, but a chicken breast would have been better”. The menu also stated “Toasties” were available. We observed a number of service users receiving this option, however when it was served it was two pieces of toast with jam placed together. We query whether this constitutes as a nutritional meal. Furthermore when served staff were heard telling service users to “ be careful, it’s extremely hot” Haylands DS0000005610.V366237.R01.S.doc Version 5.2 Page 16 We looked at three weeks menu and found that it required changes to ensure that service users are offered a nutritionally balanced diet that offers choices. There was minimal fresh fish, vegetables or fruit served. One service user required that he received a “nutritious diet” which should be “monitored.” We evaluated the records of food served and found that they failed to demonstrate that he had been provided with appropriate quantities of nutritious foods. The records were unclear. There was no indication that the service users had had anything different than on the menu and was in fact identical to the menu. There were no recordings of snacks or suppers taken, or quantities eaten. When we asked the cook about how specialist meals were prepared, she was unaware of how to pre pare such diets. When asked if she was aware of how much protein should be in a meal for service users she did not know. We feel that because of the lack of appropriate staff training, the current menu and unclear recording systems, some service users may be at risk of not receiving the diet they require to keep them healthy. Throughout the inspection we observed some service users walking around the home, however some staff appeared to restrict the movement of some service users. Staff repeatedly told some service users to stay in their lounge when they attempted to walk around the home. Care files failed to identify service users preferred rising and retiring times and their independent and or preferred routines. To support and make sure service users are living as far as possible the lifestyles they want, records should be developed to be person centred and reflect the individual service users preferences for their daily routines. Not withstanding that, most gentlemen at the home appeared satisfied with their care and told us they were “ok” and that things were “alright” Service users’ meetings are held by the registered manager. Whilst we can confirm that the menus and activities are discussed. We found that the meetings never varied in their contents and that the same things have been discussed for well over twelve months. Such meetings should be developed to encourage service users to express their opinions and become involved in the developing of the home and services they receive and keep them informed of any changes within the home. Haylands DS0000005610.V366237.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. Service users are protected by written adult protection and complaints procedures. EVIDENCE: Haylands has a written complaints procedure which is included within the service users guide and statement of purpose. The complaints procedure is also displayed within the home. The registered manager has received three complaints since the last inspection, two of which were from staff members. Records detailed the nature of the complaint and the action taken by the manager to find a positive resolve. We have received one complaint about the home. It was non specific but indicated that the standards within Haylands had decreased since the previous manager had left. We considered aspects of the complaint during this inspection process and monitored all the required standards. We also observed a number of compliments and thanks you cards which have been received from relatives since the last inspection. Adult protection procedures continue to be in place, however we are not clear about the process undertaken by the manager to ensure service users are Haylands DS0000005610.V366237.R01.S.doc Version 5.2 Page 18 made aware of them and how to report any concerns they have. We are recommending that systems are put into place to make sure service users are made aware of safeguarding procedures and how those can be accessed if they have any concerns. Some staff have not completed adult protection training or have out dated training. Action should be taken by the manager to make sure all members of staff receive appropriate adult protection training provided by the Local Authority. Haylands DS0000005610.V366237.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a home which needs some upgrading to make sure all parts offer comfort, support and homely surroundings. EVIDENCE: Haylands is a large detached property set in its own gardens. These areas offer service users pleasant places to sit and wander in fine weather. Internally a number of areas need upgrading. Some bathrooms and toilets are institutionalised and need modernisation. The AQAA stated that showering facilities are not suitable for all service users. We think that consideration should be given to providing more suitable showering units which will enable the more dependant service users to use them without difficulty. Haylands DS0000005610.V366237.R01.S.doc Version 5.2 Page 20 Some service users bedrooms were very personalised and homely, whilst others were bland and institutional. One double room was also used to store medical supplies and there was an indication medical treatments may be carried out within the bedroom. Some service users did not have bedside lighting, or bedside tables. Bedroom door contained glass, which reduced privacy for service users and many doors had plaques which stated people’s and/or companies’ names who had at one time supplied furniture for the room. Again we feel this is institutionalised practice. Because the dining room is based between two rooms, it does not have its own windows, because of this, the room has a number of light fittings. However low wattage bulbs and one fitting not working made this room dismal and dark. An audit of the home’s fixtures and fittings is recommended which includes beds, bedding, and towels. Where required identified items are below standards replacements should be planned for. Service users are able to smoke in a designated lounge. However this lounge is in a central part of the building, and directly opposite the dining room. There is no increased ventilation within this room, and the effects of the smoke could be felt in other parts of the home including the dining room. There was no signage to inform people this was a smoking area and the door was left permanently open. We were told that some service users who used this room were non-smoking. Risk assessments should be in place and records evidence that they have been consulted about where they would prefer to sit. Inspection of the kitchen identified that record keeping needed to be improved to ensure the registered manager can demonstrate good kitchen management systems. We observed that windows were open without fly screens being in place. We also noted that a staff’s handbag and other items remained on a work surface throughout the site visit. This is not good hygiene best hygiene practice. Cleaning schedules were not sufficiently detailed to identify that cleaning routines were carried out at the required frequency. We also observed that care staff frequently entered the kitchen to make drinks and snacks for themselves. Staff should be restricted from entering this area, wherever possible in order to maintain appropriate hygiene standards. Haylands DS0000005610.V366237.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. The recruitment procedures in place are insufficient and do not offer enough protection in ensuring that only suitable people are employed at the home. EVIDENCE: The staff team consists of the registered manager, two deputy managers, two senior carers, eleven care assistants and ancillary support workers including cooks, and domestics. The AQAA stated that a 100 of the care staff team have achieved NVQ training at level 2 with seven staff achieving NVQ3. This exceeds the required standard. The registered manager told us that because of NVQ training, there are gaps in other areas of training. Training records confirmed for example eight staff have not received moving and handling training with a further eleven in need of refresher training. All staff need infection control training or updates. Kitchen staff need training in nutritional awareness and food preparation. The registered manager told us that she was aware of where the gaps in training were and has plans in place to ensure additional training is prioritised. Haylands DS0000005610.V366237.R01.S.doc Version 5.2 Page 22 The recruitment and selection of two staff were looked at. Prospective staff complete an application and attend face to face interviews. However we noted that one staff appeared to have started work at the home without a CRB check being received. There was no letter of appointment and the procedure for the new started was vague. Whilst the homes induction had been completed, the Skills for Care Common Induction procedure had not been completed. There was evidence to support that the staff member was receiving supervision and being appraised. The second file identified that the application form was completed in a very brief manner and that the history of employment required further details. CRB and POVA first checks had been received before employment began, but again there was no offer of employment in place. There was no staff photograph on file, poorly detailed references, no information on the interview process and no evidence of the Skills for Care Induction being completed. Information was available to confirm that the staff received some supervision and had had a staff appraisal. We could find not details about either staff’s probationary period or what that entailed. Because the registered manager does not ensure robust recruitment and selection procedures are in place, we feel that service users may be at an increased risk of being cared for by people who could do them harm. The rota of hours worked by staff failed to identify that sufficient numbers of staff were on duty at all times. We noted that domestic staff were not on duty at week ends and that cooks hours in the main finished at 1pm each day. This means that care staffing hours are reduced as care staff complete domestic, laundry and cooking duties. The hours worked by the registered manager were not recorded, so we could not determine the actual numbers on staff on duty within the home. The rota of hours worked by staff should be in detail including, staffs full name, their staffing position, when they are covering other duties such as domestic and cooking. Haylands DS0000005610.V366237.R01.S.doc Version 5.2 Page 23 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. Service users live in a home which is managed by a person fit to be in charge, and who promotes their health, wellbeing and safety. EVIDENCE: Since the last inspection the manager of the home has successfully completed the registration process with us and became the registered manager of Haylands on June 8th 2008. She has 10 years experience caring for older people in residential settings. She also has 4 years management experience Haylands DS0000005610.V366237.R01.S.doc Version 5.2 Page 24 and has obtained an NVQ in care at levels 3 &4 and recently completed the Registered Managers Award. The registered manager needs to continue with her own learning and development and should receive support to do this. Her training records identified that she needs some up dated and additional training to assist her in her new position as the registered manager of Haylands. During the site visit we looked at health and safety and servicing records. We found that servicing was in place by professional contractors, for gas and electrical equipment, lifts and hoists. Inspectors from other agencies had been in to inspect the premises. Fire safety records could not confirm that all staff had received practical fire drill training and that annual lectures and fire safety talks were outstanding for some staff. As a consequence of this the registered manager took immediate action and commenced practical fire drill training, which included the training of night staff. Not withstanding that we have made a requirement about this matter. The fire safety officer last inspected the premises in December 06. As stated earlier in the report systems are in place to consult with service users, however we feel that service user meetings should be more frequent and encourage service users to share their views on how the service can be developed. Whilst the home appears to have completed a quality audit in 2005/6, the outcome was not formally reported. The information provided to us at this site visit was not clear and did not tell us what action had been taken as a consequence of the information received. We recommend that an up to date quality audit is completed. Consideration should be given to how the views of service users are sought and collated. The views of staff and other people involved with the service should also be incorporated into the quality audit. Upon completion the registered manager should complete a report of the outcome and make it available to the public and provide us with a copy. We are told that there have been no changes to the way the registered manager supports service users with their finances. Generally service users families assist service users with their financial arrangements. The home has petty cash for residents’ use and receipts are held for all transactions made on behalf of residents Haylands DS0000005610.V366237.R01.S.doc Version 5.2 Page 25 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 2 2 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Haylands DS0000005610.V366237.R01.S.doc Version 5.2 Page 26 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 OP9 Regulation 13 (2) Requirement Timescale for action 31/07/08 2 OP29 23 (4) (e) 3 OP38 13 The registered manager must make sure that medication administration procedures are carried out in a safe and appropriate manner thereby ensuring that service users receive the right medication. The registered manager must 31/07/08 ensure that robust recruitment and selection procedures are in place and followed at all times so that only suitable people are employed at the service. The registered person must 31/07/08 ensure that all staff have up to date fire safety training which includes practical fire drills at the appropriate frequency so that staff know what to do in the event of a fire. Haylands DS0000005610.V366237.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The Service Users Guide and Statement of Purpose needs to be developed to make sure they contain all the required information. They should be in an easy to read and understandable format and information provided including comments made by service users should be up to date. Once updated, current service users should be provided with their own copies of the documents and a copies should also be provided to us. All service users contracts should be reviewed and amended to ensure they are in a format that can be understood by the service users and or person asked to sign. That they contain the required details that includes the service provision and the cost. Up to date contracts should be supplied to service users and or their representative, with time given to supporting them to understand what they are signing for. Pre assessment records need to be completed in more details to make sure they reflect accurately the needs, requirements and preferences of the service user. Care plans should include more details on the service users needs and care requirements and how they should be met. They should be person centred and evidence that service users have been consulted about their wishes. Systems should be in place to make sure all service users receive routine optical, dental and hearing checks. Action should be taken to make sure that prescribed creams are not used communally. Service users records should detail their personal preferences for their daily routines and systems in place to promote their independence. The registered manager should make sure systems and staffs practice are designed to promote the independence of all service users at all times, including mealtimes, where they should have the opportunity of serving themselves and others. DS0000005610.V366237.R01.S.doc Version 5.2 Page 28 2 OP2 3 4 OP3 OP7 5 6 7 8 OP8 OP9 OP12 OP14 Haylands 9 10 11 OP15 OP15 OP15 12 13 OP15 OP18 14 OP18 15 OP19 16 OP19 17 OP19 18 OP26 Action should be taken to ensure that the menu offers a variety of food options at each mealtime which are nutritionally balanced. The registered manager should make sure that there are ample quantities of fresh fruit and vegetables made available to service users each day. Service users at risk of weight loss, should have accurate records to reflect what diet they have taken. Such records should be monitored and appropriate professionals consulted if required. All staff with the responsibility of preparing meals and specialised diets, should be appropriately trained. Systems should be put into place which ensures that service users are made aware of adult protection procedures and are made aware of how they can report any concerns they may have about the services they receive and or if they feel unsafe. The registered manager should make sure all staff have received training in adult protection procedures and are aware of their responsibility to report any suspicions of abuse. To improve conditions within the home and provide increased comfort to service users, a full room by room audit should be undertaken throughout the home. Upon completion an action plan should be devised and provided to us which details the plans for improvement where identified and timescales. To ensure that environmental health standards are maintained, kitchen management systems should be in place and followed which includes improved record keeping and staffs practice. The registered manager should take action to reduce the effects of smoking within the home for people who do not wish to inhale smoke. The registered manager should ensure she is aware of the legislation regarding “smoke free” environments and of the action she must take to protect non smoking service users and staff. To enable an accurate evaluation of staffing numbers, the rota of hours worked by staff should be in detail including, staffs full name, their staffing position, when they are covering other duties such as domestic and cooking. All staff should have training and development plans in place and action should be undertaken to ensure they receive all the required training to fulfil their role and responsibilities. DS0000005610.V366237.R01.S.doc Version 5.2 Page 29 19 OP27 20 OP30 Haylands 21 OP33 A quality audit should be completed which includes seeking the views of service users, relatives, staff and other stakeholders. Upon completion a report should be published of the outcome and supplied to us. Haylands DS0000005610.V366237.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Haylands DS0000005610.V366237.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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