CARE HOMES FOR OLDER PEOPLE
Haylands 93 Crofts Bank Road Urmston Manchester M41 0US Lead Inspector
Helen Dempster Unannounced Inspection 22nd February 2006 12:00 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.V278542.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. Haylands DS0000005610.V278542.R01.S.doc Version 5.1 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 Mrs Alicia Leigh Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Haylands DS0000005610.V278542.R01.S.doc Version 5.1 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. 29th September 2005 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, which the residents can enjoy in fine weather. 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 is an adequate number of toilets and bathrooms on each floor. A stair lift provides access to all floors and there are additional toilet facilities on the ground floor with disabled access. Haylands DS0000005610.V278542.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the second unannounced inspection for the year. It was carried out on 22nd February 2006 from midday to 3.00pm. Time was spent talking with a member of management team, staff and residents. This included discussing welfare matters relating to the residents the home supported and examining documentation in relation to the running of the home, the management arrangements, staffing, care planning and the residents’ satisfaction. The term of address preferred by the users of the service was confirmed as “residents”. It was felt this best reflected the function and purpose of the service. The inspection only looked at a limited number of standards, so this report should be read together with the earlier report to get a full picture of how the home is meeting the needs of the residents. What the service does well:
The home was clean, tidy, warm and comfortable and residents said that they were happy there. Care plans were good. They included having a pen picture/past history, which gave staff information about the issues important to each individual resident. Care plans were well linked to the needs assessment for each aspect of care by describing the need and then detailing how it would be met. The nutritional and risk assessments relating to the risk of low body weight were of a high standard and ensured that the safety and wellbeing of residents were promoted. Day to day records about residents were of a high standard. Each resident had a page for each day so that their wellbeing was monitored by each shift and food eaten by residents that day was recorded to enable staff to monitor diets. Residents enjoyed a nutritious and appealing diet with alternative choices offered. Without exception, residents spoken to said that the food was “very good”. One resident said that it was particularly good that residents can have a cooked breakfast, including bacon and egg every day. Breakfast menus were extensive and varied and after evening meals, residents could have cheese and biscuits in addition to a dessert. The residents were pleased with this. Residents benefited from being cared for by sufficient numbers of staff, who were appropriately supported and trained.
Haylands DS0000005610.V278542.R01.S.doc Version 5.1 Page 6 Residents said that the staff are “very good”, “kind” and care for them very well. Residents said that there are always enough staff to look after them. What has improved since the last inspection? 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. Haylands DS0000005610.V278542.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 Haylands DS0000005610.V278542.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): EVIDENCE: These standards were assessed at the previous inspection and will be assessed again at the next inspection. Haylands DS0000005610.V278542.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. Residents’ health and wellbeing was promoted through the use of detailed care plans. However, developing the risk assessments and care plans for medication could enhance this good practice further. EVIDENCE: A requirement was made at the previous inspection to the effect that the home needed to provide detailed care plans. On reviewing a sample of care plans evidence was found that confirmed this requirement had been met. It was evident that management and staff had worked hard on developing these care plans. Care plans included a pen picture/past history, which provided clear details of the issues important to each individual resident. This is good practice. Care plans were well linked to the needs assessment for each aspect of care by describing the need and then detailing how it would be met. Care plans covered such issues as personal care, pressure prevention, oral health, foot care, mobility, history of falls, continence, medication, mental state and cognition, social, religious and cultural needs, communication and risk assessments. Care plans were being reviewed on a monthly basis.
Haylands DS0000005610.V278542.R01.S.doc Version 5.1 Page 10 The nutritional assessments and risk assessments relating to the risk of low body weight were of a very high standard and ensured the safety and wellbeing of residents. This is commendable. Day to day records were also of a high standard as each resident had a page for each day so that their wellbeing was monitored by each shift. Good practice was also evident in that food eaten by residents that day was recorded to enable staff to monitor diet. While some risk assessments were clear and detailed, it was felt that risk assessments were in need of further development to include all aspects of risk to individuals and to specify agreed control measures to minimise risk. Advice was given and a requirement was made accordingly. A medication care plan was in place, but this needed further development to provide an explanation for what medication, including PRN medication, is prescribed for. A requirement was made accordingly. Haylands DS0000005610.V278542.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): 15 Residents enjoyed a nutritious and appealing diet with alternative choices offered. EVIDENCE: The chef was interviewed, menus were viewed and a number of residents were asked about food. At the time of inspection, a lunch of hot dogs or sandwiches or jacket potatoes was served. A dessert of jelly and ice cream was also provided. Without exception, residents spoken to said that the food was “very good”. One resident said that it was particularly good that residents can have a cooked breakfast, including bacon and egg every day. Breakfast menus were noted to be extensive and varied and after evening meals, residents could have cheese and biscuits in addition to a dessert. This is good practice. Haylands DS0000005610.V278542.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): EVIDENCE: These standards were assessed at the previous inspection and will be assessed again at the next inspection. Haylands DS0000005610.V278542.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): EVIDENCE: These standards were assessed at the previous inspection and will be assessed again at the next inspection. Haylands DS0000005610.V278542.R01.S.doc Version 5.1 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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): 27. Residents benefited from being cared for by sufficient numbers of staff who were appropriately supported and trained. EVIDENCE: The staff rotas for week ending 17/02/06 were seen. The Deputy Manager said that the minimum staffing levels during the day are 2 carers and a manager between 8am and 11pm. At night, 2 waking staff and a manager sleeping in on call are provided between 11pm and 8am. In addition to this, there are 2 domestic staff on duty every morning on weekdays and a cook each day. Residents said that the staff are “very good”, “kind” and care for them very well. Residents said that there are always enough staff to look after them. The Deputy Manager said that staffing levels can be reviewed in response to increased needs of residents. Since the previous inspection, staff had received training in health and safety and were about to update manual handling training. Haylands DS0000005610.V278542.R01.S.doc Version 5.1 Page 15 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): 35 and 38. Residents benefited from varied levels of support to secure and manage their finances. Overall, fire safety practice safeguarded residents, but this could be compromised by not always fully completing the records of fire safety checks. EVIDENCE: It was not possible to look at residents’ financial records as these are secured so that only the manager, treasurer and resident has access. This standard was therefore assessed by interviewing the Deputy Manager and asking residents about finances. The Deputy Manager explained that one resident manages finances independently, 8 residents are supported by their families to manage finances and the home holds money for safekeeping for the remaining residents. The home is not appointee for any of the residents for benefit purposes. Residents said that they were satisfied with the arrangements for managing their finances.
Haylands DS0000005610.V278542.R01.S.doc Version 5.1 Page 16 The home holds £100 petty cash for residents to use at all times. The Deputy Manager said that receipts are held for all purchases made on behalf of residents. The fire safety records were viewed and it was noted that the record of fire safety checks was not fully completed in a number of cases. A requirement was made accordingly. Haylands DS0000005610.V278542.R01.S.doc Version 5.1 Page 17 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 2 Haylands DS0000005610.V278542.R01.S.doc Version 5.1 Page 18 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. OP8 13 and 15 Standard Regulation Requirement Risk assessments must be in place to address all aspects of risk to each individual resident. The risk assessments must specify agreed control measures to minimise risk and must be reviewed regularly. This must include risk assessments concerning self medication. The care plan for the administration of medication, including “when required” (PRN) medication, including Paracetamol, must confirm why medication is prescribed and in what circumstances and for what conditions, PRN medication is given. The outcomes of fire safety checks must be fully recorded consistently. This includes checks of the fire alarm, means of escape and emergency lighting. Timescale for action 24/03/06 2. OP9 13 24/03/06 3. 24/03/06 OP38 23 Haylands DS0000005610.V278542.R01.S.doc Version 5.1 Page 19 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 Haylands DS0000005610.V278542.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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