Inspection on 13/03/08 for Hayleigh

This inspection was carried out on 13th March 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hayleigh 05/10/06

Hayleigh 25/11/05

Hayleigh 31/05/05

Hayleigh 30/11/04

Hayleigh 26/06/04

Hayleigh 27/01/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Hayleigh Myrtle Street Bedminster Bristol BS3 1JG Lead Inspector Sandra Garrett Unannounced Inspection 08:30a 13 and 14th March 2008 th 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 Hayleigh DS0000036207.V360169.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. Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hayleigh Address Myrtle Street Bedminster Bristol BS3 1JG 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) 0117 9039983 0117 9039984 Bristol City Council Barbara Ann Cairns Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: NONE Date of last inspection 5th October 2006 Brief Description of the Service: Bristol City Council runs Hayleigh which is a large, purpose built care home. The home houses forty people and is registered in the older persons category. It’s situated close to the busy shopping area of Bedminster and to local bus routes and community facilities. The home is accessible to disabled people with a lift to the first floor, self-opening front entrance and accessible toilet and bathing facilities. It has large mature gardens with trees and a patio. Fees for the service are £460 per week (full fee). People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority fees payable are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk http:/www.oft.gov.uk The certificate of registration and a copy of the last inspection report (dated 5 & 6th October 2006) were displayed in the entrance foyer of the home. Hayleigh DS0000036207.V360169.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 experience adequate quality outcomes. Before the visit, all information the Commission for Social Care Inspection (the Commission) has received about the service since the last visit was looked at. This information was used to draw up an inspection record in preparation for the visit. The record is used to focus on and plan our work so that we concentrate on checking the most important areas. The deputy manager was on duty and had been managing the home in the unavoidable absence of the acting manager (who is seconded from another home). The acting manager had just returned to duty and both she and the deputy now have joint management of the home. Both were welcoming and open to the inspection process during the two days of our visit. Before and at this visit we looked closely at a wide range of records. These included: the Annual Quality Assurance Assessment (AQAA) that the home has to fill in before the visit, the home’s own independent quality assurance survey report, plus care, complaints, health and safety and staffing records. We visited before the inspection to fill in our own surveys with seventeen people living at the home and these were used to give us more information about peoples quality of life. We also received three surveys that relatives had filled in and sent back to us. Comments from all of them are included throughout this report. We also spoke with ten people living at the home and twelve staff. What the service does well: What has improved since the last inspection? Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 6 Of three requirements made at the last visit in October 2006, two were met. Medication management and administration has improved and no errors were found or poor practice witnessed. This makes sure people are kept safe and protected. A number of bedrooms had been identified as needing either re-decoration or new carpeting. All had been done and people were seen enjoying fresh, clean and hygienic rooms that were comfortable and met their needs. Of two good practice recommendations made at the last visit one was partly adopted and one had been almost fully adopted: A list of training needed for staff had been drawn up that showed some staff had done safeguarding adults from abuse training. However, see below for a requirement about safeguarding adults training for those staff that haven’t done it. All staff files had clear photographs of each staff member except one. The photographs make sure people are protected and cared for by staff that are recruited and vetted properly and their identities known to everyone. What they could do better: A requirement made at the last visit about making sure ‘end of life’ plans that clearly show peoples wishes about the end of their lives, hadn’t been met. ‘Last Offices’ sheets were seen in peoples files but these gave very little meaningful information about how people want to spend the end of their lives and what their wishes are. The requirement is therefore moved on with a short timescale. Four new requirements were made: Overall care records were checked regularly so that changes in peoples needs were being picked up. However, from looking closely at one person’s care records it was clear that information from the original care assessment hadn’t been transferred into the care plan. Further exploration of the care plan showed that needs weren’t being recorded or highlighted to show what help was needed or being given. The outcome for the person is that her/his health could get worse if staff don’t make sure they meet the needs already picked up from the assessment. From looking at staff records we had concerns about differences in training being done by night staff from that being done by day staff. Further, supervision records showed night staff’s unwillingness to do training other than the most essential. This puts people using the service (particularly those with dementia or behaviours that challenge) at risk at night from staff that aren’t Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 7 fully trained to meet their needs. It also disadvantages night staff as they aren’t keeping up with training they need to make sure people are kept safe. A further requirement about staff training is made to make sure staff are able to properly deal with peoples sexuality in ways that will keep people safe and doesn’t discriminate against them. Further, given the number of people with dementia living at the home, all staff including night staff and domestic workers must have proper training in dementia awareness and care. Four good practice recommendations were made: People benefit from wholesome, tasty and well-prepared meals. However main courses at lunchtime focus on red meats or higher fat meats more often than lower fat chicken or fish dishes. Menus should therefore be looked at to move towards a healthier balance of low fat meals that could also offer a non-meat alternative. Although the home has benefitted from much re-decoration and refurbishment and continues to do so, some areas were looking tatty and in need of minor repair. A list should be drawn up of minor repairs or cleaning to make sure the overall building is comfortable and welcoming for people living there. From separate discussions with the deputy manager and staff it was clear that staff tensions aren’t being resolved. This could lead to divisions between staff that would negatively affect the care that people get. Team building sessions should be done to try and reduce the tensions so that people benefit from living in a happy and positive environment. Overall care records were good. Lots of positive and informative records of peoples lives in the home had been written. However it was disappointing to note that some negative recording was seen that didn’t show people are cared for from a person-centred perspective (meaning that people are valued, respected, treated with dignity and not judged). Further, no records were seen about how people enjoyed the recent Christmas festivities or their birthdays. Records should therefore show how people enjoy a good quality of life and also be written in a more respectful way. 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. Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 8 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 Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 9 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): 1,3,4 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People benefit from being given clear information about the home and the fees payable, when they come into it. Whilst assessments are done before a person comes into the home these aren’t always used properly to make sure peoples needs are met. Peoples needs for intimate personal relationships are supported as much as possible, though staff may not always have the skills or training to help them. EVIDENCE: A copy of the most recently amended Statement of Purpose was seen pinned up on a notice board close to the dining room and also in peoples individual files. The Statement covers all that people need to know about the service and how it’s run. It sets out the range of needs to be met and shows that staff have the skills, abilities and qualifications to meet them. It also includes a Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 10 statement on Equalities and Diversity though this could be written more clearly to show that the home is welcoming to different groups in society. People also have information about the home itself and the services it offers in a service users guide, together with copies of their contracts. These are also kept in folders that they have in their rooms. We asked people in our survey if they had been given enough information about the home before they moved in so that they could decide if it was the right place for them. Five people said ‘yes’ although eleven people said ‘no’. Comments included: ‘They were very forthcoming about that, ‘Yes staff at my previous home advised me to come here’, ‘It was my choice to come here after the other place closed down’, ‘I came to see the room before making my decision’, ‘I waited a long time to come here because I was in hospital’, ‘My daughter just brought me here and nothing was said’ and: ‘I came here straight from my previous home that closed’. Pre-admission assessments are done by social workers for each person considering a move into a care home. The home is sent a copy of the assessment from which initial care needs are picked up. This then forms the basis of a care plan that is developed over the four-week trial period each person has. At this visit we picked up a healthcare issue affecting one person. When we looked at the assessment the actions needed to make sure her/his health was kept up wasn’t properly transferred into the home’s care plan. This meant that serious healthcare needs around help with eating and keeping up proper weight levels weren’t being met. (Please see standards 7-11 below for more about this). It was clear that the deputy manager was aware of some peoples specialist needs particularly around sexuality and developing or keeping up personal relationships outside the home. She had worked hard to make sure one person’s needs were properly met that would keep the person safe from possible harm or abuse and records showed clear actions taken to try and meet the person’s needs. However staff need more training in sexuality issues so that they don’t make judgements about behaviours and are aware of how to keep people safe. (Please see Standards 27 – 30 below). The home doesn’t offer intermediate care (short-term care needed if someone is ill, or recovering from illness or injury, to stop them from needing to be hospitalised). However, members of staff from the community intermediate care team come in to the home to offer advice and to help staff make sure any needs are met. Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 11 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 & 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Regular care plan reviews make sure peoples day to day needs continue to be met. However, healthcare needs aren’t always picked up and put into care plans that may mean peoples needs don’t get met fully. Improvement in medications management means people living at the home are looked after well in respect of their medication needs. Being treated with dignity and respect benefits people using the service. However, records written about people being cared for towards the end of their lives don’t show that attention is given to recording their wishes. EVIDENCE: We ‘case-tracked’ four people living at the home. This means looking in detail at a sample of peoples records so that we can check the quality of care given. All showed clear evidence of being looked at monthly and changes were noted on the review sheet kept for this purpose. Six monthly review sheets were Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 12 seen that included a meeting with the person and/or her/his relatives, to check that all care being given meets their needs. Whilst checking medication we found large numbers of food supplement drinks, some of which were out of date. Checking further led us to look at one person’s care plan as s/he regularly has the drinks to supplement her/his diet. From looking closely at the person’s records, it was clear that information from the original assessment about diet and help with eating hadn’t been transferred into the care plan. The use of the food supplements had been agreed with the GP but there was no record of checking how much or how often s/he had been taking them. We spoke to the person who told us s/he did have the drinks but couldn’t say when or how much. Further exploration of the care plan showed that needs around diet and help with eating weren’t being recorded or highlighted to show what help was being given. The social work assessment showed that the person would need help ‘if having a bad day’. However none of the home’s records showed this was being checked or help was being given. The person’s weight wasn’t being checked regularly enough to make sure s/he was getting enough nutrition. We immediately required that the person be weighed. This was done but the way s/he was weighed and possible problems with the scales didn’t give an accurate reading. S/he was weighed again using digital sit-on scales and her/his weight was found to be at an acceptable level yet lower level than the last record done in October ‘07. The deputy manager was asked to look at the care plan and make sure it shows accurate information about the person’s care needs. Again this was done but still didn’t properly show the issue about help with eating so that the person is able to keep her/his weight up. Healthcare issues were seen recorded in care records. GP and district nurse visits are recorded in red to make them clearer in peoples daily records. We asked people if they got the medical support they needed and fifteen people said ‘always’. Comments included: ‘Lots!’, ‘I’ve seen a doctor whilst here’, ‘Well, when I want or need it’ (three similar comments), ‘They’re brilliant like that’, ‘If I were bad they’d get me a doctor’, ‘They’d get me a doctor from the medical centre if I needed one’, ‘I’m sure I do but I haven’t needed any for a long time’ and: ‘I’m generally healthy so I don’t need a lot’. We saw moving and handling risk assessments that were properly filled in and assessed and other risk assessments for issues such as self-medication, oxygen, behaviours and safeguarding adults issues etc. The deputy manager was clear about the need to keep people safe from harm as were staff we spoke to. Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 13 We followed up a requirement made at the last visit. Medication management and practice had improved and all medicines were stored safely and given out properly. We advised the deputy manager to remove the out of date food supplement drinks and to make sure dates are regularly checked. Medication administration sheets showed no gaps in daily recording. Controlled medication was kept securely locked away. Records showed it was properly signed for, witnessed and amounts left were correct. A medication fridge is kept securely although it was empty at this visit. A minimum/maximum thermometer showed a temperature of 3°c and daily records of this were seen. We saw staff talking with and helping people throughout the two days of the visit. Staff showed respectful attitudes. Peoples privacy and dignity was respected and call bells were answered quickly. Sixteen people said ‘always’ to our question ‘do the staff listen and act on what you say?’ Comments included: ‘They are very good like that’, ‘They do their best’, ‘They do anything for me & bring me anything I want’, ‘They’re great’, ‘No trouble at all’ and: ‘Yes but I never have to ask for anything though’. We followed up a requirement made at the last visit about putting in place ‘end of life plans’. These should be written in a person-centred way and include not just funeral arrangements but peoples wishes about the way they want to be treated both before and after they die. We saw a sheet called ‘last offices’ that was very basic and gave short details of the type of funeral and the funeral directors to be used. We discussed it with the deputy manager who immediately contacted other homes to ask about a different format for recording peoples wishes. Staff may need training in how to approach the subject, as the current form used doesn’t show that people are consulted about their wishes at all. The requirement is therefore moved on with a short timescale. Hayleigh DS0000036207.V360169.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 good. This judgement has been made using available evidence including a visit to this service. People benefit from an improved range of social and leisure activities that makes them happy and meets their needs. Encouragement of contact with the community helps people stay in touch with what is happening outside the home. Few restrictions placed on people living at the home gives them lots of choice in a relaxed atmosphere. Meals at the home are well managed and prepared, giving daily variation and social contact for people. However mealtime practices may benefit staff rather than the people living at the home. Further, traditional meals that offer a high level of red meats may not give people opportunities for a healthier diet. EVIDENCE: We saw and heard about lots of activity going on in the home at this visit. A notice board in a ground floor corridor had been devoted to photos and information about the newly developed weekly baking session that had Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 15 recently started. The photos showed and people told us, that they really like the sessions and take pride in the cakes they have baked. Further, a gardening club has also been started. Activities records gave a lot of information about how people enjoy this and what they are planting. People use their previous experience of gardening to help and inform others. We asked people about the activities and got mixed comments about them: ‘I like joining in with the activities and they’re regular. There are a couple of things written up on the board now’, ‘We’re always doing something and I join in with everything’ ‘There are activities but I like to stay in my room. I like to go to the pub once in a while’, ‘There is but I do my own thing. I keep my mind occupied’, ‘There is if you want it and quite often people come in to entertain’, ‘I like to join in sometimes; I prefer to do my crocheting most of the time though’, ‘There are some but I like my mates to come and see me and we go to the pub or out for the day every Saturday,’ ‘There is but I don’t bother’, ‘There’s a game of bingo now and again I think’, ‘We get lots and I especially enjoy the bingo and the cookery’, ‘I like my bingo and I enjoy doing my own bit of cleaning’, ‘I love my bingo’, and: We had bingo the other day and I have plenty to do with my knitting & reading’. One person told us that s/he enjoys going to the gardening class and feels that the activities have ‘really improved’. People get one to one ‘key time’ (time that’s set aside for social activities or anything a person wants to do) and examples of these were seen highlighted in daily records. People go out into Bedminster shopping with staff for example, or to the pub. One person loves the band Status Quo and said staff had taken her/him twice last year to see them play live at the Hippodrome. Another person likes to help staff and was seen helping with the drinks trolley during our visit. The Annual Quality Assurance Assessment (AQAA) filled in by the deputy manager before this inspection, showed that daily life and social activities have been given greater importance. However she also wrote that more frequent and smaller group outings could happen for people. The home’s own quality assurance survey report also included comments from relatives about this i.e. ‘it would be nice if they could reinstate trips out. My relative used to go out with her key worker every few weeks (three similar comments)’. A new activity room has been made out of one of the lounges and we saw things like Easter and other cards that people had made displayed there. The room has a good selection of books and is a large space for people to use as a group. However we saw that some books were in crates on the floor rather Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 16 than being put in shelves and a number of wheelchairs were stored there. This doesn’t help give people ‘ownership’ of the room or make sure all the things they want to use are accessible to them. The activities record book showed lots of good examples of how people joined in with and enjoyed various activities. However we looked at records over the Christmas period. There were no records of how people enjoyed the Christmas festivities although we’re aware that the home works hard to give people a good time. Records about general activities were written on 18th and 27th December but neither of these mentioned Christmas. Further, peoples enjoyment of their birthdays wasn’t given much of a mention in their daily records. One person’s birthday fell during the Christmas festivities but nothing had been written about this to show whether the person enjoyed it or had a good time. Notes of a residents’ meeting held in January ’08 did however record that people felt there was ‘enough entertainment, sweets and drinks etc available over the Christmas period’. The notes went on to say that ‘all present were unanimous in stating their Christmas was wonderful with plenty to eat and drink’. People were asked at the meeting for suggestions for 2008 entertainment and activities. We also saw notes of a meeting with a number of people held in February especially to discuss activities, as there had been no feedback from the January meeting. From this the new programme that includes arts and crafts as well as gardening and cooking, was set up. Further, Bingo is now held on Saturday nights to include sherry to make it more festive. Although people do go out into the local area e.g. to shops or the pub, little improvement in getting the community involved with the home has happened. The deputy manager told us about one person’s religious needs that the home have helped to resolve after it became difficult for the person to go to church. Church services are held regularly in the home and peoples need to see different ministers of religion are met as and when needed. The deputy manager had written in the AQAA that she hopes to get relatives more involved in the home and for people to ‘access community events and programmes more’ this year. From all the above it’s clear that people get a lot of choice particularly about activities and daily living routines. At this visit it was good to see people listening to their own choice of music on the CD player in the entrance area and changing CD’s themselves rather than having to wait for staff to do it for them. Lots of people choose to stay in their own rooms and not join in with group activities and this is respected. Meals at Hayleigh are of a consistently high quality and this hadn’t changed at this visit. We asked people what they think of the meals. Comments were mixed and included: ‘The meals are lovely and we get a choice of 2 menus everyday’, Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 17 ‘Its very good food’ ‘No complaints about the food it’s always hot and there’s plenty,’ ‘I’ve no appetite for the meals here’, ‘I’ve never had a grumble about the food’, ‘I eat what I want’ ‘The food is nice but can be a bit samey’, ‘It varies. It isn’t too bad at all though’ (two similar comments) ‘The food is lovely’, ‘I can’t grumble at the food’, ‘The food is very good’ and: ’They’re passable but the menu says one thing and they serve another’. We looked at menus and found a good choice of wholesome, largely traditional style meals. Curry is available twice monthly and one person was enjoying the lamb curry on offer on the first day of the visit. The emphasis is on red meat with chicken or fish not available as often as beef, lamb or pork. This can mean that people get a higher fat diet rather than a balance of both traditional and healthy food. Further, the two choices of main meal are both meat rather than perhaps offering a vegetarian second choice. Concerns had been raised about this issue in the home’s own quality assurance survey report i.e. ’staff not always mindful of dietary needs of individual residents (e.g. obesity – the need to promote healthy eating to achieve weight loss)’. People were seen being asked by staff for their choices for the following day. The day’s menu was written up on a large white board in one corridor. It wasn’t clear how accessible this would be to people with sight difficulties however. We sampled lunch with people living at the home on the first day. The meal was hot and tasty with a choice of steak and kidney pudding as well as the lamb curry and rice. Vegetables were served in dishes on each table so that people could help themselves. Pots of tea were similarly served at the dessert course. Five different types of dessert were offered, three of which are hot. However we heard people being asked if they wanted extra helpings of the main course soon after they had been given it, rather than waiting until they had nearly finished. People said yes and were given more even though they still had lots on their plate. We then saw that people couldn’t finish their meal as they had too much. The reason for this was unclear but could have been for the benefit of kitchen staff rather than the people themselves. This practice should be discouraged as it may mean people can’t face large plates of food and not eat enough rather than eating the amount they want and can manage. Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 &18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Satisfactory complaints management and recording ensures people living at the home can be confident in raising concerns about any aspect of their care. The way abuse issues are handled keeps people protected from risk of harm or abuse happening to them. However improvements in staff training in the subject is needed to keep people safe. EVIDENCE: Sixteen people said they knew who to speak to if they are unhappy, although only thirteen said they knew how to make a complaint. Seven people said they would go to the office if they weren’t happy. Comments about complaints included: ‘I’ve got a form in my drawer & I know I could go to the office’, ‘I wouldn’t want to make one though, they’ve got enough on their plates’, ‘Yeah I’d just shout at Sharon and that would get the message over’, ‘I haven’t got any to make anyway’ and: ‘It wouldn’t do any good to’. One relative commented: ‘If anything was amiss I would talk to the staff. They are always very approachable’ but went on to say: ‘I have never had cause to question anything’. Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 19 Information about the city council’s complaints procedure was seen on notice boards, in the Statement of Purpose and in peoples individual files kept in their rooms. One person told us of things s/he wasn’t happy with. The deputy manager was aware of these and told us actions that had been taken or were going to be taken. One person made very negative comments in our survey about almost all areas yet it was clear s/he has a good relationship with the deputy manager and staff and visited the office regularly during our visit. We looked at the complaints record book. Since the last inspection three complaints had been made. These ranged from noise at night, to trees in the garden blocking light into a person’s room and one from a neighbour about a bright security light in the car park. The deputy manager had immediately investigated and taken swift action on each complaint and all were responded to within a day or a week. Two complaints were upheld and one partly upheld. Staff we spoke with confirmed that they had all had safeguarding adults from abuse training and were clear about what they would do about it. Copies of notices sent to us about possible safeguarding adults’ issues before the visit showed quick action taken to keep people safe. However when we looked at staff training records we saw that some staff, including night staff had no training in the issue recorded at all. The deputy manager gave us a sheet of training needed that confirmed this and she said the training had been highlighted as a need. She said that the staff involved would do the training at the first available date. We also picked up the issue of peoples sexuality and how staff need to act promptly to make sure they are kept safe, without making judgements about it. A potential issue around keeping people safe from possible sexual abuse was picked up at this visit and discussed with the deputy manager. A new course for staff in dealing with the issue has just been developed and staff must do this training so that they are aware and can make sure people are kept safe from risk of harm or abuse. Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24 &26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from living in a well-maintained home that is accessible to them and meets their needs. However the lack of attention to minor repairs and maintenance makes it look somewhat scruffy and that could affect peoples morale. Improvements to the décor and flooring in peoples rooms makes sure they are able to enjoy their own space in comfort. Good, proper cleaning and hygiene makes sure residents are protected from risk of infection as far as possible. EVIDENCE: Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 21 A requirement made at the last visit about redecorating or refurbishing a number of peoples bedrooms was met. All the rooms identified last time had either been redecorated or re-carpeted that made them look and smell fresh and pleasant. People told us they like their rooms and are able to have a say in the décor chosen. A number of lounges had also been decorated and modern furniture and fittings bought for them. Someone had recently donated a budgie that now lives in one of the lounges that people liked to talk to and adds to the homeliness of the room. The deputy manager said that further rooms had been earmarked for redecoration. In the home’s own quality assurance survey, the environment scored highest out of all the areas surveyed at 87 . No major areas of concern were picked up from the survey and people reported that they felt safe, comfortable and secure with their own bits and pieces around them. The overall look of the home is comfortable, clean and fresh. However one relative had commented in our survey: ‘I think the building and some of the environment needs updating’. The home’s own quality assurance survey report also picked up issues about the premises: ‘Bathroom and toilet facilities need to be updated’. As we went around we saw that there were minor issues such as torn wallpaper, dirty glass in window corridors and scuffs on paintwork. We recommended the deputy manager has a ‘snagging’ list of minor repairs that can be done on a rotating basis to keep all parts of the home up together. Bedrooms are of different shapes and sizes. It was clear on the first day of our visit that problems with television pictures were frustrating for people. The deputy manager immediately took action to try and remedy this. In one person’s room the wallpaper border was peeling off all around the wall that made it look untidy and uncared for. The deputy manager was advised to get this re-done as soon as possible. Whilst overall the home smelled fresh and clean we noticed an unpleasant odour in one of the corridors. We saw domestic staff cleaning all areas and all toilets and bathrooms were very clean. One staff member said that corridor carpets are deep cleaned regularly but the smell can’t be got rid of entirely. Cleaning materials were properly locked away and none were seen about the home that could pose a risk to people. Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 22 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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home benefit from having adequate numbers of care staff to meet their needs. However disagreements about staff performance may affect staff morale that could lead to a reduction in the quality of care given to people. Progress with National Vocational Qualification in Care training for all staff makes sure people are properly looked after. Insufficient training in subjects such as dealing with behaviours that challenge and dementia awareness fails, to make sure peoples needs for support with these issues are met. Some staff’s refusal to do training doesn’t make sure the home is run in the best interests of people living there. EVIDENCE: In our survey we asked people living at the home: ‘Are the staff available when you need them?’ Eight people said ‘always’, five said ‘usually’ and two said ‘sometimes’. Comments about it were mixed and included: ‘Sometimes they have to get agency in and I find them hard to understand a lot of the time’ ‘We’ve got plenty’ (two similar comments), ‘They get here quickly if I need them’, ‘I sometimes don’t see many about when they’re busy’, Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 23 There seems to be and I don’t wait long for anything (two similar comments), ‘I don’t suppose there is’, ‘I know that the weekends can be a struggle’, ‘There isn’t many at the moment - I think they’re a bit short’ and: ‘They do seem to be short staffed a lot more lately. We spoke to a group of staff that included cook, kitchen assistants, domestic and care staff. Staff agreed that there are times when there aren’t enough staff and they can struggle especially if working on their own. Four care staff were on duty the first day of our visit and they told us that they have lots of tasks to do in the morning. They also said they felt there were problems with distribution of staff e.g. having lots working downstairs but fewer upstairs. Domestic staff echoed this as with only two on duty they said they struggle to get the work done. The deputy manager said that they are trying not to use too many agency staff so cover with permanent staff doing extra shifts. The home’s own quality assurance survey report also flagged up concerns about staffing. However, relatives commented in our survey: ‘The staff are always very helpful and will help even when busy’, ‘the staff are always very caring’, ‘they always make us feel welcome. We can visit unannounced and there is always a friendly and happy atmosphere in the home’ and: ‘the staff are very caring and dedicated to the residents’ welfare and happiness’. More worrying at this visit were the comments from staff about tensions within the whole staff team. Staff told us that there are some that ‘don’t pull their weight’ and leave others to do the work. They also commented about management team attitudes and rudeness from assistant managers when asking for information from them. Staff said that although they felt uncomfortable about doing so, they had reported incidents and discussed their concerns in supervision - but nothing had changed. The deputy manager said she was aware of some of the issues and felt she had dealt with them, so was disappointed that staff were raising them again. From this it was clear that quality of care given to people living at the home could be affected by staff tensions and lack of teamwork. We therefore strongly recommend that teambuilding sessions that have been run successfully in other homes be held at Hayleigh. These will help to raise morale and encourage staff to sort out their differences. Progress with National Vocational Qualification in Care training continues. Out of a total of eighteen care staff, seven day and three night staff have Level 2. Two are working towards it and two are waiting to do it. Training records showed staff have the qualification and certificates were seen. Staff confirmed that they either have or are working towards gaining the qualification. This means that the recommended minimum target of 50 of staff with NVQ is met. Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 24 Training records were looked at. The deputy manager had devised a sheet with each staff member’s name and a list of all training done or needing to be done. The list showed where gaps were but didn’t show whether dates to do the training had been planned except for person-centred care training. From the list seen, very few staff had done training in dementia or dealing with behaviours that challenge. Individual training records also confirmed this. Some staff had done effective recording skills training and had done essential training such as moving and handling updates, fire safety and basic food hygiene among others. However, night staff training records showed that they had done only essential training and no others. Further, they were recorded as refusing to do nonessential training in their supervision records. This is of concern as there are a number of people with dementia living at the home and others with behaviour that challenges. Therefore people may be at risk from staff that aren’t trained in understanding or being able to meet their needs. Further, if some staff do the training yet others don’t this could lead to further divisions within the team. Staff that don’t do training could become marginalised as they won’t have the skills or experience that other staff have. The deputy manager said she was aware of the issue but felt unable to take action about it. However this is a matter for the registered provider to take up as it shows that the home isn’t being run in the best interests of people living there. Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36, 37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A trained and experienced management team, that understands peoples needs and the inspection process, makes sure they are well cared for. Suitable ways of making sure people can comment about life in the home helps them to be sure their views and opinions will be taken note of. Proper management of peoples money makes sure they are protected from financial risk or abuse. People get consistent care from a staff team that have opportunities to regularly reflect on their working practices. However improvements to the way records are written are needed to show greater respect for people being cared for. Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 26 Records including fire safety show that peoples’ health and safety is important and they are kept safe from harm. EVIDENCE: Both the deputy manager Sharon Baker and the acting manager Lesley Edmonds are trained to National Vocational Qualification in Care level 4. The acting manager had been unavoidably away from the home for several weeks and the deputy manager had taken over. The acting manager had just returned and it had been decided that both would jointly manage the home at this time. The deputy manager was welcoming and open to the inspection process and showed clear commitment to making the home a comfortable and happy place for people to live in. We saw that she has good relationships with people that live in the home and staff also spoke highly of her. Comments included: ‘she’s lovely’. ‘She gets things done but is relaxed and approachable’ and: ‘She lets us know if she’s busy’. The home has a quality assurance survey done by an independent organisation each year. The most recent one had been done in July ’07 and a copy sent to the Commission. From this the environment, food and drink, health care, management and staff had scored over 80 satisfaction. People that live in the home and their relatives had made positive comments as well as ones that need to have some action taken about them. The home also sent us their AQAA as mentioned above that gets them to assess their own performance against the Standards before we inspect. Further, copies of the team manager’s visits to the home that are also used to check quality of care are also sent to us. The deputy manager was aware of almost all the issues we raised with her from the visit that showed her knowledge of the way the home is run and peoples needs within it. We did a random check of peoples cash kept at the home. All amounts checked matched against the individual records. Two signatures were seen where possible and itemised receipts attached. The deputy manager said that no-one lacks any money to pay for small items and relatives are quick to bring in more when needed. Staff told us that they get regular supervision four to six weekly. We checked each care staff member’s supervision records. We saw a checklist of dates filled in by management staff that matched with actual dates on records. In the year 2007–2008 all staff had had at least five or six sessions a year as set out in the Council’s own policy. Further, each staff member except one had had an appraisal, that helps them look back at their work over the year and plan things like training needs in the following year. Records showed that staff get opportunities to think about their work and discuss issues affecting people that they care for. Some records were detailed although others were brief. We picked up the issue of night staff refusing to do non-essential training from Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 27 supervision records but actions taken weren’t clear about this or ‘no further action’ was recorded. The deputy manager talked about her wish to move to a more person-centred way of working and developing care plans. This means writing plans and giving care from the person’s own wishes and feelings and valuing and respecting them. Care plans looked at could be written in more person-centred ways so that all needs are picked up from the person’s own wishes and point of view. Care records generally were positive, clear and gave good indications of peoples lives in the home. Some were also written in a person-centred way. However, night care reports looked at suggested that at times some staff use the records to express their feelings, including use of an institutional approach, rather than a person-centred one. Therefore the records weren’t always respectful to the person being written about. Examples included too much emphasis on emptying commodes and bowel actions and negative comments about peoples behaviours, even though some type of brain impairment may cause these. Some staff had recently done effective recording skills training although others hadn’t, including night staff. Fire safety records were looked at. A new fire safety risk assessment had been done in December ’07 and was clear and detailed. The contractor supplying fire safety equipment had visited to check it in February ‘08, as had the contractor for the fire alarm system. Ten day staff had done fire safety training in January ’08 when the fire procedure had been discussed and questionnaires filled in. Fire drills had taken place regularly the last one in December ’07 with eight staff attending. Weekly records of health and safety and fire safety were seen. Checks included emergency lighting, fire equipment, the call system, prevention of legionnellosis and water temperatures. All were satisfactory. Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 X 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 2 3 Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES 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 OP3 Regulation 14(1)(c) Timescale for action Needs that have been identified 30/04/08 in pre-admission assessments must be transferred into a care plan with clear actions recorded as to how the needs will be met. This will make sure peoples needs will be properly met. Where health needs around diet 30/04/08 and help with eating have been identified, these must be clearly recorded and proper actions taken to make sure the person is kept safe and her/his health doesn’t get worse. Clear, person-centred ‘end of 30/04/08 life’ plans must be put in place for every person that clearly shows their wishes after death have been recorded. (Timescale not met from the October ’06 inspection) All care staff including those on 31/05/08 nights must have regular training in safeguarding adults from abuse. This will make sure that people are kept safe from risk of harm or abuse. DS0000036207.V360169.R01.S.doc Version 5.2 Page 30 Requirement 2. OP8 13(4)(c) 3. OP11 12(3) 4. OP18 18(1)(c) (i) Hayleigh 5. OP30 18(1)(c)(i) All staff including night staff 31/05/08 must have training in dealing with sexual issues, dementia awareness and care and effective recording. This will make sure people are treated with dignity and respect and staff will have greater awareness and develop skills in meeting their needs. 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 OP15 Good Practice Recommendations Menus should be looked at to make sure people are offered lower fat foods such as chicken and fish or nonmeat alternatives more often. This will make sure people get a healthier, balanced diet. A list of minor repairs and cleaning should be drawn up and used to make sure the environment is kept up to a good standard. This will make sure people have a comfortable and homely place in which to live. Team building sessions facilitated by an external person should be held to help raise staff morale and iron out any differences. This will help to make sure the home is run in the best interests of people living there and that they will be cared for by a united staff team. All care records should be written in a positive, personcentred way and focus on the quality of peoples lives in the home rather than bodily functions or behaviours. This will make sure people will be respected and valued and the quality of their lives made the main focus. 2. OP19 3. OP27 4. OP37 Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Hayleigh DS0000036207.V360169.R01.S.doc Version 5.2 Page 32 - 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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