CARE HOMES FOR OLDER PEOPLE
Hayleigh Myrtle Street Bedminster Bristol BS3 1JG Lead Inspector
Sandra Garrett Unannounced 31 May 2005 09:30 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 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 D56_36207_Hayleigh_225963_310505_Stage2.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Hayleigh Address Myrtle Street Bedminster Bristol BS3 1JG 0117 9039983 0117 9039984 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Bristol City Council Barbara Ann Cairns PC Care Home 40 Category(ies) of OP Old age (40) registration, with number of places Hayleigh D56_36207_Hayleigh_225963_310505_Stage2.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: May accommodate one named person aged 64 years with Physical Disabilities. Registration will revert to OP when named person leaves. May accommodate one named person with Learning Difficulties. A specific condition is added to the Certificate of Registration for the Home in respect of this named person being accommodated there. The registration will be permanent, to lapse only when the named resident leaves the Home. Hayleigh care staff must undertake training in the care of older people with Learning Difficulties. This must be a rolling programme of regular training, to include any new care staff taken on after the service user is admitted. Date of last inspection 25-Apr-2005 Brief Description of the Service: Hayleigh is a purpose built care home registered with the Commission. It is operated by Bristol City Council Social Services & Health (SS&H). The home is capable of housing forty residents and is registered in the older persons category. A variation of its registration is in place in order to provide accommodation for one older person with learning difficulties. This resident now occupies the area that used to be the staff flat. Hayleigh is situated close to the busy shopping area of Bedminster. It is close to local bus routes and community facilities. The home is fully accessible with a lift to the first floor. The home has extensive mature gardens with trees and a patio. ‘Safe haven’ beds that provide temporary extra care for service users who need it rather than being admitted to hospital, are in place and are regularly used. Hayleigh D56_36207_Hayleigh_225963_310505_Stage2.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an inspection following an additional visit carried out on 25 April. One of two requirements made at that time were met at this visit and all three good practice recommendations had been implemented. This inspection took place over one day. Opportunity was taken to tour the premises, examine a range of records and talk to residents and staff. Most of the residents living at the home were seen during the inspection and several were spoken to. What the service does well: What has improved since the last inspection?
Four out of six requirements made at the last inspection in December ’04 had been met at this visit. These were in respect of medications practice, disability access, redecoration of premises and starting a new quality assurance process. Two requirements and two recommendations had been met from the additional visit made on 25 April ’05. These were in respect of meeting the assessed needs of one resident and specialist training for staff.
Hayleigh D56_36207_Hayleigh_225963_310505_Stage2.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hayleigh D56_36207_Hayleigh_225963_310505_Stage2.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Hayleigh D56_36207_Hayleigh_225963_310505_Stage2.doc Version 1.30 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 standard(s) 2,3 & 4 Prospective residents can be confident that the home can meet their needs. However they are not fully informed about the terms and conditions of their residency. Specialist needs of individual residents are met wherever possible. EVIDENCE: The ongoing issue with residents’ contracts has not been resolved and the requirement made at the last inspection was not met. Signed contracts were seen in individual residents’ rooms without any reference to fees payable. This issue is being discussed with the registered provider in an attempt to resolve the matter on behalf of all residents. Assessments of need are obtained for each resident and care plans are developed from them. The home gets copies of assessments carried out by social workers or other health and social care professionals before a resident is admitted to the home. An assessment for nursing care in respect of one resident with a high level of care needs had been done recently by a social worker following a requirement made at the inspector’s visit on 25 April. The requirement is therefore met.
Hayleigh D56_36207_Hayleigh_225963_310505_Stage2.doc Version 1.30 Page 9 This revealed that the specialist needs of the resident were still being met by the home and evidence was seen of this. Hayleigh D56_36207_Hayleigh_225963_310505_Stage2.doc Version 1.30 Page 10 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 standard(s) 7, 8 & 9 Assessed needs are met and reviewed regularly, although evidence of review is not fully accessible. Healthcare needs are met appropriately and there is regular contact with GP’s, district nurses and other healthcare professionals. Legal requirements in respect of medication are appropriately met. EVIDENCE: Detailed, clear and comprehensive care plans are in place for each resident. Three plans were examined at this visit. These are kept in each resident’s room and were seen there. Actions to meet individual assessed needs were clearly addressed. Amendments to the plans were seen that included actions to meet new needs as they arose. Although plans are reviewed and updated there was no clear evidence of monthly review. The manager and assistant manager said that for each ‘key group’ of staff, residents they care for have plans reviewed monthly and the evidence is written in individual staff supervision records following discussion with the group supervisor. As supervision records are confidential to staff, yet residents’ records are confidential to them, clearer evidence of review must be put in place e.g. a sheet at the front of each resident’s file with dates, detail of review and outcomes. Hayleigh D56_36207_Hayleigh_225963_310505_Stage2.doc Version 1.30 Page 11 Healthcare needs were recorded in daily records with clear information about GP, district and continence nurse visits, hospital appointments and procedures, medication and strategies for dealing with anxiety. Requirements in respect of meeting healthcare needs for one resident made at the 25 April visit, were met. A requirement made at the last inspection in respect of appropriate recording of controlled medications was met. A new controlled medications book was in place with details of administration, witnessing and quantities left. Medications practice was observed and carried out appropriately. A requirement made at the additional visit on 25 April ’05, for one resident’s medication to be reviewed to ensure maximum pain relief, was partly met. It was noted that the home were in regular contact with the GP about the matter but a review had not been carried out. It was also noted that the home were doing all they could to ensure the review of medication is done and advice was given as to how to move the situation forward to meet the resident’s needs. Hayleigh D56_36207_Hayleigh_225963_310505_Stage2.doc Version 1.30 Page 12 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 standard(s) 12, 14 & 15 Residents are enabled to have a high level of activity and entertainment, although their enjoyment of these is not fully recorded. Residents are able to exercise choice in many areas of their lives. Meals provided are of a high quality with a good standard of assistance and autonomy. EVIDENCE: Lots of information was available about activities and entertainment provided by the home. Information was seen on noticeboards, in activities records and in residents’ individual records. Activities ranged from: card games, bingo, reminiscence, cake making, watching the Cup Final on TV, sitting in the garden and going out to local shops. Entertainment included a Hawaian dancer, visiting entertainers and film shows. The assistant manager said that records about how residents enjoy activities/entertainments could be found written in individual care records but this was not the case in five residents attendance at an activity. Further the activities record lacked qualitative information about how residents enjoy activities and entertainments, mainly referring to the type of activity/entertainment and numbers/names of people attending. Residents confirmed the choices available to them and the manager gave information about a resident who likes to be very independent. This resident is able to go out into the local community, chooses when and if s/he wants to bathe, whether s/he wants to join in with activities/entertainment or not and
Hayleigh D56_36207_Hayleigh_225963_310505_Stage2.doc Version 1.30 Page 13 whether s/he wants to come to the dining room for lunch or have it in her/his room. Meals remain a high point of life at Hayleigh. A menu was seen written up on the noticeboard and two choices of main meal and several choices of dessert are offered each day. The quality of cooked meals is high and residents are offered greater autonomy by having tureens of vegetables and pots of tea on each table from which to help themselves. This is good practice. Residents spoke highly of the meals. Lunch is provided over two sittings and staff discreetly assist residents if they need help with eating. Hayleigh D56_36207_Hayleigh_225963_310505_Stage2.doc Version 1.30 Page 14 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 standard(s) 16 only Compliments, comments and complaints are given high priority at the home. Residents know how to make complaints and are empowered to do so. No service user complaints had been received in this inspection period. EVIDENCE: The complaints record was reviewed at this visit. The file also contains compliments and it was noted that a resident had complimented the home on its meals service that was deemed to be ‘excellent’. No complaints from residents had been received since May ’04. The Commission for Social Care Inspection had been contacted about a concern in respect of caring for one resident that had led to the additional visit. This concern was found not to be met although requirements were made. Complaints are recorded on an appropriate form that contains the complaint itself, details of the investigation and by whom, the outcome and date the outcome is relayed to the complainant. Hayleigh D56_36207_Hayleigh_225963_310505_Stage2.doc Version 1.30 Page 15 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 standard(s) 19,22 & 26 Residents live in a well maintained home with a high standard of décor and cleanliness. Access for disabled people is being developed. Requirements made at the last inspection were met. EVIDENCE: The home was very clean and hygienic at this visit with no unpleasant odours. One room had been re-carpeted. Some rooms looked in need of updating or minor repair. The main front door of the home was not in use at this visit as new selfopening doors accessible for disabled people, were in the process of being fitted. All visitors had to access the home via the dining room that could have caused disruption for residents at meal times. The manager said she had requested visitors refrain from visiting at these times. A new parking bay for disabled visitors had also been put in place although this is in the car park to the rear of the home. An outstanding requirement from the last inspection in respect of installing a Loop system for hearing impaired residents in the dining room, had been met. This is of especial importance for hearing impaired
Hayleigh D56_36207_Hayleigh_225963_310505_Stage2.doc Version 1.30 Page 16 residents as most of the entertainment is held in the dining room and music is also played there at lunchtimes. A requirement from the last inspection in respect of redecoration of the home’s airing cupboard was met. The cupboard had been painted and looked clean and fresh. Hayleigh D56_36207_Hayleigh_225963_310505_Stage2.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29 only Personnel records are not kept at the home. Residents may not be protected from risk of harm or abuse if records including proof of identity, photographs and Criminal Record Bureau (CRB) clearance are not available EVIDENCE: It was disappointing to note that a requirement to ensure staff personnel records are kept at the home was not met at this visit. Records that must be kept include: proof of identity including a recent photograph, copy of the job application, details of past experience, skill and qualifications, two references and an up to date disclosure statement from the Criminal Record Bureau (CRB). The Commission is in discussion with the registered provider in respect of this issue, that affects all local authority homes. Therefore the requirement is withdrawn at this time. However proof of identity and photographs must be in place in order to ensure residents’ protection. Hayleigh D56_36207_Hayleigh_225963_310505_Stage2.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33 & 37 The manager of Hayleigh is qualified, skilled and experienced. There is an experienced management team in place. The manager ensures an open and inclusive atmosphere is present within the home. New quality assurance processes are being carried out. Record keeping needs improvement especially in respect of daily records. EVIDENCE: The manager of Hayleigh, Mrs Barbara Cairns was welcoming and open to the inspection process at this visit. Mrs Cairns is qualified to NVQ level 4 and has almost finished the Registered Manager’s Award. Mrs Cairns was able to give clear information about her management style and said that she had been monitoring the care practices of a resident that staff have concerns about. A clear behaviour chart had been put in place for this resident that was a requirement at the additional visit made to the home on 25 April ’05. The chart was clear with dates, description of behaviour, how it’s managed and outcome
Hayleigh D56_36207_Hayleigh_225963_310505_Stage2.doc Version 1.30 Page 19 for the resident. This is good practice. The manager was positive and knowledgeable about care for this resident and others within the home. A new system of quality assurance monitoring has started for all local authority homes. The manager said that the consultant had issued questionnaires and had interviewed a number of residents. The final report will be available in early June ’05. The requirement made in respect of this at the last inspection is therefore met. However a new requirement is made in respect of sending a copy of the consultant’s report to the Commission. A good practice recommendation made at the last inspection in respect of positive, non-judgemental care recording had not been implemented. It was disappointing to note negative and judgemental records consistently recorded in one resident’s records, and more focus on personal care needs rather than an holistic description of residents’ enjoyment of life in the home, in others. A new requirement is made to ensure that statements about behaviour are only recorded on charts drawn up for this purpose. Further, all care records must be written from a positive and person-centred perspective with more detail of residents’ daily lives and experiences. Hayleigh D56_36207_Hayleigh_225963_310505_Stage2.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 2 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 x x 3 x 3 x 3 STAFFING Standard No Score 27 x 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 2 x x x 1 x Hayleigh D56_36207_Hayleigh_225963_310505_Stage2.doc Version 1.30 Page 21 NO Are there any outstanding requirements from the last inspection? 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. 2. Standard OP7 OP33 Regulation 15(2)(b) 24 (2) Requirement Timescale for action 30 June05 3. OP37 12(4)(a)( b) Clear evidence of care plan monthly reviews must be put in place for each resident A copy of the forthcoming quality 30 June 05 assurance report must be sent to the Commission for Social Care Inspection when it is received by the home All care records must be written 30 June 05 from a positive, person-centred perspective that respects each residents privacy and dignity.Specific issues in respect of behaviour that challenges must be recorded in an appropriate format e.g. a behaviour chart. 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 Good Practice Recommendations Hayleigh D56_36207_Hayleigh_225963_310505_Stage2.doc Version 1.30 Page 22 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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