Inspection on 13/06/08 for Hays House

This inspection was carried out on 13th June 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hays House 22/01/08

Hays House 23/08/07

Hays House 03/10/06

Hays House 10/11/05

Hays House 10/06/05

Hays House 24/01/05

Hays House 10/06/04

Similar services:

Hunters Care Centre

Manor Lodge

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

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

CARE HOMES FOR OLDER PEOPLE Hays House Sedgehill Shaftesbury Dorset SP7 9JR Lead Inspector Susie Stratton Unannounced Inspection 09:20 13th June 2008 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 Hays House DS0000015916.V364284.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. Hays House DS0000015916.V364284.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hays House Address Sedgehill Shaftesbury Dorset SP7 9JR 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) 01747 830282 01747 830005 hayshouse@btconnect.com Park Healthcare Ltd Manager post vacant Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43), Terminally ill (1) of places Hays House DS0000015916.V364284.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. No more than 1 person in receipt of terminal care at any one time No more than 43 service users with Old Age at any one time. There are staffing conditions as agreed following the serving of the notice of proposal of 01 October 2002. 22nd January 2008 Date of last inspection Brief Description of the Service: Hays House is an old country house, parts of which date back to the early Victorian era. The home is situated in eight acres of grounds and accommodation is provided over four floors. A new purpose-built wing was completed in the summer of 2002 and provides ground floor accommodation to the rear of the building. The home is owned by Park Healthcare Limited and the responsible individual is Mr R Clarkson, who visits the home on a regular basis. The registered manager’s post is currently vacant and an acting arrangement is in place. The acting manager is supported by a team of registered nurses, care assistants, administrative and ancillary staff. The home is situated off the A350, between the villages of Sedgehill, East Knoyle and Semley. It is three miles north of Shaftesbury and eight miles south of Warminster. The nearest railway station is in Gillingham, Dorset. Fees charged by the home are £630 to £812. Additional charges are made for hairdressing, newspapers and sundries such as toiletries. Copies of the service users’ guide are available in all residents’ rooms and the front entrance hall. Hays House DS0000015916.V364284.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 2 stars. This means the people who use this service experience good quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included visits to the service and takes into account the views and experiences of people using the service. As part of the inspection, 30 questionnaires were sent out to residents and their relatives and 17 were returned. Comments made by people in questionnaires and to us during the inspection process have been included when drawing up the report. On 3rd March 2008, a formal meeting was held with the provider, Mr Clarkson. Following this meeting, a warning letter from us was sent to the home. As part of this inspection, the home’s file was reviewed and information provided since the previous inspection was considered. A random inspection took place on 17th April 2008 and the findings of that inspection were used to inform this inspection. The site visit took place on Friday 13th June, between 9:20am and 4:00pm. The prospective manager was on duty during the inspection and available for the feedback at the end of the inspection. During the site visit, we met with five residents, three visitors and observed care for seven residents for whom communication was difficult, in different parts of the home. We reviewed care provision and documentation in detail for six residents. As well as meeting with residents, we met with three registered nurses, four carers, a cook, a kitchen assistant, an activities coordinator, the laundress, the maintenance man and the administrator. We toured all the building and observed practice, including a lunchtime meal. We had an observed medicines administration round and looked at medicines administration records. A range of records were reviewed, including staff training records, staff employment records, maintenance records and financial records. What the service does well: This home has an owner who is keen to support his staff and manager in improving service provision. He has appointed a new manager since the last inspection. The new manager is experienced and has been able to make marked improvements in a range of areas in a short space of time. People spoken with felt that the new manager was approachable and had would listen to what they had to say. One person described the home as being “Much more settled now”. People also commented on the commitment of the permanent staff who had remained working in the home whilst it was without a consistent Hays House DS0000015916.V364284.R01.S.doc Version 5.2 Page 6 manager. One person reported that without the commitment of these members of staff to the home “it would have been a shambles”. People commented favourably on the home. One person reported, “It’s a lovely room” about their bedroom, another “It’s lovely here” about the home and another “since her admission I have considered her very will looked after and the staff extremely helpful”. People commented on the staff, one person reported, “the carers at Hays appear to me to be friendly and helpful carrying out their duties pleasantly and skilfully” another “The staff are very nice” and another “Oh yes, the staff help me.” What has improved since the last inspection? At the last inspection, 25 requirements were made and 13 recommendations. Many of these requirements and recommendations had remained unaddressed for several inspections. Under the new manager, all the requirements had been addressed in full by this inspection and 11 of the 13 recommendations had been addressed and one showed progress. One requirement and three recommendations were made at the random inspection. The one requirement and two recommendations had been addressed and one showed progress. The prospective manager has fully revised information given to people and ensured that it is readily available to them. Information required by us is now promptly reported. The home’s improvement plan is now an accurate reflection of the situation with realistic dates for addressing areas needing attention. Assessments of need are accurate and revised when a person’s condition changed. Care plans are consistently completed and evaluated regularly. Care is now provided in accordance with care plans. There are now full records of care given to frail residents and these records accurately reflect the care given. As a result of this, no further residents have sustained pressure damage. There are clear records of relating to the treatment and evaluation of residents who had wounds. Registered nurses are now able to concentrate on performing medicines administration and not be distracted by other roles. Where a resident has not taken medication, there is now evidence that this is noted and there is evidence taken of actions to address the matter. Where a resident is prescribed a topical cream, there are full care plans in place relating to this. Much work has been put in to ensuring that nursing and care is always provided so that the person’s privacy and dignity is upheld. All matters of concern and complaints are now being documented, together with information on actions taken to address the matter. The safeguarding adults’ policy has been fully revised. Where a resident needs a restraint such as safety rails or lap belts, assessments of need now always take place. Hays House DS0000015916.V364284.R01.S.doc Version 5.2 Page 7 Equipment to meet resident needs is now provided. This included adjustable height beds and pressure relieving equipment. Security and communication systems across the home have been improved. Equipment such as oxygen cylinders is safely stored, with appropriate warning signage. A risk assessment has been completed for the lift. Improvements are being made in staff support, including induction and training provision. All staff have been involved in mandatory training, including catering and domestic as well as nursing and care staff. Systems for staff supervision have been put in place. 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. The summary of this inspection report can be made available in other formats on request. Hays House DS0000015916.V364284.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 Hays House DS0000015916.V364284.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. Hays House does not admit for intermediate care, so 6 is N/A Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Prospective residents will be given full information about services offered prior to admission and their needs will be assessed so that they can be assured that the home can meet their nursing and care needs. EVIDENCE: At the previous inspection, it was not clear how prospective residents and their supporters were given information about the services offered by the home and the information that was available needed review, to conform to current guidelines. One relative reported, “At the time my relative was admitted there was no brochure it was being up-dated”. The prospective manager, who came in post since the last inspection, has reviewed the home’s service users’ guide and statement of purpose, since he has been in post. He has made revisions where indicated, so that both documents now conform to guidelines. A copy of both documents is available in all residents’ rooms and in the front entrance Hays House DS0000015916.V364284.R01.S.doc Version 5.2 Page 10 hall. Information includes a wide range of matters, including how many staff and their skill mix on duty for each shift. The home has a detailed admission assessment document. Pre-admission assessments are performed by registered nurses. One registered nurse reported that they had recently performed two pre-admission assessments. They reported that they had felt able to report back to the manager on whether they felt that the home could meet the residents needs and did not feel pressure from the manager to admit a person where they considered that the home would not be able to meet the person’s needs. This is despite the home having several empty beds. Very few people have been admitted since the random inspection on 17th April 2008. One person reported, “The carers at Hays appear to me to be friendly and helpful carrying out their duties pleasantly and skilfully”. A relative reported “Since her admission I have considered her very will looked after and the staff extremely helpful”. Hays House DS0000015916.V364284.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 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents’ health and personal care needs will be met by the improved systems put in by the new manager and the staff in the home. EVIDENCE: The new manager and his team have put extensive work into improving the standards of nursing and care for residents in the home. The random inspection, which took place on 17th April 2008 showed marked improvements across a range of areas, this has been built on, so that by the time of this inspection, outcomes for residents in this area are good, with only a very few areas needing attention. One person reported “Both medical and social care is of a high standard” and one relative commented “There has been a vast improvement since [the new manager] came.” This is commendable as meeting health and personal care needs of residents is an area which had not shown good outcomes for residents for an extended period of time. Hays House DS0000015916.V364284.R01.S.doc Version 5.2 Page 12 Assessments of residents’ needs are now accurate and were up-dated when a resident’s condition changed. For example, one person had very clear wound assessments, which reflected what staff told us. Assessments of this person’s wound were regularly evaluated. The standards of care planning had also much improved and reflected what was reported to us, what was observed and what carers and nursing staff told us about. This matter had been outstanding for several previous inspections. Care plans were also up-dated when a resident’s condition changed. One resident had a very clear care plan about their diabetic care needs, which was written in measurable terms and clearly directed staff on what actions to take is a person’s blood sugar levels were too high or too low. Another resident’s care plan documented how often they needed to have their position changed to reduce risks of pressure damage and documented the type(s) of equipment needed to reduce risks of pressure damage. A few areas remained to be addressed. One resident had an appliance documented in their assessment but there was no information in their care plan as to whether they were independent using the appliance or not. Another resident had a different appliance, which was observed to be in use during the inspection but their care plan was not clear. It indicated that it was generally used at night, not during the day, as we observed. It also did not provide any details of how it needed to be applied. Two residents had additional mental health care needs. Their care plans needed more detail on what the actual needs were, as stated in their daily records and the actions to be taken to meet these needs. Marked improvements have been made in the care of very frail residents. All records relating to provision of care were accurately completed, at the time care was given. These records showed that frail residents had their positions changed in accordance with their needs. As a result of this, no residents have sustained new pressure damage since the previous inspection. Records showed that residents were given regular fluids and the amount of diet they had taken in was observed to be accurately documented. Residents were weighed regularly. Their weight, and the amount of food and fluids taken in, were included in their care plan evaluations. For example one person was documented as being reluctant to drink fluids and a realistic daily intake for them was included in their care plan. Whether they had been able to drink this amount, was then included in their care plan evaluation. The new manager has worked with local GPs to ensure that all residents now have a regular review of their medical conditions. One resident had detailed notes of contacts made with their GP about a particular skin condition. Residents who need it receive regular chiropody and full records are maintained in their notes. The prospective manager is working on establishing closer links with other external healthcare professionals. A medicines administration round was observed and the registered nurse performed it in accordance with guidelines. The new manager ensured effective Hays House DS0000015916.V364284.R01.S.doc Version 5.2 Page 13 practice in administration of medication and has taken action to ensure that staff, such as agency registered nurses, perform medication rounds in accordance with guidelines. Registered nurses are now able to concentrate on performing medication rounds and not distracted by other duties. Some residents were self-medicating. They had signed a disclaimer about this and a copy was retained in their records. However risk assessments for self medication had not been completed as is required. Several residents were prescribed medication on an “as required” basis, for example mood altering drugs or painkillers. Where this is the case, care plans need to be drawn up to direct staff on the protocols for administering these drugs. Some residents were prescribed drugs which may affect their daily lives, such as aperients. Where this is the case, care plans should be drawn up, these should then be regularly evaluated so that the effectiveness of the drugs can be evaluated. Much effort has been put in by the new manager and staff to improve privacy and dignity for residents. All personal care was performed behind closed doors. One resident had a care plan about reduction in odour, as this was an issue for them. The care plan reported on how important this aspect of their care was, to ensure their dignity. One resident commented that staff now always promptly removed items such as urinals when they had been used. Where residents shared a room, screening was available and was observed to be used when needed. Frail residents who spent all or much of their time in bed looked comfortable, with clean bed linen and night clothes, brushed hair and clean fingernails. Hays House DS0000015916.V364284.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. Residents are able to choose how they spend their daily lives, are supported in their recreational needs and are able to enjoy their meals. EVIDENCE: Hays House employs activities coordinators who support residents in meeting their recreational care needs. The activities person on duty when we visited the home was very much in evidence, including at lunchtime. Staff also supported residents. One carer and a cleaner were observed to try to involve a resident in discussions about buying a car. The carer commented to us afterwards on how important it was to involve residents in discussions about such matters, to keep them aware of issues outside the home. All residents had a care plan relating to their social and recreational needs, these were regularly evaluated and records were maintained of activities they participated in. Several residents commented on how much they enjoyed the gardens in the summer and the new manager reported that he is seeking to make all of the gardens more wheelchair accessible. One relative commented “I have noticed a number Hays House DS0000015916.V364284.R01.S.doc Version 5.2 Page 15 of interesting activities from time to time at Hays” and another “the staff are always trying to help with involvement – they never give up”! During the inspection, we observed several relatives coming into the home. One relative commented that they visited often and were made to feel welcome and knew many of the staff well. One resident commented on how much they appreciated their visitors being able to visit when they wanted. The new manager is trying to forge links with the local community, and is shortly to talk to a meeting in the local village. There are close links with the local Anglican church and the local Roman Catholic priest visits regularly. One resident who was a member of a different church had a clear care plan about this, together with information on who the home should contact if they wished for more advice on the person’s practice of their religion. Residents said they felt able to choose how they spent their days. One person’s care plan included details about their preferences for when they got up and went to bed, which they said staff kept to. One resident said that they were pleased that they were consulted about calling in their GP, saying “I wasn’t very well 2 weeks ago; they wanted to call the doctor in and I said No; I got better”. A mealtime was observed and, as at the random inspection of 17th April 2008, it was observed that more residents now ate their meals in the dining room than previously. The new manager was very much in evidence throughout the mealtime to receive comments from residents. The chef also came into the dining room to hear what residents felt about the meal. Staff were available to assist residents, sitting with them supporting them in eating if needed. One carer saw that one resident had forgotten their meal and gently reminded them about it, so it did not become cold. One relative said: “Staff have taken care to mince meat for my [relative] and have portions of meat and veg separate on the plate which we appreciate.” We discussed meals with a carer who was supporting residents who stayed in their rooms. They said they ensured that residents got their meals promptly and showed a detailed knowledge of what different residents liked to eat and how they preferred to be helped to eat their meals. One relative said that they had felt that their relative had not had enough supper one day, so they went to visit the cook and the cook had prepared an extra snack for their relative. The manager is aware that the quality of meals provision needs review and said that now he has improved care provision and staffing, this is an area which he will start considering. The chef commented on how the new manager had ensured that there are now enough staff in the kitchen to provide the service needed. All staff have received an up-date in food hygiene. Staff commented particularly on how improvements have been made in the provision of cooking equipment, pointing out several new pots and pans and other items. They reported that they felt that they could ask for equipment, as they needed it. Hays House DS0000015916.V364284.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence, including visits to this service. Residents’ concerns and complaints are listened to and acted upon and the there are systems in place to ensure people are safeguarded from abuse. EVIDENCE: The home has a complaints procedure, which is available in the service users’ guide and displayed in the entrance hall. The home has a complaints book, which records in detail matters raised and actions taken to address them. This included verbal as well as formal complaints. Of the 17 people who responded to this part of the questionnaire, all reported that they knew how to make a complaint. One person reported that they would “head for the top but it has not been necessary”, if they had any concerns and another “I’d talk to sister, she’d do something, she’s very good.” One resident reported that they had realised specific concerns about an agency carer with the sister, how they had been listened to and of the actions taken by the home to ensure that the issue did not occur again. This had been fully documented in the home’s complaints book. The new manager has ensured that all staff have been trained in safeguarding adults, since he came into post. He has also fully revised the home’s safeguarding procedure. All staff spoken with were aware of their responsibilities towards safeguarding residents. The new manager has Hays House DS0000015916.V364284.R01.S.doc Version 5.2 Page 17 improved security of the home since he came into post and all external doors are now always secured, using a number locking system. This was commented on by people. One relative commented favourably on how the “Manager has put a security system on the doors”. Staff reported that they felt much safer now, particularly as the home is situated in a rural area, well back from the road and at a distance from agencies who could support them, such as the police. Hays House DS0000015916.V364284.R01.S.doc Version 5.2 Page 18 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, 22 & 26. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents will be cared for in a well maintained environment, which is clean and comfortable and where equipment needed to meet their needs is provided. EVIDENCE: Hays House is a large country house where accommodation is provided over four floors and a ground floor wing to the rear of the building. There is a passenger lift between the floors. The lift has presented some problems since a new lift was installed. Staff reported the lift breaks down much less frequently than previously and had not broken down since the manager last called in the maintenance company. The home is supported by a very enthusiastic maintenance man. Staff reported on how quick he was to respond when matters were identified. The maintenance man is working his way through a back-log of matters since has been in post and much of the home Hays House DS0000015916.V364284.R01.S.doc Version 5.2 Page 19 now shows the benefit of improved attention to a range of areas which had needed maintenance. At the time of the inspection, the maintenance man was improving a vacant room to provide an en-suite as well as a general up-grade and re-decoration. He reported that he was planning to make similar improvements to other rooms in the home. The new manager reported that he was developing an action plan to look at further improving a range of facilities across the home. The new manager has ensured that the home has fully invested in equipment to meet the needs of frail people with complex nursing and care needs. Residents who need nursing care are cared for in variable height beds. The manager reported that he has purchased nine fully profiling beds since he came into post. All residents who are at risk of pressure damage are cared for using appropriate mattresses and chair cushions and staff reported that such equipment was readily available to them. One resident commented “Oh yes, I’m comfortable here”. A range of hoists are provided to residents who have manual handling needs and staff were observed to be competent in their use. The manager has supported staff in discontinuing the use of old equipment, such as old safety rail protectors which can no longer be wiped down. Staff may continue to need support not to use such items, as one person had two safety rail protectors which had deteriorated and so could not be wiped down and one resident had a urinal which was stained, probably with long-standing lime-scale. The new manager has appointed a housekeeper to oversee ancillary staff. This housekeeper was reported to have improved standards across a range of areas. One person reported “The room looks better now a new housekeeper is in post – very presentable”. One of the domestic staff reported on how they felt standards of cleaning had improved since they had been more supported in their role. Staff reported that they had a full supply of disposable gloves and aprons. The laundry was clean; this included the areas behind the machines. The laundress reported that staff always placed potentially infected clothes in appropriate red bags. Discussions with her indicated that she re-sorted laundry prior to washing. She reported that she used gloves to do this but did not use an apron. Any person who handles used laundry must use a disposable apron, to reduce risks of micro-organisms from being transferred to their uniform when they are being re-sorted and it is recommended that used laundry be sorted at source, to reduce risks to cross infection presented by handling. Hays House DS0000015916.V364284.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents are now supported by the numbers and skill mix of staff in the home, who have been safely recruited. Plans are being developed to extend training provision to staff, to ensure that they can meet residents nursing and care needs. EVIDENCE: The new manager has worked hard since he has been in post to stabilise and recruit more staff. He has gradually reduced reliance on agency staff and reported that by mid-July 2008, he will not have to routinely use agency staff for any shifts in the home. This is a real achievement for this home, as it has shown a history of reliance on agency staff for an extended period of time. Residents saw the effects of this. One person reported “Staffing levels are better now” and another “They’ve got all these new people in”. One resident commented on improvements when they rang their bell, stating “They’re quite good at coming, better than they were”. A relative commented on how registered nurses were available when they needed them, stating “If I have wished to talk with one of the senior staff they have always made themselves available without delay”. The new manager has invested in a portable communication system for staff across the home. All staff spoken with reported on how this had improved communication systems. One carer Hays House DS0000015916.V364284.R01.S.doc Version 5.2 Page 21 explained that in a home with so many floors, if they needed the advice of a registered nurse quickly, rather than having to walk round a large building several times looking for a registered nurse, whilst the resident they had concerns about had to wait, they could quickly locate the registered nurse. A registered nurse reported that it assisted her in supervision of carers, as she could now always locate where each carer on each shift was in the home. The new manager has set up improved systems to ensure that staff are safely recruited. All staff have police checks and complete a health status declaration. All new staff have two references on file. Staff are given job descriptions and terms and conditions of employment. Staff from abroad have their employment status verified. All registered nurses have their personal identification number checked with the Nursing and Midwifery Council. The prospective manager has had to fully review the home’s systems for induction and training since he has been in post. He has developed an induction programme, which complies with guidelines and is planning to further develop supports to new staff. During the inspection, we met with two newly employed staff. Both reported on how much they enjoyed the work and how they felt supported by more senior staff. One of the registered nurses was observed to take care to ensure that a carer on induction was appropriately supported by a senior carer. One resident reported that new staff listened when he told them what he needed, saying “If they don’t know, I’ll soon put them right”. The provider has always supported care staff in undertaking National Vocational Qualifications. The prospective manager reports that he is planning next to fully review all staff employment and training records, so that he can make an assessment of what training staff have received and areas for development. Since he has been in post, he has ensured that all staff have been trained in mandatory areas and also in areas important for resident care, such as prevention of pressure damage. Hays House DS0000015916.V364284.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The new manager has developed systems to ensure that the home is effectively managed and that the principals of health and safety are up-held. EVIDENCE: The prospective manager of the home is a very experienced manager, who has succeeded in improving other homes in the past. By the random inspection of 17th April 2008, he had already successfully made improvements in service provision to residents by meeting requirements which had been unmet for an extended period of time. By this inspection he had built on this and was identifying other areas in service provision which needed development. One person commented on how “The atmosphere is happier, less tense, everyone Hays House DS0000015916.V364284.R01.S.doc Version 5.2 Page 23 smiles”, since he had been in post. Another person commented on his approachability, stating “His office door is always open – you can talk to him” and another “[the new manager] is always here.” The prospective manager has maintained close working links with us, informing up of developments and actions he has needed to take to improve service provision. The prospective manger has begun setting up systems for quality audit, since he has been in post. He is planning to fully develop these throughout the next few months, so that he can have an overview of services provided to inform his provider, residents and their supporters and us. The home has clear systems for monthly invoicing of residents for additional items such as newspapers, chiropody and sundries. The new manager reported that he wanted to ensure that the home was safe as one of his first priorities on coming into post. In order to progress this, all staff working in the home have been fully up-dated in the mandatory areas of fire safety, manual handling and infection control. Several staff were observed using manual handling equipment during our inspection. They did this in a safe manner, using correct equipment and working effectively as a team. Several of the staff spoken with reported on how useful they had found the recent fire safety training. All staff who handle food have been fully trained in food handling. There are clear records of the regular maintenance of equipment and services. The home now maintains very clear accident records. These are audited by the manager. Hays House DS0000015916.V364284.R01.S.doc Version 5.2 Page 24 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 3 X X N/A 3 X X 3 X X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Hays House DS0000015916.V364284.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Where an assessment or records indicate that a person has a care need, a full care plan must always be drawn up, to direct staff on how this need is to be met. Where a service user wishes to self-medicate, a written risk assessment must always be drawn up. This assessment must be regularly evaluated. Where a resident is prescribed a medicine “as required”, a care plan must always be put in place to direct staff on the protocols for use of the drug. People who handle used laundry must always use disposable aprons, to prevent risk of cross infection. Timescale for action 31/08/08 2. OP9 13(2) 31/08/08 3. OP9 13(2) 31/08/08 4. OP26 13(3) 30/06/08 Hays House DS0000015916.V364284.R01.S.doc Version 5.2 Page 26 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 OP9 Good Practice Recommendations Where service users are prescribed medication which can affect their daily lives, such as painkillers, mood-altering drugs or aperients, care plans should be drawn up so that staff can assess response to treatment. Recommendation in progress. All equipment used in care such as safety rail protectors or urinals should be surveyed and any which cannot be easily wiped down/cleaned, disposed of. Recommendation in progress. Used laundry should be sorted at source and not re-sorted in the laundry. 2. OP26 3. OP26 Hays House DS0000015916.V364284.R01.S.doc Version 5.2 Page 27 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 Hays House DS0000015916.V364284.R01.S.doc Version 5.2 Page 28 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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