Inspection on 22/01/08 for Hays House

This inspection was carried out on 22nd January 2008.

CSCI found this care home to be providing an Poor 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

Hays House 13/06/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hays House Sedgehill Shaftesbury Dorset SP7 9JR Lead Inspector Susie Stratton Unannounced Inspection 11:35a 22 January & 7 February 2008 nd 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 Hays House DS0000015916.V354070.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.V354070.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 ****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.V354070.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. 23/08/07 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 £500 to £720. Additional charges are made for hairdressing, newspapers and sundries such as toiletries. The service users’ guide is in draft form and it is not clear how people are informed of the services provided by the home. Hays House DS0000015916.V354070.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 0 star. This means the people who use this service experience poor 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, 40 questionnaires were sent out to residents, their relatives and social workers and 22 were returned. Comments made by people in questionnaires and to us during the inspection process have been included when drawing up the report. The home’s file was reviewed and information provided since the previous inspection was considered. An improvement plan was submitted by the home following the last inspection. This document also provided information to support this inspection. The site visits took place over two days, on Tuesday 22nd January 2008 between 11:35am and 5:50pm and on Friday 8th February 2008 between 9:35am and 5:30pm. It was carried out by two of our regulation inspectors. The acting manager was on duty for both days. Two management consultants employed by the proprietor were available on the second day, as was the proprietor, who was present for a feedback at the end of the inspection. During the site visits, we met with eight residents, three visitors and observed care for eleven residents for whom communication was difficult. We reviewed care provision and documentation in detail for eight residents, two of whom had been admitted recently. As well as meeting with residents, we met with four registered nurses, nine carers, the activities coordinators, the chef, six people working in the kitchen, the laundress, the administrator and the maintenance man. We toured all the building and observed a lunch-time meal and an activities session. We observed systems for administration of medicines and a medicines administration round. A range of records were reviewed, including staff training records, staff employment records, maintenance records and financial records. What the service does well: Hays House is a large country house, where accommodation is provided over a range of floors. This means that all rooms are different from each other and many have extensive views over the surrounding countryside. The home benefits from well-kept gardens and many of the ground floor rooms have access via French windows. One person described the grounds as “lovely”. Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 6 The home employs two activities coordinators, who work flexibly; they are motivated and keen to develop their service. The owner of the home is closely involved in running the home and visits it at least twice a week. He is keen to improve and develop service provision, employing management consultants to support staff and ensuring that senior registered nurses can work on a supernumerary basis when needed. People made a range of comments about the service. One person described how the home “Creates a very good atmosphere with pleasant, friendly and helpful staff. Another reported “The care home has a very comfortable atmosphere; the rooms are always clean and the staff very friendly when I speak to them” and yet another said “I am very happy with my relative’s care at Hays”. Comments were made about the staff; one person reported “All of the staff, administrative, nursing and the handyman are pleasant and helpful. Another described staff as “very kind and warm” and yet another reported “I am often surprised by what they can achieve with my relative.” What has improved since the last inspection? At the previous inspection 34 requirements and 13 good practice recommendations were identified. Of these, 17 requirements and eight good practice recommendations have been addressed in full. Nine requirements and one recommendation showed progress. Improvements have been made in the provision of nursing and care. Residents had been left with access to their call bells. Where a resident had medical needs, there was evidence that consultation had taken place with relevant healthcare professionals. Registered nurses were observed to administer medicines and maintain medication records in accordance with the home’s policies and procedures. The home’s medicines policy and procedure has been reviewed. All residents have records of their likes and dislikes for meals and drinks included in their records. The activities coordinators have been supported in attending a course relating to their specialist field. Staff have been provided with badges which state their name and designation. Improvements have been made to the home environment. All equipment needed to prevent spread of infection is now provided. This equipment was properly used and kept in a clean state. All areas in the home which present a high risk of cross infection, such as the laundry or sluice rooms, had walls which could be wiped down easily and neither dust nor debris was not evident. Staff were following infection control guidelines when handling used linen. Where a resident was having a dressing performed , this is now always performed using full aseptic procedure. Damaged areas under soap dispensers in residents’ rooms had been repaired. All commode chairs and urinals had been labelled with the resident’s name, to ensure that they are used only for that resident. The home has developed its procedures. Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 7 Any issues relating to safeguarding adults are now referred, in accordance with local safeguarding adults’ procedures. The home has reviewed its systems for security of the building, including systems to enable staff to communicate with each other across the home and answer the front door. All staff files now include two references, and for registered nurses there is a recent reference relating to their clinical skills. All staff files now include evidence of proof of identity and any gaps or discrepancies in employment history have been investigated. There is now a full written audit trail of all valuables handed in for safekeeping. The home has put in systems to ensure that all staff comply with the principals of health and safety, including records to show that all fire safety tests have been carried out and all electrical items appropriately tested. What they could do better: At this inspection, 25 requirements and 13 good practice recommendations were made. Of these, 14 requirements two good practice recommendations had been identified at previous inspections. Developments continue to be needed in the provision of care. Assessments of need must be accurate and include all factors which may affect the resident. All care plans must be consistently completed to the same standard and accurately include all matters relating to the resident. Assessments and care plans must be properly evaluated and revised when a resident’s needs change. Where a resident is dying, an end of life care plan should always be drawn up. Care must always be provided in accordance with care plans. There must be evidence that frail residents are receiving the care that they need. Records must be accurately completed and at the time that care was provided. All matters relating to residents’ health and well-being must be documented and reported to relevant persons. Gaps should not be left in residents’ daily care records. Nursing and care must always be provided in such a way that a resident’s user’s privacy, dignity and comfort is maintained. Personal comments about residents should not be used when completing care records. The home should ensure that relevant matters about individual residents is communicated to support staff, so that these staff members can meet individual residents’ needs. Attention is needed to improving nursing and medical care of residents. Where a resident has a wound, there must be full and accurate records relating to the wound and response to treatment. When administering medication, registered nurses must be enabled to concentrate on this role and not have to perform other tasks as well, to reduce risk of medication error. Where a resident has not taken a medication, there must be evidence of investigation into why this has happened. Where a resident is prescribed a topical application, there must be full care plans relating to this and all staff must be made aware of them. Where residents 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. Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 8 Improvements are needed in equipment provision for frail and disabled people. Where a resident is assessed as needing equipment to prevent risk, this must always be provided. Where residents have equipment in use such as safety rails, or lap belts, an assessment of the need for this equipment must always be made. All residents who have complex needs must be cared for on an adjustable height bed. Developments are needed to the environment. Regular monitoring should take place of facilities and equipment in the kitchen to ensure that all parts of the kitchen are maintained in a clean state. The plastic coating on one bath hoist should be repaired/replaced before it becomes a risk to cross infection. In order to prevent risk of cross infection, systems should be put in place so that all laundry is sorted at source, to reduce handling by the laundress. The home needs to improve its training provision and staff support systems. There must be evidence that all newly employed staff receive an induction suitable for their role. The home must support staff in training for NVQs and areas relating to resident nursing and care. Records of training must be accurately maintained. Consideration should be given to the range of training needs for catering staff. All staff who perform bed safety rail assessments should be trained in how to perform and review these assessments. Records of training of staff in abuse awareness should be accurately maintained. All staff must be supervised in their roles. All supervision records should be signed by the supervisor and supervisee. Developments are also needed in policies and procedures. All prospective residents/supporters must be given full information about the services provided by the home, including information on the home’s most recent inspection. All complaints must be documented. The homes policy on safeguarding adults must be finalised. Improvement plans developed by the home must be an accurate reflection of the situation in the home and put forward realistic dates for addressing requirements. All matters which need to be reported under Regulation must be reported to us. Where oxygen is in use or stored, all cylinders must be fully secured and British Standard warning signage used. A risk assessment for the lift must be drawn up, to assess the range of risks presented and how potential risk is to be minimised. We are concerned that a range of requirements have not been addressed since the last inspection, that further requirements were identified at this inspection and that this home therefore continues to be assessed as giving poor outcomes to its residents. We will be seeking a meeting with the proprietor and a clear improvement plan following this inspection. A random inspection will take place before the next key inspection and if the situation is not improving, we will use our statutory powers to ensure that improvements are made in service delivery. Please contact the provider for advice of actions taken in response to this Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 9 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.V354070.R01.S.doc Version 5.2 Page 10 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.V354070.R01.S.doc Version 5.2 Page 11 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 people for intermediate care, so 6 is N/A Quality in this outcome area is adequate. This judgement has been made using available evidence including visits to this service. People who are admitted to the home are not provided with up-to-date information to assist them in deciding if the home can meet their needs. Assessment of need is completed, however there needs to be more attention paid to meeting needs of frail people, to ensure that all their nursing and care needs are met. EVIDENCE: Information relating to the home was available in the entrance area. However on both site visits, this information was partially covered by a plant. It was reported in the home’s improvement plan submitted after that last inspection that the statement of purpose and service users’ guide had been fully revised since the last inspection. However the information in the entrance hall on the first day of the inspection was the service user’s guide and statement of purpose which had been available at the last inspection. Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 12 Discussions with the management team indicated that the current statement of purpose and service users’ guide were still in draft form, not completed as stated in the improvement plan. It was reported that the revised documents would be available by early March 2008 and forwarded to us. This indicates that some of the pre-inspection information provided was not an accurate reflection of the situation in the home. There was a lack of clarity about whether prospective residents or their supporters were given full information about the home. Of the ten people who responded to this section of the questionnaire, all reported that they had had enough information about the home and services provided prior to admission. However one person did comment “Information is made available on request, rather than proactive”. A prospective resident’s family were looking round the home during one of the site visits. We explained the process of inspection to them and that they could ask for a copy of the home’s last report or download it from the internet. They were unaware that they could do this. This indicates that the home could not demonstrate that people are given full information about the services they provide. During the inspection, we met with two people who had recently been admitted. Both people were in a very frail state and found communicating with us difficult, so were unable to comment on the admission process. Assessments of their needs generally included a wide range of matters and largely provided a good basis for care plan development. However one of these people had been assessed as having a high risk of pressure damage, including a history of pressure damage in the past, but had been provided with a mattress which provided comfort, not pressure relief. The type of mattress was documented in their records but the reason for providing a lower specification than would be anticipated, considering the person’s assessed degree of risk, was not documented. The acting manager was not aware of this situation and did not know why a lower specification mattress had been provided. One registered nurse also did not appear to be aware of why an appropriate mattress had not been provided. This is a matter which has been raised at previous inspections. One member of staff showed much understanding of how a person must feel when recently admitted from hospital to an environment which is strange to them. For this newly admitted resident, it was clear that staff in the home maintained regular contact with their next of kin, to support the resident through the admission process. One person commented “[my relative] has been in Hays House for a few months and in that time we have encountered no difficulties. The matron and all of the staff are invariably pleasant and helpful” and another “In the period that [my relative] has been there, the home have improved......’s communication skills and moods by 100 ” Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 13 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 poor. This judgement has been made using available evidence, including visits to this service. Residents are protected by some documentation and some staff showed an awareness of their needs, however this was not the case throughout. Deficits in this area had the potential to put frail residents and residents who are dying at risk. Attention is also needed so some aspects of medicines administration and ensuring that residents’ privacy and dignity is respected at all times. EVIDENCE: Since the previous inspection, a full review of provision of nursing and care has taken place. This involved a revision in documentation and included ongoing training to nursing and care staff. The minutes of a recent staff meeting showed that the home have identified areas of short-fall in the care planning process and are developing action plans to assist staff in ensuring effective care planning. Since the last inspection we felt that some progress had been made; however there continued to be a wide range of areas where action is needed to ensure that residents’ nursing and care needs are met. Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 14 These findings were reflected in comments made by residents and their supporters. One social worker reported “At a recent review the individual’s health needs were, in our opinion, being met by the service. Regularly completed monitoring sheets for: fluid intake; pressure care (i.e. turning); and bowel function were apparent. Previously expressed concerns (e.g. regarding manual handling practices).” However a relative commented “In terms of personal attention, a degree of sloppiness is sometimes manifest”. Another relative commented “there has been a slight improvement” and another “When [my relative] first went to Hays House there was a carer nominated for their care and who was my contact for any queries. This system has now changed and the current system is inferior.” One part-time carer reported on the effectiveness of the reporting system when they returned to duty. However one agency carer commented that they were not informed of residents’ needs and another permanent carer reported that agency carers did not always provide the care residents needed. A review of residents’ documentation showed some improvements. For example one person’s records were clear and detailed, reflecting what was observed and what staff reported. However another person’s records noted that they were unable to use the call bell and that they would need “regular checking”. This directive did not state how often the person was to be checked on and there was no indication in their daily record that the person was being checked on regularly. The care plan for a diabetic resident stated “take appropriate action” without stating what the actions to be taken were. Where a resident had swallowing difficulties, care plans were in place, specifying how thick liquids needed to be to meet the individual needs of residents. One carer spoken with was not able to clearly describe how thick fluids needed to be for a certain resident. The new documentation system includes assessment of risk. These include manual handling risk, falls, risk of pressure damage and dietary risk. Where risks are identified, care plans are put in place to direct staff on how risk is to be reduced. One person had an assessment for risk of falls. Their assessment stated that they had not had any fractures in the recent past, despite other records showing that in fact they had done. The assessment had not therefore been completed using all relevant information and their assessment of risk was lower than it should have been. Attention continues to be needed across a range of areas, particularly in relation to prevention of pressure damage. For example for one person who was assessed as being at risk of pressure damage, their care plan stated “observe pressure area care”. This is not a clear directive and members of staff unfamiliar with the resident would not be informed of actions needed. A higher use of appropriate pressure relieving equipment was noted than at the last inspection. Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 15 However it was observed that one person who had a changing condition and whose risk had thereby increased, had an air mattress on their bed but that throughout the first site visit, a period of six hours, the person was sitting in a chair, with no provision of appropriate chair cushion to protect their sacral area. This person’s records stated that they were to have a cushion on their chair which provided comfort, not pressure relief. This cushion was also not provided. This has the potential to put the resident at risk. Another person’s records indicated that they had an appropriate air mattress on their bed, however other records indicated that this mattress had been removed and replaced with a lower specification one. This was confirmed by a registered nurse. The reasons for this substitution were not documented and a registered nurse was not clear on the reasons for this substitution. An appropriate air mattress was provided for this resident two weeks after this resident had sustained pressure damage. Current guidelines indicate that in order to prevent pressure damage, which will cause much discomfort to a person and has the potential to take an extended period to heal, appropriate equipment must be provided to prevent damage occurring. Provision of appropriate equipment after damage has occurred is too late. Frail people who were unable to change their positions and needed assistance to eat and drink had charts in place to monitor that they received the care that they needed. On the first site visit, the completion of these charts during day duty was improved, although there continued to be occasions when charts had not been completed. This was not sustained by the second site visit. There continued to be concerns that frail residents were not receiving the care that they needed. Two residents who were assessed as being at risk of pressure damage and who spent most of their days in the sitting rooms were not observed to have their positions changed regularly. It was reported that one agency nurse had brought some residents who generally spent much of their time in bed down to the lounges, despite directives in care plans. The registered nurse had not ensured that such frail persons returned to bed for a period of time during the day to relieve pressure on their sacral areas. One carer was observed completing a record relating to a person’s fluid input in a different resident’s records. One person’s condition had changed and their care plan stated that they now needed to have their position changed every two or three hours. Records did not show that this was taking place. The standards for completion of charts at night needed attention. A review indicated that on many nights that all people were turned at 2:00am and at 7:00am. This was despite directives in care plans stating that people were to have their positions changed three to four hourly. Additionally considering that there were only four staff on night duty and changing a person’s position needs two people for this to take place safely and also that there were many people who needed their positions changing, it would not be possible for all residents to have their positions changed at 2:00am and 7:00am. This indicated that these night time records are likely not be an accurate reflection of care given. All of these matters are of concern, particularly as at least four residents were identified with pressure damage during the two site visits. Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 16 The acting manager was not aware of all these pressure ulcers or of when the pressure damage was sustained. Where residents had wounds, care plans were in place; however the home does not use a monitoring or assessment record. Generally, it is anticipated that where a wound needs dressing that an assessment chart would be used, to enable staff to plot the wound’s response to treatment in a systematic way and record significant factors, such as presence of pain or evidence of infection. One person’s records indicated that the wound had been dressed. However different dressings were documented from the care plans and the reasons for this were not included. Three registered nurses were unable to inform us of the grade of this person’s pressure ulcer. The acting manager and her deputy had not been informed of the presence of a pressure ulcer for another resident. Documentation relating to this person’s development of pressure ulceration was poor, with no care plan being developed to direct staff on how the wound was to be managed until several days after wound treatments had been developed. A review of records and discussions with residents indicated that the home called in residents’ GPs when indicated. Of the ten people who responded to this section of the questionnaire, seven people reported that the home always, two usually and one sometimes received the medical care that they needed. One relative reported “They call the doctor in promptly”. One social worker commented on the “Good liaison with one GP over one resident’s emotional care.” One social worker reported that “the home did not seem to proactively seek advice/pass on information regarding the service user’s change of needs. They were providing “palliative care” and although the GP had visited, Hays had not informed the local authority.” It was reported that the continence adviser been in recently and the quality of continence pads has improved. Staff reported that they were now changing bed linen less often at night. A medicines round was observed at lunch-time on the first site visit and the registered nurse was noted to perform the round in an organised manner, checking the resident’s names against medication administration record and medicine containers, waiting patiently with the resident until the medicines were taken and locking the trolley each time when they left it. One resident asked to have medicines put in their hand; this was kindly refused and the registered nurse waited until it was seen that the medicine had been taken. Discussions with the registered nurses indicated that the registered nurse is expected to answer the phone and the door bell, this included when she is administering medication. This is a known risk factor in medication errors. During the inspection, it was observed that a minor medicines error relating to a bowel preparation took place. The error was noted promptly, but the registered nurse reported that she had been distracted several times during the medicines round. Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 17 She was aware that she had rectified one potential error caused by an interruption but following a further interruption, had missed this matter. This is an area which needs to be considered by management, to ensure that a major medication error does not take place. A review of two different residents’ medication records showed a lack of clarity as to why a resident had not taken their medicine. For example one person’s records stated “sleepy” or “not found”. A category of “F” was used several times on the medicines administration record, but there was no record of what this category was for. We discussed what “not found” on a record meant with the acting manager; she reported that it indicated that the medication, not the resident was not found and was reported to relate to if the home they were out of stock or an agency worker could not find the medication. It is of concern that until identified by us, the senior staff did not appear to have identified this matter and taken action to ascertain why these drugs had not been administered. The home is developing care plans in relation to medicines which can affect residents’ daily lives, such as pain killers, aperients or mood-altering drugs. Care plans are still fairly limited and while they state the function of the drug where a person is prescribed it on an “as required” basis, they do not state significant factors, such as how often the drug can be administered or side effects to be observed. No assessments had been made of the effectiveness of the treatment, for example if the person was now out of pain or in a calmer mood. One resident had three topical applications in their room. They had a care plan about one of these but not the other two, so staff would not have been aware of where or how often the application was indicated. Another residents topical application was out of date. When a care assistant was asked about what applications were used for this resident, they were unsure of the needs of this resident for topical applications. Discussions with staff indicated that they fully understood the importance of ensuring that residents’ privacy and dignity needs were met, however a few did comment that agency care and nursing staff did not always show the same commitment to care provision. When one resident was visited at just before lunch-time, it was observed that they had a nearly full urinal bottle on their bedside table, and the liquid in the urinal was cold. The resident was unable to empty the urinal themselves. When we visited the resident during the later afternoon, the urinal was still there and in the same condition. We rang the person’s call bell and the carer who came to the room was visibly distressed by the situation, apologising that some staff did not understand how unpleasant it would be to eat lunch with a full urinal on their bedside table. Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 18 Two different peoples’ records contained language which was inappropriate, with people being described as “very messy”, rather than appropriately stating in precise, measurable terms, the condition the resident was found in. Personal comments need to be avoided in residents’ records. One relative reported “In terms of personal attention, a degree of sloppiness is sometimes manifest.” One relative commented “The individuality and particular needs seem by and large to be taken into account”, another relative commented “The fact that [my relative] is there for physical disability and blindness only is realised by most staff and has made a difference.” One social worker commented on how the “Resident was well dressed – attention to jewellery for example”, however another social worker commented that the home would be improved by “Greater respect for individuals.” During the inspection, we considered records relating to two residents who had recently died and one person who was reported to be dying. Discussions with staff and records indicated that the deaths were not unexpected and it was clear that discussions had taken place with residents’ GPs and relatives on a regular basis. None of the relatives of the residents were able to stay with them, but this was not taken into account in any care plan. No end of life care plans had been put in place, as recommended by Department of Health guidelines. The night that they died, one resident’s records indicated that they were not attended to during the night at the frequency indicated in their care plan on. Records showed that for one person, when they died, an administrative error had occurred and there were five, not four staff on duty during the night shift, so it is of surprise that there was no evidence that one staff member had not been allocated to remain with the resident most of the time, so that they were not alone when they were dying. The person who was dying during the inspection was reported to be receiving end of life care. However a care plan had not been put in place to reflect this and all of their review dates in the records remained to be evaluated for at least a month in advance. When a person is close to the end of their life, reviews of care plans need to take place much more frequently, to ensure that at this time, appropriate care can be given. There was limited evidence to show if staff had been trained in palliative care. Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 19 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 visits to this service. Residents are supported by systems which provide choice in how they spend their days, engage in social activities and at mealtimes. EVIDENCE: Of the eleven people who responded to this section of the questionnaire, three people stated there were always, one usually, six sometimes and one never activities arranged by the home that they would take part in. Some residents qualified their responses by outlining their own difficulties in engaging in activities. One person reported “It is difficult as I am unable to walk, am nearly blind and suffer from dementia”. One person reported that they did not like mixing and preferred to spend time on their own, watching television. One relative commented “I have noticed a variety of activities in which suitably able residents were involved.” Another relative commented, “ The efforts made to involved and entertain the residents are extremely good”. One social worker commented on the “Evidence of person-centred planning and interest and use of personal histories”. Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 20 One relative did comment “More people just to talk to the patients and spend time with them if they are in their rooms all the time as my relative now is.” The home employs two activities co-ordinators, one full time and the other one part-time. We met both staff during the inspection. Both were very keen to engage with residents. They have drawn up a new plan of action for activities and given each resident a copy of the forthcoming month’s activities. Copies of these were seen in residents’ rooms. Some activities take place in the lounges and some residents have one to one time their rooms. Activities for January included quizzes, board games, picture making, manicures, a reading circle and “let’s talk about what is in the papers”. Flower arranging was taking place during the second site visit. Both staff members said they were very interested in developing their knowledge of their job and would like some training in dementia. By the second site visit, a course on dementia had been sourced for them and they were both planning to do this. Also on the second site visit both activities coordinators had been issued with a smart new uniform Both residents and visitors commented that family and friends could visit whenever they wished. One person reported “Visitors are always made welcome”, another commented “the friendliness of the staff towards the residents and their relatives is impressive” and one resident commented “Visitors – very good, no restriction.” We observed a lunch time meal. Very good communication by staff with residents was observed. Staff were patient when assisting residents to eat with one to one support for all residents who needed help. Special plates with lips were available and cups with spouts for people who needed them. There was a choice of drink for residents. The dining room is a large, bright room with carpeting. Small round tables are used, but other tables in another room are able to be used if needed. Some people prefer to eat in their rooms. Where they did this meals were taken to them on trays by staff. Some of the very frail residents were not able to come down to the dining room. In such cases, carers sat with them assisting them to eat and were observed to try to engage them in conversation, to make it a social occasion. Some residents had chicken and some had salmon. Pudding was coconut sponge or fruit salad & custard or blancmange. Staff recorded what each resident had eaten. All pureed food was served separately in portions on residents’ plates. We spoke to the cook on the second site visit who described why she did that, so that people would feel they were still eating a meal which had different colours and flavours. We also discussed any training with her and she reported that she had had none recently. Of the ten people who responded to this section of the questionnaire, one reported they always, five usually, three sometimes and one never liked the meals. Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 21 Comments varied from “A good varied diet”, “The food here is very good, usually” through “Not the same standard as used to be in years gone by” to “Not awful – it’s tasteless, no flavour in it” or “They appear to buy the cheapest thing they can”. We observed thickening agents being used. One staff member reported how they knew what to add and said that one resident liked their drinks very thick but that most residents had it syrupy. We spoke to six staff who were in the kitchen and using thickeners in drinks. We discussed with them how they knew how much to add. There were no care plans in the kitchen but there were records of which resident needed thickeners. One staff member said that some residents had one spoon and that one person had two and a half spoons. Staff reported that they would appreciate detailed instructions about how much thickening agent to add and when this changed for residents. In the kitchen it was observed that the deep fat fryer contained old dirty fat. Staff reported that they cleaned it every week and were going to use it that day and then clean it. There were large ovens/cookers along the wall in kitchen. The right hand side ovens externally were very dirty with brown stains and needed cleaning. Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 22 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 visits to this service. Residents are largely protected by most of the home’s procedures, although full records are not maintained for all areas and this could mean that not all matters of concern are investigated. EVIDENCE: The home has a complaints procedure, which is displayed and is available in the service users’ guide. Of the eighteen people who responded to this section of the questionnaire, sixteen reported that they knew how to make a complaint. However of the nineteen people who responded to the section on whether they knew who to speak to if they were not happy, ten reported that they always did, six that they usually and three that they sometimes did. The relative of one newly admitted resident reported “I was invited by the Matron to discuss with her any difficulties which might arise whenever I thought it necessary” and another relative commented “we have not had any concerns about [our relative’s] care.” One resident commented “the manager knows my opinion.” However a relative commented that they “rarely see anyone of authority in the office. Two years ago the matron made a point of being available at any time I went in, but now I feel there is never anyone to talk to other than the odd carers, who only have time to say “hello”. No formal complaints have been made to us about this home since it was last inspected. The home maintains a record of complaints. Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 23 A review of this file showed that the home generally complies with its own polices and procedures. However it was noted that while some of the matters raised with us in questionnaires had already been reported to the home and action taken to address matters, others were known by the acting manger but had not been documented, so the acting manager did not have a full audit trail of actions taken to address complaints in all cases. The home has a policy and procedure relating to safeguarding adults. This has been up-dated recently and still needs some further work performing on it relating to compliance with local procedures. Staff spoken to were aware of the importance of safeguarding adults. Permanent staff reported that they had recently been trained in the area, although this was not full supported by the home’s training records. No referrals have been made via local procedures since the last inspection. At the first site visit it was noted in one person’s daily records that a carer noted that the resident had bruising on their hand and knee. No accident form, written notification or body chart record had been made. This was discussed with the acting manager who was unaware of the situation. A similar observation was noted for a second resident and again adequate records had not been made. By the second site visit, this had been addressed and rectified. However it is of concern that staff are not ensuring that correct procedures are undertaken when such observations are noted, particularly as this matter had been identified at the previous inspection. Several residents were observed to be provided with safety rails on their beds. Safety rails are regarded as a form of restraint and additionally may present a high degree of risk to a person’s health and safety, so should only be used it there are no other alternatives. The home have now introduced a standard assessment tool for use when such rails are deemed necessary, which complies with advice from the Health and Safety Executive. One person who had safety rails on their bed did not have an assessment for their use. All of the assessments which had been completed had not been correctly completed. There is a trigger question to ask if the assessor had considered or tried alternatives to safety rails. All assessments stated that this had not taken place. At the end of the assessment, a further question asked if there was no alternative to using safety rails. All assessments had ticked the box to state that there was no alternative. These two responses are contradictory. This indicated that staff who assess for use of safety rails need to be trained in this area. One resident considered in detail was documented as needing a lap belt when in a wheelchair. A risk assessment for this was not included in their records. Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 24 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, 20, 22 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Hays House presents a pleasing, clean environment, with a range of facilities. Management is progressively investing in the provision of equipment to meet the needs of frail and disabled people. EVIDENCE: Hays House is a large country house. Accommodation is provided over four floors and includes a purpose-built wing to the rear of the building. All rooms in the main building are different from each other, some are very large and much exceed National Minimum Standards. One person commented, “I like my room. It’s big too.” Rooms in the newer extension have direct access to the garden. The house had the advantage of large gardens. One relative commented “In good weather the staff and family can take residents into the lovely grounds”. Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 25 A range of different communal rooms are available on the ground floor, including three sitting rooms, a conservatory sitting area and a dining room. One relative commented on how they saw this as an advantage as by moving to different parts of the house, the home provided residents with a choice of where to sit during the day and prevented boredom. Maintenance of the home has much improved since the employment of a permanent maintenance man. Several areas had recently been re-decorated and work was ongoing in several bathrooms. All damaged areas under soap dispensers have been attended to. One room showed staining to the ceiling and another, damage to the wall. The maintenance man knew all about these areas and had action plans in place for improvement of these areas. In one assisted bathroom, the plastic coating on the bath hoist was perishing, this will need attending to before it deteriorates further and becomes a risk to cross infection. The home have reviewed security of the building, to ensure the safety of residents and staff. The home has a range of equipment to meet needs of people with a disability. They are investing in profiling beds and many of the people who have complex needs are now cared for in appropriate variable height beds. The acting manager reported that the home are continuing to invest in such beds, with the aim that all people with complex manual handling needs will be provided with such beds. The home has also invested in pressure relieving equipment and a range of air mattresses and air cushions were now being used to protect residents who were at risk of tissue damage. However it was noted that one person who was assessed as being at the end of their life was not cared for in an appropriate bed with an appropriate mattress and not all other residents who needed variable height beds or appropriate pressure relieving equipment had been provided with such equipment according to assessed need. This was despite a report in the home’s improvement plan that this had been addressed by 31/12/07. A range of hoists, slide sheets and other aids to manual handling were also observed across the home. All residents had been left with access to their call bells. The home was clean throughout. We met with two domestics, who were observed to carefully perform their roles. Of the eleven people who responded to this part of the questionnaire, six responded that the home was always and five that it was usually fresh and clean. One person commented “Weekends suffer due to staff shortages” another “Table by bed needs cleaning more regularly” and another The wheelchairs need more maintenance (the tyres e.g.) and to be cleaned regularly which I do not think they are.” There were appropriate systems for managing clinical waste and registered nurses reported that all wound dressings took place using full aseptic procedure. Equipment has been provided to prevent the spread of infection and all equipment was in a clean and well maintained state. All commode chairs have now been labelled with the resident’s name so that it is used only for that resident. Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 26 We visited the laundry and spoke to the laundress. The laundress reported that staff largely kept to the home’s policy on management of infected and potentially infected laundry and that all such laundry is placed in separate bags, so that it is not handled. She reported that she had a good supply of gloves and aprons to use when handling laundry. She reported that she still needs to re-sort some categories of laundry and it is advisable that systems be put in place to ensure that all categories of laundry are appropriately placed in bags at source, to reduce the need for further handling. Issues have been raised with us in the past about residents not having their own clothes returned to them. The laundress reported that much work has been put into ensuring that all clothing is now named and returned to their owners. Clothing relating to three female residents were reviewed in their wardrobes and chests of drawers. All had been correctly marked with the person’s name or room number. One resident commented on the service saying, “the laundry is very good, they take away daily and bring back next day, all washed and ironed” and another “The laundry – we get our own clothes back.” Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 27 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 poor. This judgement has been made using available evidence including visits to this service. Residents are not supported in all cases by staff who know them. There are safe recruitment systems but there is a lack of evidence that appropriate training has been provided to meet the needs of the people in the home. EVIDENCE: As Hays House is a care home with nursing, there is always at least one registered nurse on duty. This registered nurse is supported by care assistants, with varying numbers on duty at different times of the day. The care and nursing staff are supported by teams of catering, domestic, laundry, maintenance, administrative and activities staff. All staff now wear name badges. Many comments were made about staffing levels by a range of people. One person stated “I feel that home suffers from shortages of staff particularly at weekends”, another “There are sometimes staff shortages which makes responded time to the bell, too long”, another “The staff are rushed very often” and another “There are too many agency staff, half the old staff have left.” Discussions with staff indicated that the home needs to rely on agency staff to ensure that there are enough staff on duty. This is particularly the case for night duty and weekends, and includes both carers and registered nurses. Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 28 Several people commented on the difficulties resulting from high usage of agency staff. One person said “there are a core of agency staff at weekends and half terms etc which is unsettling and gives lack of continuity but at least gives cover.” One member of staff commented “some days I’m the only person on who isn’t agency”. One resident described how they had to tell agency staff how they needed to be helped, as they did not seem to know what they needed. Variable responses were made in relation to management of agency staff. One registered nurse described how she planned for each shift where she was in charge, making sure that agency staff always worked with a permanent member of staff or, it that was not possible, an agency carer who had worked in the home on several occasions before. However one agency carer commented that on some occasions, generally on night shifts, the permanent members of staff worked together and that they were left either to work on their own or with agency staff. Response times to call bells were reported to be variable, depending on who was on duty. One person reported “Staff are very good about coming, very helpful when I ring my bell,” another “I rang my bell and they came in five minutes, I asked for a cup of tea but they didn’t come back after 20 minutes, so I had to ring again” and another “response times are variable – this girl – she’s a good one.” One member of staff commented “Not all staff come quickly.” The home have fully revised their systems for the recruitment of staff at all levels. Files of four recently recruited staff now included a full employment history, two references, police checks and health checks. All staff are assessed for their role using an interview assessment tool. Management consultants employed by the proprietor have fully revised the home’s induction systems. A blank induction record was reviewed and it appeared to comply in full with guidelines. Completed induction records could not be reviewed at this inspection as it was reported that this induction had only recently been introduced. Several staff reported on the induction of new staff, feeling that improvements were needed, as newly employed staff were felt to be moved too many times and not given time to get to know a group of residents and their needs before being moved to other areas. The management consultants are developing training for staff at all levels and files are in place to show training planned for 2008. Records indicated that twelve staff had achieved NVQ Level 2 and three staff NVQ Level 3. One member of staff reported “training is starting to come thorough”. Full records of training could not be reviewed at this inspection as training across a range of areas had only recently been commenced. The records available were limited, several records examined were largely blank and did not provide evidence that staff had been trained in areas relating to elderly care such as prevention of pressure damage, continence care or palliative care. Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 29 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, 36, 37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence, including visits to this service. Residents are supported by a proprietor who is committed to investing in service improvement. Residents could be put at risk by inadequate record keeping, supervision of staff and systems to ensure the health and safety of residents, visitors and staff. EVIDENCE: Hays House has been without a manager for an extended period of time. Several managers have been appointed, but for a range of reasons, they have not remained in post beyond their probationary period. At the time of the inspection, there was an acting over arrangement by the manager of the proprietor’s sister home. The proprietor reports that he is pursuing an active Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 30 recruitment campaign for a new manager. The proprietor is keen to work with us, ensuring that he regularly up-dates us as to the situation about management in the home. The proprietor is supportive of improving services and has engaged a range of external professional supports to work and improve service provision. This included a full quality audit of services by an external management company. This company has put forward action plans for service improvement and has been working with the home, monitoring progress and providing training and support to staff. The proprietor has also ensured that key registered nurses could work on a supernumerary basis, when needed to improve service provision to residents. Certain staff records showed evidence of disciplinary action being taken by the home if indicated. The home sent in an improvement plan following the last inspection, as required. Not all areas had been accurately completed and some areas indicated that certain matters had been addressed in full when this inspection showed that they had not been. The home have revised their systems for management of residents’ personal moneys. All expenses, such as newspapers or hairdressing are managed by a monthly invoicing system, with individual accounts for residents, which show a full audit trail. There is also a full audit trail for valuables handed in for safekeeping. Supervision of staff showed some improvement. During the first site visit, staff were evident in sitting rooms and across the home and no care or nursing staff were observed to perform ancillary roles. Staff were observed to be attentive when residents gave the appearance of needing support, attending promptly and in a kindly manner. However on the second site visit, a group of permanent and agency staff were observed to be talking amongst themselves in a quiet corridor, away from resident areas and not performing their roles. Registered nurses in charge did not appear to be aware of this and did not ensure that care assistants were performing their roles. While there is a system for allocation of duties on day duty, such a written system is not available for night duty, so it is not clear how care staff, particularly agency staff, are supervised in their roles. Records relating to staff supervision are now in place. Many records and supervisory agreements had only recently been commenced and had not been signed by the supervisor or supervisee. Where training needs are identified, there was no evidence of action plan development to ensure that training takes place. While improvements in record-keeping were noted, some areas of development continue to be needed. All residents have a daily record of their care and condition completed. However it was noted in these records that many showed gaps between entries; this is not advisable, as it leaves space for records to be adjusted after they have been completed. If gaps between records are indicated, they should have a line drawn thorough them, so that subsequent alterations are not possible. Some records were contradictory, for Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 31 example for one person different parts of their records documented different types of bed being provided to them, during the same time period. During the inspection, daily records for three residents indicated reports of bruising to different parts of their bodies. One of these records documented that the bruising had been reported to the registered nurse. No entries had been made in the home’s accident book. Full records of all accidents must always be made. This is a matter which has been identified previously and actions are still indicated by staff. During the inspection, it was identified that at least four residents had sustained pressure damage since the last inspection. No reports relating to this had been made to us as is required by regulation. During the first site visit two carers from an agency were observed hoisting a resident. They were very careful, talking to them, explaining what they were doing. Both these agency carers work regularly in the home. Records relating to training in health and safety showed that a moving and assisting update had taken place in May 2007, with signatures of eight staff attending. Fire awareness training took place in April 07 with three separate days for staff and records showed that many attended. It was reported that training in infection control was planned for the near future. Four individual staff files indicated that staff had largely been trained in mandatory areas. However some showed some gaps in areas such as manual handling up-dates and fire safety updates, and only one person’s file showed evidence of infection control training. Record-keeping systems in relation to training in mandatory areas need to be improved so that management is able to evidence the training that has taken place and action to be taken to ensure that all staff are regularly trained in mandatory areas. During the site visits, it was observed that one resident had been prescribed oxygen and oxygen cylinders as well as an oxygen concentrator were placed in their room. The cylinders were placed on the floor and not restrained in any way. Oxygen cylinders are very heavy and have the potential to topple over, due to their shape, unless fully secured. Additionally whilst a sign had been placed on the resident’s door to notify that oxygen was in use, it was not a British Standard sign and so in the event of an emergency, such as a major fire, would not adequately advise emergency services of the additional risk presented by the presence of oxygen in the resident’s room. During the inspection, we discussed the lift with a range of people. People spoken with reported that the lift continued to break down at times but was breaking down less often than it had been. In order to both operate and call the lift, the button has to be depressed the whole time, or the lift stops moving. This must be difficult for a frail person or a person with concentration difficulties. The lift itself does not have an inner door, so the inner wall of the lift shaft is directly accessible as the lift moves from floor to floor and there is a small gap between the lift itself and the shaft. It was reported that there are standard safety systems to prevent a person from touching the shaft wall or accessing the gap between shaft and lift. This was not supported by a risk Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 32 assessment. Full risk assessments are also needed to identify how residents are to be protected, particularly in elation to emergency situations where a member of staff may need to attend to an unwell resident but can also not take their had off the button or the lift will stop. Discussions with the maintenance man and reviews of his documentation showed that all services to the home are regularly maintained according to guidelines. Fire safety and manual handling equipment is regularly checked. All electrical equipment is tested for safety, including electrical equipment of newly admitted residents. Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 33 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 3 x 2 x x x 3 STAFFING Standard No Score 27 1 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 2 2 2 Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 34 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 OP1 Regulation 4(1), 5(1) Requirement Timescale for action 31/03/08 2. OP7 14(1)(2) 3. OP7 15(1) All prospective residents/ supporters must be given full information about the services provided by the home, including information on the home’s most recent inspection. Assessment of service user need 31/03/08 must be accurate and include all factors which may affect the service user. Assessments must be reviewed when a service user’s condition changes. All care plans must be 31/03/08 consistently completed to the same standard and accurately include all matters relating to the nursing and care of the service user. UNMET REQUIREMENT: This requirement was identified at the inspection of 23/8/07, with a compliance date of 31/12/07 Care plans must be properly 31/03/08 evaluated and revised when a service user’s nursing or care needs change. UNMET REQUIREMENT: This 4. OP7 15(2)(b,c) Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 35 5. OP7 13(4)(c) requirement was identified at the inspection of 23/8/07, with a compliance date of 31/12/07 Where equipment is in use which 31/03/08 is not in accordance with the service users assessed degree of risk, the clinical indicator(s) for this different equipment must always be documented. UNMET REQUIREMENT: This requirement was identified at the inspection of 10/11/05, when the timescale for action was 30/11/05. Progress was noted at the next inspection of 31/10/06 but it had not been addressed in full, a compliance date of 31/01/07 was set. At the inspection of 23/8/07, the then manager had been in post for a few weeks only, so a new compliance date of 31/12/07 was agreed. Care must always be provided in accordance with care plans, and where this is not possible, an accurate record of why this did not happen is made. 6. OP7 12(1)(a) 31/03/08 7. OP8 17(1)S(3) (3, k) UNMET REQUIREMENT: This requirement was identified at the inspection of 23/8/07, with a compliance date of 31/12/07 Records must be in place to 31/03/08 show that service users who need frequent care are receiving this care. Records must be accurately completed and at the time that care was provided. UNMET REQUIREMENT This requirement was identified at the inspections of 10/11/05 and 21/01/06. As parts of the requirement had been addressed by the inspection of 31/10/06, more time was given to address Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 36 8. OP8 17(1)(a)S 3(3,k,n) 9. OP9 13(2) 10. OP9 13(2) 11. OP9 13(2) 12. OP10 13(4)(a) the requirement in full, with a compliance date of 31/11/06. At the inspection of 23/8/07, the then manager had been in post for a few weeks only, so a new compliance date of 31/12/07 was agreed. Where a service user has a wound, there must always be full and accurate records relating to the wound and response to treatment. Managers must ensure that they are fully informed of every wound and its condition. When administering medication, registered nurses must be enabled to concentrate on this role and not have to perform other tasks as well. Where there is evidence that a service user has not taken a medication, there must be evidence of full investigation into this and action(s) taken Where a service user is prescribed a topical application, there must be full care plans relating to this and all staff must be made aware of which applications are indicated and how they are to be applied. Nursing and care must always be provided in such a way that a service user’s privacy, dignity and comfort is maintained. REQUIREMENT IN PROGRESS: This requirement was identified at the inspection of 23/8/07 with a compliance date of 30/09/07 All matters of concern must be documented by the person being informed of the issue. REQUIREMENT IN PROGRESS: This requirement was identified at the inspection of 23/8/07, 31/03/08 31/03/08 31/03/08 31/03/08 31/03/08 13. OP16 22(2) 31/03/08 Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 37 14. OP17 13(6) with a compliance date of 31/10/07 The home’s policy and procedure on safeguarding adults must be fully revised, to reflect current guidelines. REQUIREMENT IN PROGRESS: This requirement was identified at the inspection of 23/8/07 with a compliance date of 31/12/07 Where service users have equipment in use such as safety rails, or lap belts, which are considered to be a restraint, an assessment of the need for this equipment must always be made. Assessments must be accurately completed and regularly reviewed. REQUIREMENT IN PROGRESS This requirement was identified at the inspection of 3/10/06, with a timescale of 31/01/07. At the inspection of 23/8/07, the then manager had been in post for a few weeks only, so a new compliance date of 31/12/07 was agreed. All service users who have manual handling needs or need to be fed in bed must be cared for on an adjustable height bed. REQUIREMENT IN PROGRESS: A similar requirement was identified at the inspection of 10/11/05, with a timescale of 28/02/05. Due to changes in management of the home, they were given more time to address the requirement, with a revised compliance date of 31/3/07. At the inspection of 23/8/07, the then manager had been in post for a few weeks only, so a new compliance date of 31/12/07 31/03/08 15. OP18 13(7) 31/03/08 16. OP22 13(4)(c) 31/03/08 Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 38 17. OP22 13(4)(c) was agreed. Where a service user is assessed as needing equipment to prevent risk, this must always be provided. 31/03/08 18. 19. OP30 OP30 REQUIREMENT IN PROGRESS This requirement was identified at the previous inspection, with a timescale of 28/02/07. At the inspection of 23/8/07, the then manager had been in post for a few weeks only, so a new compliance date of 31/12/07 was agreed. 18(1)(c,i) There must be evidence that all 31/05/08 newly employed staff receive an induction suitable for their role. 18(1)(c, i) The home must support staff in 30/04/08 training in NVQs and areas relating to service user nursing and care. Records of training must be accurately maintained. REQUIREMENT IN RPOGRESS: This requirement was identified at the inspection of 23/8/07 with a compliance date of 30/04/08. The home’s improvement plan must be an accurate reflection of the situation in the home and put forward realistic dates for addressing requirements. All staff must be supervised in their roles. A system for documentation of appraisals and supervisions must be put in place. REQUIREMENT IN PROGRESS: This requirement was identified at the previous inspection, with a timescale of 31/03/07. At the inspection of 23/8/07, the then manager had been in post for a few weeks only, so a new compliance date of 31/12/07 was agreed. 20. OP33 24(a) 30/04/08 21. OP36 18(2) 31/03/08 Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 39 22. OP37 17(1,a)S3 (3) All matters relating to service users’ health and well-being, must be documented and reported to relevant persons. Records must be completed contemporaneously by the person who observed the occurrence. All accidents to service users must be fully documented in the home’s accident book. 31/03/08 23. OP37 37(1) 24. OP38 13(4)(a,c) 25. OP38 13(4)(a,c) REQUIREMENT IN PROGRESS: This requirement was identified at the inspection of 23/8/07 with a compliance date of 31/10/07. All matters which need to be 31/03/08 reported under Regulation must be reported to the Commission for Social Care Inspection Where oxygen is in use or 31/03/08 stored, all cylinders must be fully secured and British Standard warning signage used. A risk assessment for the lift 30/04/08 must be drawn up, to assess the range of risks presented and how potential risk is to be minimised. 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. Personal comments about service users should not be used when completing care records. Where a service user is dying, an end of life care plan DS0000015916.V354070.R01.S.doc Version 5.2 Page 40 2. 3. OP10 OP11 Hays House 4. 5. 6. 7. 8. OP15 OP19 OP26 OP26 OP28 9. 10. OP30 OP30 11. 12. 13. OP36 OP37 OP38 should always be drawn up, in accordance with Department of Health guidelines. Regular monitoring should take place of facilities and equipment in the kitchen to ensure that all parts of the kitchen are maintained in a clean state. Records of training of staff in abuse awareness should be accurately maintained. The plastic coating on one bath hoist should be repaired/replaced before it becomes a risk to cross infection. In order to prevent risk of cross infection, systems should be put in place so that all laundry is sorted at source, so that handling by the laundress does not need to take place The home should ensure that relevant matters about individual service users is communicated to support staff such as the catering staff, activities coordinators and laundresses, so that these staff members can meet individual service users’ needs. (This was recommended at the previous inspection; it has not been addressed). Consideration should be given to the range of training needs for catering staff. All staff should be trained in prevention of pressure damage. (This had been recommended for the past two inspections; it has not been addressed). All supervision records should be signed by the supervisor and supervisee. Gaps should not be left in daily care records, if a gap is indicated, a line should be drawn through the space. All staff who perform safety rail assessments should be trained in how to perform and review these assessments. Hays House DS0000015916.V354070.R01.S.doc Version 5.2 Page 41 Commission for Social Care Inspection South West Regional Office 4th Floor, 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. 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