Inspection on 03/10/06 for Hays House

This inspection was carried out on 3rd October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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 22/01/08

Hays House 23/08/07

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 Key Unannounced Inspection 9:25 3 & 31st October 2006 rd 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.V313751.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.V313751.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 Limited 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.V313751.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. 10th November 2005 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. At the time of the first site visit, there were 35 persons resident in the home. 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 an experienced manager, who is also a registered nurse. She 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 3 miles north of Shaftesbury and 8 miles south of Warminster. The nearest railway station is in Gillingham, Dorset. Fees charged by the home are £461 to £805. Additional charges are made for hairdressing, newspapers and sundries such as toiletries. Two copies of the service users guide are available in the front entrance hall and a copy is given to all new residents or their supporters. Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 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, 15 questionnaires were sent out and 10 were returned. Comments made by residents and their relatives in questionnaires, during the inspection and from relatives, GPs and social workers, who were contacted after the first site visit, have been included when drawing up the report. The home also provided information requested by the CSCI prior to the inspection, relating to residents and staff. As Hays House is a medium-sized registration, the site visits took place over two days, on Tuesday 3rd October 2006 between 9:25am and 5:00pm and Tuesday 31st October 2006, between 9:30am and 2:40pm. A pre-inspection meeting with the owner, acting manager and her deputy was also held on Friday 29th September 2006, to discuss proposals for the future management arrangements of the home. The first inspection site visit was unannounced. The acting manager was on duty for all three of the site visits. During the site visits, the inspector met with seven residents privately, and observed care for 14 residents who were unable to communicate. The inspector reviewed care provision and documentation in detail for seven of these residents, two of whom had recently been admitted. The relatives, GPs and social workers (if applicable) of these residents were written to, to gain their opinion of the quality of care provided. As well as meeting with residents and visitors, the inspector met with three registered nurses, three senior carers, two junior carers, the chef and her assistant, two cleaners, the laundress, the administrator and an activities coordinator. The inspector toured all the building and observed a lunch-time meal and two activities sessions. Systems for administration of medicines and the clinical room were inspected. A range of records were reviewed, including staff training records, and employment records, maintenance records and residents’ financial records. What the service does well: Hays House is a large country house, which is furnished to suit its style. The house is well maintained and the owner seeks to improve facilities, for example a new lift had been installed since the last inspection. The house benefits from a large garden, which residents say they enjoy, and a range of different communal rooms. Some of the residents’ rooms are very large and residents can personalise them if they wish. Residents reported that they enjoyed the activities and outings provided and the activities coordinators are enthusiastic in their roles. While there has been a considerable staff turnover, it is also Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 6 interesting to note that some staff have returned to work in the home, following recent changes, and that a core of staff have continued to work in the home throughout the changes, providing continuity of care to residents. Many residents expressed their appreciation of the home, one reported “I have found it excellent for my needs”, another reported “I have been happy here” and another “A very good home”. Many of the residents expressed their appreciation of the staff, one said ”Staff are kind and gentle and I’m fairly fussy”, another reported “The staff are the most spirited, loving and giving” and another “Some of the staff are excellent at their jobs and are also bright and cheerful”. Some people commented on other specific people, one commented particularly on their cleaner, describing her as “excellent and extremely thorough and a nice person” and another commented on how much they appreciated the owner coming to visit them on their birthday. One visitor reported “They helped him to settle in well – he had anxieties about leaving his own home”. What has improved since the last inspection? Hays House has had two random inspections since the previous inspection which was on 10th November 2005. At that inspection, nine requirements and eight good practice recommendations were identified. This was followed by a formal meeting at the offices of the CSCI with the owner and the then registered manager. A random inspection took place on 21st January 2006, to review progress towards meeting requirements. At that inspection, two further requirements were identified. A random inspection took place on 15th September 2006 in response to a vulnerable adults allegation, no new issues were identified at that inspection. Of the requirements identified at previous inspections, seven had been addressed in full. Systems for management of medicines have been made much safer and more organised, and all out of date items used in residents’ nursing and care have now been disposed of. The CSCI is now informed of any event which could seriously affect a residents’ well-being. If a resident requests or needs their room door held open, this is now respected and a device which has been approved by the fire officer is always used. Sterile procedures are now always used when performing wound dressings, to prevent risk of infection. A written review of the current staffing levels has taken place. Call bells are being answered more promptly. Seven of the recommendations identified at previous inspections have also been met. Where a service user experiences skin tears, risk assessments and care plans are in place to direct staff on how risk is to be reduced. Falls risk assessments have improved. New carpets have been provided. Staff in charge of the home have been informed of Conditions of Registration relating to staffing levels. The home is working to improve continuity of care to residents and have re-introduced a key worker system. The acting manager has analysed the reasons for staff leaving the home, to provide information and to improve quality of care to residents. Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 7 What they could do better: At this inspection, 11 requirements, four of which were identified at the previous inspection of 10/11/05, were identified. Twelve recommendations were made, one of which was identified at the previous inspection. Persons must not be admitted, until the home has confirmed that they can meet their needs in writing and can evidence that all the equipment they need to meet their needs is in place. All residents must have full risk assessments drawn up and where a resident has a risk identified, a full and detailed care plan must always be put in place to direct staff on how the risk is to be reduced. This was identified at the inspection of 10/11/05, some progress has been noted but it has not been addressed in full. Where equipment is in use, which is not in accordance with a residents assessed degree of risk, the clinical reason(s) for this different equipment must always be clarified. This was also identified at the inspection of 10/11/05, it has not been addressed. All residents must have full and detailed care plans available, which relate to all their care needs, these need to detail areas such as skin care, care of ostomies, diabetes, instructions about treatments from professionals such as the physiotherapist, use of suction apparatus or bladder washouts for urinary catheters, as well as nursing and care needs. All frail persons who are not able to move their position or give themselves fluids must have a written monitoring system in place, so that staff can ensure that the service user receives the care that they need. This was identified at the inspection of 10/11/05. It has almost been met. Where residents have equipment in use such as safety rails, an assessment of the need for this form of restraining equipment must always be made. All residents who have manual handling needs or need to be fed in bed must be cared for in an adjustable height bed to ensure their safety. A similar requirement was identified at the previous inspection of 10/11/05. Where a resident is assessed as needing equipment to prevent risk, this must always be provided. Equipment must be fit for purpose and correctly used, in accordance with manufacturers’ instructions. Suitable stocks of equipment must be maintained in the building, so that residents are not put at risk. A permanent manager must be appointed to the home. The manager must ensure that all staff are supervised in their role to provide appropriate service user care. A system for documentation of appraisals and supervisions must be put in place. The wording of care plans should be precise and measurable, this includes personal care, nursing care, wound care and dietary care. Where a resident’s fluid intake is being recorded, the amount of fluids taken in every 24 hours should be totalled. Where a resident is prescribed medication which can affect their daily living, such as aperients, pain killers or mood altering drugs, a care plan should be in place so that staff can monitor the effectiveness of the Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 8 treatment regimes. All staff should have access to information on service users’ past lives and preferences for activities and be able to up-date them. A permanent maintenance man should be employed. A system should be put in place to enable staff to communicate with each other across the home and answer the phone and front door. This was recommended at the previous inspection, but has not been addressed. An interview assessment tool should be used for all staff. All staff should be trained in prevention of pressure damage. 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. Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 9 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.V313751.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Hays House does not provide intermediate care, so 6 is N/A Quality on this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visits to the service. Hays House now has a comprehensive pre-admission assessment process but residents could be put at risk by the home not ensuring that the equipment needed by the resident is in place at admission. EVIDENCE: The acting manager, who is a registered nurse, has ensured that all residents who have been admitted since she took over the home have a full and comprehensive assessment of their nursing and care needs. She reported that she goes to visit prospective residents in their own settings prior to admission, to assess if the home can meet their needs. One recently admitted person reported that they remembered being visited in hospital by the manager before they were admitted. Two of the people who responded to questionnaires reported that the home was able to meet their needs. One person who visited the home prior to their relative’s admission reported that they “had a look around and liked what I saw, very clean and friendly”. One Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 11 carer said that they were informed of a prospective resident’s admission during report and were given enough information to prepare to meet their needs. The manager does not confirm in writing to the prospective resident or their representative that they can meet their nursing and care needs, as is required by regulation. The manager is required to do this so that there is evidence that all needs of a prospective resident have been considered prior to admission. One recently admitted resident clearly needed appropriate pressure relieving equipment on admission, and protection for safety rails. The protection for the safety rails was not delivered until 16 days after their admission and it was noted the resident was being cared for on a mattress which provided comfort, not pressure relief, 16 days after their admission. Another resident was also not provided with appropriate pressure relieving equipment, although they clearly needed it from their admission assessment. One resident had gone on to develop pressure damage after admission. Since the first day of the inspection, the acting manager has further developed their pre-admission assessment forms so that such matters are taken into account. Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality on this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visits to the service. Some residents may well be put at risk by inconsistent assessment and care planning systems in the home, this includes healthcare as well as general care needs. Residents are protected by the home’s systems for management of medication. Staff generally ensure that residents are treated with respect but some matters indicate an increased need for staff supervision. EVIDENCE: Hays House has a care planning documentation system, which the acting manager is planning to change, to make it more person-centred. Staff are currently being given training in the new documentation system. A range of issues relating to poor care planning was identified at this inspection. The acting manager reported that some of these issues related to the current documentation systems used by the home, which she reported did not facilitate consideration of individual care needs. Other issues related to the needs for staff training in a resident-centred approach. In order to support staff, the acting manager has re-allocated lead nurses and key workers in a way which suits the geography of the building. Care planning has also been Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 13 disrupted by the recent turnover in registered nursing staff. One of the registered nurses met with had been in post for a long period of time, she knew all her allocated residents well and her care plans reflected their needs. Three of the senior carers also knew their residents and their care needs in much detail and were positive about the changes in allocation of key clients, saying that this made them able to concentrate on meeting individual resident need. A wide range of concerns relating to assessment and care planning were identified at this inspection, however there were clear improvements from the poor situation at the previous random inspection and the acting manager and her staff have clearly managed to address some issues. Residents have a range of assessments completed in many, but not all areas. Care plans are being developed to meet resident need but they have not been addressed for all areas. One person commented “I feel that the care here is not acceptable” however another reported that “I do think that [the acting manager] will bring/is bringing much needed improvement.” At the random inspection it was required that where a resident had a risk identified, a care plan must always be put in place to direct staff on how risk is to be reduced. This was progressing but it had not happened in all cases. Attention needs to be paid to pressure damage risk assessment and care planning. Elderly people tend to be at risk of pressure damage and, if damage is sustained, resulting wounds can be painful and take a long time to heal. One resident had a pressure damage risk assessment and care plan to direct staff on how risk was to be reduced. The plan was generalistic and did not direct care. It stated that the resident was to be moved “regularly” to prevent pressure damage, but did not state how often the resident needed to be moved. The equipment in use for them provided comfort only and did not reduce risk of pressure damage. Their record stated on 24/9/06 that the resident needed an air mattress but by 3/10/06, one had not been provided and there was no documented reason as to why this was. This person’s records indicated that they had sustained pressure damage. Another resident was assessed as being at high risk of pressure damage but did not have a care plan to direct staff on how risk was to be reduced. A different resident, who had sustained pressure damage prior to admission, did not have a risk assessment for pressure damage and there was no care plan to direct staff on how risk of pressure damage was to be reduced. The equipment used in their room did not relate to their probable degree of risk. One resident’s pressure damage risk assessment did not include an accurate assessment of all the risks presented by their individual condition. Several staff spoken with were keen to develop their knowledge of prevention of pressure damage and showed a need for training in the area. The acting manager is developing action plans to address this need. Two residents’ dietary risk assessments indicated that they were at risk nutritionally but they did not have a care plan in place to direct staff on how Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 14 risk was to be reduced. One resident’s daily record indicated that they had experienced a recent choking incident. Their medical history also indicated that this could be likely, however an assessment of risk had not been drawn up following the incident and a care plan had not been put in place to direct staff on how risk was to be reduced. More positively, a carer reported that one resident had been admitted on a PEG feeding regime but with the care that had been provided in the home, a liquidised diet had been gradually introduced and the PEG feeding system had been discontinued. As required at the random inspection, most frail residents now have charts in place to ensure that their position is changed regularly to prevent tissue damage and to ensure that they are given adequate fluids and diet. However, one person who was not able to give themselves fluids or to move themselves independently did not have such a chart in place. This person had sustained pressure damage in the home. A review of these charts showed that where residents did have them in place, they were having their positions changed regularly, as required in the random inspection, apart from at night, when most charts showed that residents did not have their positions changed for periods of time after 9:30pm. This varied from resident to resident, some residents had their positions changed after five hours, but others had to remain in the same position for a much longer period of time. Residents did have clear records to show that they were offered fluids regularly, however the amount of fluids taken was not totalled every 24 hours, so it was not possible to assess if residents were receiving adequate fluids. Some records of food eaten noted what the resident had been given, however some simply stated, “lunch” or “supper”. As the home offers 3 choices of meals, in order to assess if the resident has had an adequate diet, which they like, the record should state what the resident had actually been given. One resident had a mobility care plan, which fully reflected both what they told the inspector, and the aids which were observed in their room. Another resident had a clear care plan relating to maintaining their safety in the home environment. A resident was documented as having dry skin and had a care plan in place to direct staff on how this was to be managed. A different resident had a range of topical applications in their room, their care plan did not specify all the applications in their room or which application was to be applied to which part of their body. It was clear that some issues relating to the topical applications had been referred back to the resident’s doctor but the care plan reflected neither the resident’s current needs, as stated in the letter from the home to their doctor, nor the regime as described in a response letter from the resident’s doctor. Another resident had a prescribed topical application in their room but there was no care plan relating to this treatment. Some care plans were completed using generalistic wording. For example, one resident’s care plan documented that they needed “all assistance” for personal care. This did not reflect what the resident or carer reported. Both reported that the resident was able to wash a few areas of their body and to assist a Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 15 carer in some parts of dressing themselves. One resident had an ostomy, the presence of this ostomy was documented and the carer knew about it, but there was no assessment or care plan in relation to the ostomy or actions to be taken to ensure the resident’s needs were met. One resident had sustained a skin tear. Full documentation relating to the skin tear was in place and an appropriate dressing had been applied, this was in accordance with their care plan. One resident’s records showed that they had complex leg ulcers. Their records documented the treatments and progress of the wound, including when the leg ulcers were healed. Another resident was noted to have a wound. It was noted as good practice that a pain assessment chart was in place to inform staff of when the wound was painful and actions needed to reduce pain. The care plan documented the treatments to be given and dressings to be used, but there were no measurements or photographs of the wound, so it was not possible to assess the wound’s progress and response to treatment. One resident’s medicines records indicated that they were a diabetic, but they did not have a care plan in place to direct staff on how their diabetic condition was to be monitored and actions to be taken to reduce the risk of this condition to the person. Another service user did have a care plan in relation to their diabetes, but the wording of the care plan was generalistic and did not state the safe parameters for blood sugar levels, or actions to be taken if the resident’s blood sugar levels fell outside these parameters. One resident who was a diabetic had a care plan, which fully detailed how their condition was to be managed, with clear and measurable wording. Residents’ records indicated that the home promptly requests home visits by the residents’ GPs when this is indicated. None of the GPs contacted raised any concerns about the home’s management of their patients. One resident had a suction apparatus in their room. There was no indication in their records as to whether this apparatus was needed, what it was needed for or actions to be taken by staff to support the resident. One resident had specific instructions made about their treatment from a physiotherapist, this had not been put into a care plan to direct staff on exercises to be performed by them, so it was not clear from records if the physiotherapist’s instructions were being carried out. The home has one clinical room for the storage of drugs and appliances and medicines trolleys for different areas of the home, which were all fully secured. There was a clear audit trail of medicines received into the home, administered to residents and disposed of from the home. Where medicines instructions had been changed, they were signed and countersigned by a second person. Where a resident was prescribed Warfarin, the home ensured that blood tests took place in accordance with medical instructions and that the resident received changed doses in accordance with their doctor’s instructions. Where a resident wished to self-medicate, a risk assessment was completed. This was regularly reviewed. All drugs requiring cold storage were correctly stored and Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 16 the medicines refrigerator temperature checked. All Controlled Drugs were correctly stored and full records maintained. All limited life medicines had their date of opening documented so that they would not be used after the expiry date. All clinical items such as catheters, syringes and dressings were within their “use by” date. The acting manager and her registered nursing staff are to be congratulated for improving the systems for safe administration of medicines from the previous inspection and random inspection. Several residents were prescribed drugs which might affect their daily lives, such as aperients, pain-killers or mood altering drugs. Some residents had care plans about such drugs but others did not. One resident was prescribed daily bladder washouts via their catheter. This procedure has the potential to be uncomfortable for the resident but there was no documentary evidence to state why this had been considered to be necessary. There should always be a care plan when drugs are prescribed, so that staff can assess the effectiveness of the drug for the resident and be able to inform medical staff appropriately. All care was provided behind closed doors. Carers were observed to knock and await a reply prior to entering a resident’s room. Carers were heard to call residents by their own names and not use general terms of endearment when addressing them. All frail persons who were cared for in bed looked comfortable, with clean mouths, eyes and spectacles. It was observed that carers consistently used screens in double rooms when caring for residents. One carer who moved screens round one resident was observed to carefully check, after she had done so, that the other resident would not be able to see past the screens. She did this in such a manner to indicate that she always did this. Despite many of the residents experiencing incontinence, including double incontinence, no odours were observed in any area of the home. Three carers spoken with reported that they had ready supplies of wipes and other aids to ensure that residents could be appropriately washed when needed. They also reported that the systems for use of flannels had improved, with flannels being laundered daily, not weekly as previously. However some persons contacted felt that improvements were needed, one reported “health care assistants need educating or re-educating in treating residents as individuals who require their dignity and autonomy. There is poor attention to detail.” Another person commented that urine bottles were not promptly moved after use and that on one occasion, tea had been put on a bedside table and placed next to a used urine bottle. Another person reported “They listen but nothing ever gets done”. This may relate to recent staff changes and a need for increased staff supervision – please see standard 36 below. Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality on this outcome area is good. This judgement has been made from evidence gathered both during and before the visits to the service. A range of activities are provided in the home. Assessments of social care needs are in place. Residents are enabled to maintain contact with their family and friends. Residents choose how to spend their days. Residents are offered a well balanced diet and can chose where they eat. EVIDENCE: The home employs two activities coordinators. An art class session and a group supporting residents who were preparing for Halloween were observed during the site visits. The activities coordinator worked with the residents, supporting them and involving them in the activities. Several of the residents were clearly enjoying themselves. Of the 10 persons who responded to this part of the pre-inspection questionnaire, five responded there were always activities arranged which they could take part in, two said usually and three sometimes. One person reported that “This area is good” another reported “There is a wide range of activities available. I enjoy those I can take part in e.g. concerts” and another reported that they particularly enjoyed the flower arranging. The activities coordinator was highly enthusiastic in her role. She reported that the owner was happy to fund training and equipment. She Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 18 clearly knew all of the residents individually and was keen to develop activities to suit individual needs. The activities coordinator performs an assessment of residents’ social care needs and then develops this assessment as they learn more about the resident. Two senior carers spoken with showed a detailed personal knowledge of what their key residents had done in the past and what they liked to do now. The activities coordinator’s information is held in their office and is not generally available and it would be advisable for this information to be available to all staff, so that they can use it when caring for residents, to ensure that all persons are aware of the diverse social needs of different residents. The activities coordinator maintains records of which residents have been involved in which activities. Care plans relating to activities were not in place. The acting manager reported that these will be developed when the new care planning documentation is introduced. Residents spoken with said that their relatives could visit when they liked. This was supported by relatives. One resident said that they continued to go out of the home regularly for the day with their relative. The home also provides outings and one resident said that they were very pleased with the outings offered. Residents spoken with reported that it was up to them as to how they spent their day. One resident said “Sometimes I go down for meals, sometimes not, it depends on how I feel.” As Hays House is an older building, many of the rooms are different from each other and some residents had brought in a range of their own possessions, to reflect their individual likes and preferences. One relative had taken an active decision for their relative to share a room, reporting that it gave both persons company and that the companionship was good for both of them. As would be anticipated in a large establishment, there were a range of opinions expressed about the meals. Four people who responded to the questionnaire stated that they always liked the meals, five said they usually did and three said that they sometimes did. One persons said “The cooking is very good” and another said “Good choice on the menu”. Two people commented on a lack of fresh vegetables and one said that the food was not always hot, due to the distance of their room from the kitchen. One resident knew the chef by her name and reported that they often discussed meals with her. The chef reported that she frequently reviews menus and changes them according to the time of the year. She reported that roasts were popular, so she tries to provide at least two a week in colder months. All food is cooked up from raw ingredients and the chef makes her own soup. A choice of three alternatives is provided for lunch. The chef showed a good understanding of special diets and knew who to approach for further advice if needed. The inspector observed that there was plentiful and regular use of fresh vegetables in the menu. Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 19 Care practice during lunchtime was observed. Some residents ate their lunch in the dining room, which is an attractive, light area. Staff, including the registered nurses, were available to support residents. Other staff supported residents with meals in their rooms. Many of the frail residents needed to be fed their meals. Staff were observed to sit with such residents, supporting and encouraging them. Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality on this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visits to the service. Hays House does have a complaints procedure, which works in practice. Residents are largely protected from abuse by the home’s policies, however, as the home cannot evidence that it is not using restraint for some residents, there is the potential for risk to residents. EVIDENCE: Five of the persons who completed the questionnaire reported that they always knew how to make a complaint and five reported that they usually did so. Nine persons said that they always knew who to speak to if they were not happy and two said that they usually did. One person said “If I’m not happy, I talk to the staff and they do listen” another said “I tell Matron if I’m not happy – she’s all right” and another said that if they had a problem, they made a complaint “At the top of my voice”. A range of complaints had been received by the CSCI prior to this inspection. They related to different areas and were all made by persons who wished to remain anonymous. Where the matters could be reported to the home, without breaching the persons’ wish for anonymity, they were referred to the home for investigation. In these cases, the home has performed investigations of the matter and have responded to the CSCI. Where the matter would breach the person’s desire for confidentiality, they have been investigated during this inspection. Where matters have been noted which breach Regulations, they are referred to in the report. Many of the concerns Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 21 raised related to the change of managers and changes in staff following this, as well as specific practice issues. The acting manager is aware of local vulnerable adults procedures and has contacted relevant persons as needed under the procedure. One issue was identified, which was referred back to the home for investigation. A full investigation took place and relevant actions instigated to protect a resident. Another allegation necessitated a random visit to the home. The allegation was found not to be substantiated. At the time of the inspection, a multiagency vulnerable adults investigation was taking place. Hays House were fully cooperating with this investigation and no actions to ensure resident safety were indicated by the multi-agency team. All staff have been trained in abuse awareness and staff spoken with showed an understanding of their roles in protecting vulnerable persons. Several of the residents had safety rails in place on their beds. Although a brief mention was made for the use of safety rails in some persons’ assessments, none of the residents whose records were considered in detail had full assessments for safety rails, so it was not possible to assess why the rails had been put on their beds. This needs to take place, to ensure that such rails are not being used as a restraint and are only being used where an assessment shows that this is the most appropriate means of ensuring a resident’s safety. One resident’s safety rails were too short for their bed. The acting manager reported that they had identified this as an issue and would be introducing appropriate documentation when they introduced the revised care planning system. Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22 & 26 Quality on this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visits to the service. Hays House is a well maintained, attractive environment, which provides a range of different rooms for residents. Frail residents could be put at risk by inadequate provision of equipment suitable for their needs. Cleanliness in the home is high and residents are protected by the home’s systems to prevent spread of infection. EVIDENCE: Hays House is a large country house, which has been extended on the ground floor to the rear. Accommodation is over four floors. A new passenger lift has recently been installed, this serves all of the floors. One of the rooms is accessed by a short flight of steps, it was vacant at the time of the inspection. Another room’s en-suite is accessed by a short flight of steps, this room also was vacant at the time of the inspection. Many of the rooms in the older building are large and well exceed minimum standards. Some rooms have ensuite facilities and some do not. The home was registered prior to the Care Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 23 Standards Act 2000 and there are some double rooms. All double rooms are provided with screening. The rooms in the new extension at the back of the building are all single and have en-suite facilities. There are a range of different sitting rooms and one large dining room. The gardens are extensive and many persons expressed their appreciation of them. One person said “they’ve got such beautiful gardens”. The owner works to improve the home environment. New carpets had been laid in the corridors during September and the owner was currently developing plans further for the assisted bathing facilities and laundry. Additional hoists to support residents with manual handling needs had been provided to staff. All of the home appeared to be well maintained. The home does not currently employ a full-time maintenance person. Day to-day maintenance is provided by the maintenance man from the sister home, which is about 20 minutes drive away. This is clearly not ideal and a maintenance person with sole responsibility for each home is indicated, so that small repairs can be dealt with promptly. As documented at the previous inspection, not all residents who have complex manual handling needs are nursed in adjustable height beds. Residents who need to be moved using a hoist, or who need to be moved up or down a bed using an aid such as a slide sheet, need to be cared for in an adjustable bed, so that staff can adjust the height of the bed to ensure that they can safely perform manual handling procedures without risk to the resident or themselves. Additionally, where frail residents need to be fed, the person feeding them needs to be able to adjust the height of the bed to the correct level so that they can feed the person at the correct angle, to prevent risk of choking. At the previous inspection, the previous manager was required to perform an audit of residents’ manual handling needs and detail when residents who have complex needs will be provided with such a bed. At this inspection, at least six persons who spent all or most of their time in bed, who were unable to move themselves without assistance and some of whom needed to be fed, were cared for in low divan beds, so there did not yet appear to be evidence that sufficient action had been taken to meet such frail residents’ needs. The acting manager reported on the second site visit that she had assessed the situation and would be ordering two height-adjustable beds per month. As documented at the previous inspection, where equipment is in use, which is not in accordance with the resident’s assessed degree of risk, the clinical reason for use of such equipment must be documented. This related to the use of medium specification pressure relieving equipment for residents who were assessed as being at high risk of pressure damage, and equipment which provides comfort only, not pressure relief, being used for some persons who are assessed as being at risk of pressure damage. This requirement had not been met at this inspection, in that at least four persons who were at risk of pressure damage had mattresses provided which provided comfort, not Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 24 pressure relief. One of these persons had sustained pressure damage while in the home. None of the persons who were provided with mattresses for persons with high risk of pressure damage had chair cushions to the same specification, although at least two of them sat out during the day. Risk of pressure damage does not reduce when sitting out in a chair. The dial of the motor to an electrically operated mattress did not relate to the weight of the person for whom it was provided; when this is the case, such mattresses can increase risks of pressure damage. One resident who had an electrically operated mattress had a Kylie sheet on their mattress. Manufacturers’ instructions state that the use of Kylie sheets with electrically operated mattresses reduces their effect and can increase risks of pressure damage. In order to prevent risk of pressure damage, residents must be provided with the equipment which meets their needs and which is functioning and used properly. If this is not indicated for any reason, this must be documented. The acting manager reported that they had assessed the situation and would be ordering two pressure-relieving mattresses a month and providing them to residents on a priority basis. As an older building, Hays House has thick walls; whilst there is a call bell system, there is no system, such as found in other similar buildings, for staff to communicate directly with each other. This was identified at the previous inspection. There are no mobile hand sets, so the registered nurse on duty has to answer the phone as well as performing her role. This can be complex when there is only one registered nurse on duty, for example in the evenings or at night when the medicines round is being performed, as she will have to stop performing the medicines round to attend to the phone. There is a large body of research which indicates that when a person is interrupted while doing a drugs round, this can increase risks of error in medicines administration. So many of the residents need two persons to attend to them but, as there is no effective communication system between staff, getting a second person to assist is not prompt. The home needs to consider modernising its staff communication systems before problems in nursing and care provision arise. The home was clean throughout, in what must be a complex building to keep clean. One person described the home as “very clean and friendly.” Two of the cleaning staff reported that they had sufficient equipment and chemicals to do their roles properly. Both were observed to perform their roles with care. Clinical waste was appropriately disposed of. Full sterile technique is now used for all complex wound dressings. The laundry is on the ground floor. The laundress has worked in the home for many years and has a clear understanding of the principals of infection control. The laundry itself is beginning to need up-grading, some of the flooring is lifting, some of the window sills are peeling, the laundress does not have a hand wash basin, and some of the machine plinths show staining. To prevent risks of cross infection, all surfaces in a laundry need to be wipable. The acting Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 25 manager reported that she and the owner are currently developing plans for a full up-grade and modernisation of the laundry. Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality on this outcome area is good. This judgement has been made from evidence gathered both during and before the visits to the service. Hays House has undergone recent changes in staffing but the numbers and skill mix of staff continue to meet residents’ needs. Training is supported and all staff have recently been up-dated in a range of areas. Residents are now protected by the home’s safe recruitment system. EVIDENCE: Staffing at Hays House has undergone several changes since the previous inspection. At the previous inspection, high levels of agency staff were being used. The new acting manager has successfully recruited to vacant posts, some of these new employees being persons who used to work in the home and have now decided to return to employment there. At the same time, there has also been a considerable staff turnover, particularly amongst registered nurses. Some staff have remained with the home. During the inspection, the inspector met with one registered nurse and two carers who have worked in the home for a long period of time. The activities coordinators, laundress, catering staff and many of the cleaning staff have also remained with the home. As would be anticipated with such a turnover of staff, the perceptions from some residents and their supporters is that the home has become short of staff, one said “The staff are very good but do not have time to give [the resident] the support he needs” another reported “staff are always so busy” and another [my relative] “is left alone too much”. However some persons could see improvements, one reported “Care and support are improving now”. Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 27 Other persons did not report any issues with staffing, one said “Staff come practically instantly when I ring my bell” and “Everyone looks after me very well” Following the changes in staffing, there is clearly a need for consolidation and team building, which the acting manager reports she is keen to develop. Two registered nurses, three senior care assistants and a junior care assistant were highly motivated and keen to improve and develop systems in the home. Ancillary staff were equally motivated. The owner of the home is keen to support staff training and the acting manager reported that all staff training was funded, including time off. She reported that she had assessed training needs since taking over an acting role. She had identified a range of training needs and had concentrated on ensuring that all staff had received regular up-dates in mandatory areas, for example registered nurses had recently received first aid training. The inspectors’ concerns relating to prevention of pressure damage were discussed with the manager and she was advised that all staff needed up-dating of their skills in this area. The files of three recently employed persons were reviewed, all checks had taken place, including police checks, proof of identity, two references and health checks. All staff had been issued with a job description. When staff were employed from abroad, copies of relevant works permits were held on file. Only one of the three files examined showed evidence of an interview assessment questionnaire; such documentation is indicated so that a prospective employee’s strengths and weaknesses can be identified when they commence employment. Files of previously employed persons were examined; under the previous manager, relevant pre-employment checks had not been undertaken for all staff. Where this was the case, the acting manager had taken appropriate steps to ensure that residents are now protected. Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35, 36, 38 Quality on this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visits to the service. The residents could be at risk as there is not currently a registered manager in post and the acting manager is performing more than one role. Residents’ financial interests are safeguarded. Systems need to be further developed to ensure that staff are supervised. There are effective procedures to ensure the health and safety of residents and staff. EVIDENCE: The previous manager left her employment in the spring of this year. The owner put in an acting arrangement, with the registered manager of another of his homes acting into the role, supported by her deputy. Unfortunately the home were unsuccessful when seeking to recruit a new manager. The owner and acting manager have met with the CSCI to discuss the situation and are now in a position to put forward proposals for the future management of the Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 29 home. This is needed because, while the current manager is experienced in her role, she is divided in her responsibilities and the home needs one person to improve and develop care practice, in order to support residents. The acting manager has commenced setting up systems for quality audit. Given she will not be the permanent manager and has not been acting into her role for a significant period of time, this standard will need to be reviewed once all systems are fully operational. During this inspection, there were some concerns raised about the supervision of staff (see also standard 10 above, p.17). One relative reported “recently [my relative] was left in bed, staff said they couldn’t get [my relative] up as they didn’t have any clothes, but there was plenty in their wardrobe and drawers.” A different relative raised concerns about manual handling practice. They reported that they knew that their relative needed a hoist but that “I have seen staff not using the hoist and just lifting [my relative] up and sliding [my relative] over on the bed”. Ancillary staff also need support in their roles. As they have resident contact, it would assist them if they could be informed routinely of any person who has infection or anyone who is suddenly unwell or who is dying, so that they can be aware and act correctly in accordance with the circumstances. The previous manger had a system for supervision and appraisal. The current manager was not sure how effective this had been in practice and is planning to introduce a revised system, commencing with a revised appraisal process. This is indicated given the issues identified above relating to supervision of staff. The acting manager has introduced an induction programme, which complies with current guidelines. The files of three recent employees showed that these had been completed individually. The acting manager reported that staff work supernumerary for varying periods when they start, according to their individual previous experience and needs. The new administrator came into post recently and is still learning her role. She showed an awareness of her responsibilities and had already established clear systems for documenting residents’ finances. No moneys are held on behalf of residents and all finances are dealt with by a monthly invoicing system. Records seen were clear and maintained in full. It was noted during the inspection that a range of hoists were provided to assist manual handling. The acting manager reported that since she took over management of the home, she had purchased additional hoists to support residents and staff. Staff were observed on two occasions to use hoists to move residents, they performed their role carefully, telling the resident at every stage what they were doing. Staff complied with safe practice for prevention of spread of infection. There are established systems for ensuring fire safety. All equipment and systems in the home were regularly maintained, including the boilers and hoists. Water systems are complaint with health and Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 30 safety guidelines and regular checks are made on the water temperatures. Accidents to all persons are fully documented and analysed monthly. Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 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 2 3 3 X 1 X X X 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 2 x x x 3 2 x 3 Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1)(d) Requirement Timescale for action 30/11/06 2. OP7 13(4)(c) 3. OP7 13(4)(c) The registered person shall not provide accommodation to a service user unless they have confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service user’s needs in respect of his health and welfare:Service users must not be admitted, until the home has confirmed that they can meet their needs in writing and can evidence that all the equipment necessary to meet their needs is in place. The registered person shall 30/11/06 ensure that unnecessary risks to the health or safety of service users are identified:All service users must have full risk assessments drawn up relating to all of their care needs. The registered person shall 31/01/07 ensure that unnecessary risks to the health or safety of service users are so far as possible eliminated:Where a service user has a risk DS0000015916.V313751.R01.S.doc Version 5.2 Hays House Page 33 4. OP7 13(4)(c) 5. OP7 15(1) identified, a full and detailed care plan must always be put in place to direct staff on how the risk is to be reduced. (This requirement was identified at the inspection of 10/11/05, it has not been addressed in full. The timescale for action in that inspection report was 30/11/05. Due to the management and staffing changes in the home, more time has been given to address the requirement in full on this occasion only). The registered person shall 31/01/07 ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated:Where equipment is in use which is not in accordance with the service users assessed degree of risk, the clinical indicator(s) for this different equipment must always be documented. (This requirement was identified at the inspection of 10/11/05, it has not been addressed in full. The timescale for action in that inspection report was 30/11/05. Due to the management and staffing changes in the home, more time has been given to address the requirement in full on this occasion only). The registered person shall 28/02/07 prepare a written plan (the service users plan) as to how the service users needs in respect of his health and welfare are to be met:All service users must have full and detailed care plans in place, which relate to all their care needs, these to include skin care, care of ostomies, diabetes, instructions about treatments from professionals such as the DS0000015916.V313751.R01.S.doc Version 5.2 Page 34 Hays House 6. OP8 17(1)S(3) (k) 7. OP18 13(7) physiotherapist, use of suction apparatus or bladder washouts for urinary catheters as well as nursing and care needs. The registered person shall 30/11/06 maintain in respect of each service user a record which includes the information, documents and other records specified in Schedule 3 relating to the service user: A record of any nursing provided to the service user, including a record of his condition and any treatment: All frail persons who are not able to move their position or give themselves fluids must have a written monitoring system in place, so that staff can ensure that the service user receives the care that they need. Records must be in place to show that service users who need frequent care are receiving this care. (This requirement was identified at the inspection of 10/11/05, a further requirement was made at the inspection of 21/01/06 as parts of the requirement had been addressed, the timescale for action in that inspection report was extended to 28/02/06. Due to the management and staffing changes in the home, more time has been given to address the requirement in full on this occasion only). The registered person shall 31/01/07 ensure that no service user is subject to physical restraint unless restraint of the kind employed is the only practicable means of securing the welfare of that service user:Where residents have equipment in use such as safety rails, which DS0000015916.V313751.R01.S.doc Version 5.2 Page 35 Hays House 8. OP22 13(4)(c) 9. OP22 13(4)(c) 10. OP31 8(1)(a)(b) (i) are considered to be a restraint, an assessment of the need for this equipment must always be made. Assessments must be regularly reviewed. Equipment used must be suitable for use with other equipment. The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated:All service users who have manual handling needs or need to be fed in bed must be cared for on an adjustable height bed. (A similar requirement was identified at the previous inspection of 10/11/05, with a timescale of 28/02/05. Due to changes in management of the home, they have been given more time to address the requirement only). The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated:Where a service user is assessed as needing equipment to prevent risk, this must always be provided. Equipment must be fit for purpose and correctly used in accordance with manufacturers’ instructions. Suitable stocks must be maintained for any time when equipment needs to be taken out of use, so that the service user is not put at risk The registered provider shall appoint an individual to manage the care home where there is no registered manager in respect of the care home and the registered provider is an organisation or partnership:An appropriate manager must be DS0000015916.V313751.R01.S.doc 31/03/07 28/02/07 30/11/06 Hays House Version 5.2 Page 36 11. OP36 18(2) appointed to the home. The registered person shall ensure that persons working at the care home are appropriately supervised:The manger must ensure that all staff are supervised in their role. A system for documentation of appraisals and supervisions must be put in place. 31/03/07 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 OP7 Good Practice Recommendations Where an elderly person needs their position changing to prevent tissue damage, their care plan should state how often their position needs to be changed. Imprecise words such as “regularly” should be avoided. The wording of care plans should be precise and measurable. The use of words like “assistance” should be avoided and the actual assistance needed should be documented. Where a service user’s fluid intake is being recorded, the amount of fluids taken in every 24 hours should be totalled, so that staff can review the adequacy of the fluid intake over 24 hours. Where a service user is having their dietary intake measured, documentation should state what they have eaten, not “lunch” or “supper”, so that staff can assess that the service user has had an adequate diet. Where a service user has a wound, there should be systems in place to ensure that the wound is regularly measured or photographed, so that the effectiveness of the treatments used can be assessed. Care plans should state how often this assessment is indicated. Where a service user has a diabetic condition, their care plan should state in a measurable form what blood sugar levels are within acceptable parameters, and actions to be taken if the blood sugar levels fall outside these. DS0000015916.V313751.R01.S.doc Version 5.2 Page 37 2. OP7 3. OP8 4. OP8 5. OP8 6. OP8 Hays House 7. OP9 8. 9. 10. OP12 OP19 OP22 11. 12. OP29 OP30 Where a service user is prescribed medication which can affect their daily living, such as aperients, pain killers or mood altering drugs, a care plan should be in place so that staff can monitor the effectiveness of the treatment regimes. All staff should have access to information on service users’ past lives and preferences for activities, and be able to up-date them with information when relevant. A permanent maintenance man should be employed. A system should be put in place to enable staff to communicate with each other across the home and to answer the telephone and front door. (This was recommended at the previous inspection, it has not been addressed). An interview assessment tool should be used for all staff. All staff should be trained in prevention of pressure damage. Hays House DS0000015916.V313751.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 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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