CARE HOMES FOR OLDER PEOPLE
Huyton Hey Manor Residential Care Home Huyton Hey Road Huyton Knowsley Merseyside L36 5RZ Lead Inspector
Mr Paul Kenyon Unannounced Inspection 12th December 2005 11:30 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 Huyton Hey Manor Residential Care Home DS0000021478.V271280.R01.S.doc Version 5.0 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. Huyton Hey Manor Residential Care Home DS0000021478.V271280.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Huyton Hey Manor Residential Care Home Address Huyton Hey Road Huyton Knowsley Merseyside L36 5RZ 0151-489-3636 0151 426 6415 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) Cranford Care Homes Limited Miss Angharad Lloyd Williams Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability over 65 years of age of places (30) Huyton Hey Manor Residential Care Home DS0000021478.V271280.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users to include up to 30 OP and 30 PD(E) The service should employ a suitably qualified and experienced manager who is registered with the CSCI 20th May 2005 Date of last inspection Brief Description of the Service: Huyton Hey Manor is a care home registered to provide placements for 30 persons of the category old age. The home is situated in pleasant grounds in a residential area close to local amenities and Huyton Village centre. Accommodation is provided on three floors and there is a passenger lift to all levels. The home has a variety of aids and adaptations in place around the home to assist residents with mobility. Twenty-four of the bedrooms are single, three are double and none of the bedrooms have en suite facility. There are two communal toilets to the ground floor plus two bathrooms and toilet combined. There are two communal toilets to the first floor plus one shower and toilet combined and two communal toilets and one bathroom to the second floor. Huyton Hey Manor Residential Care Home DS0000021478.V271280.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second inspection to be held this inspection year (April 2005 to March 2006). The inspection was unannounced and a number of the National Minimum Standards were used to assess the quality of care provided to residents. The visit lasted four hours and took place during the late morning and early afternoon. The Manager and Assistant Manager were present during the inspection. The inspection included detailed discussions with three residents with briefer comments being provided by a further three individuals. Their comments are included within this report. In addition to conversations with residents, a tour of the building was undertaken as well as an examination of a number of records. What the service does well:
The service is good at obtaining assessment information prior to a resident coming to live within Huyton Hey Manor and reinforces this by performing its own assessment. The service is good at identifying the health needs of residents through the assessments process, including them within care plans and facilitating visits to medical agencies. The service is good at providing a safe system of medication taking the security of medication into account, the storage, administration recording, receipt and disposal into account. The service provides food that residents are satisfied with. This was gained through comments residents made during the inspection and provide residents with the opportunity to influence the menus provided. The service is good at providing residents and their families with the information needed to make a complaint as well as outlining the role of the Commission for Social Care Inspection. The service is good at providing a clean and home-like environment. The home is free of odour and well decorated. Huyton Hey Manor Residential Care Home DS0000021478.V271280.R01.S.doc Version 5.0 Page 6 The service is good at providing staffing levels, which met the needs of residents and are directly linked to their levels of dependency. In turn the service uses a recruitment procedure that protects residents. Comments made by residents during the inspection included: ‘I can’t fault it’ ‘Without these people I would have given up living years ago’ ‘I have my health needs met’ ‘I am free to go out and shop in the local towns such as Huyton or Whiston’ ‘I have no complaints whatsoever’ ‘The food is good and I get a choice’ ‘I couldn’t wish for nicer people’ ‘I have settled in’ ‘It is very nice’ ‘I could not understand why anyone would complain about this place’ ‘I am happy with my room and I can get to it with no problem’ ‘I could not wish for better treatment’ ‘Staff always explain to me what tablets they are giving me’ ‘They are marvellous’ ‘You would not get finer than here’ What has improved since the last inspection? What they could do better:
The service should provide a care planning system that is in a consistent format. Work has been started to change this format to a more detailed document and the need to provide consistency has been highlighted as a good practice recommendation in this report.
Huyton Hey Manor Residential Care Home DS0000021478.V271280.R01.S.doc Version 5.0 Page 7 Some care plans have not been signed while others have. The service must be more consistent in gaining the agreement of residents or their families in respect of the contents of their care plans. In addition to this, some care plans are reviewed at least on a monthly basis while others are not. Again the service must be more consistent in its review of care plans. These have been raised as requirements in this report. The service still needs to provide information to the staff team on the action they can take if they have concerns about the standard of care provided by the home. This should take the form of a procedure for alerting the Manager or for alerting the Commission for Social Care Inspection for an independent investigation. The service must ensure that all call alarm calls are accessible to residents in order to alert staff that they need assistance. The service needs to ensure that copies of reports following visits made by the registered person are made available to the Manager and the Commission for Social Care Inspection so that quality assurance can be reinforced further. The service must ensure that tests to fire alarm systems and emergency lighting are recorded and performed to the required frequency. 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. Huyton Hey Manor Residential Care Home DS0000021478.V271280.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Huyton Hey Manor Residential Care Home DS0000021478.V271280.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable to the service at present. Residents benefit from having their needs assessed before they enter the service. EVIDENCE: The assessments of two individuals who had been admitted into the service since the last inspection were examined. In both cases, assessments from the Funding Authorities were available and had been obtained prior to the person coming to live within the home. In addition to this, the home conducts its own assessment. This assessment includes the social and health needs of residents as well as the level of personal care needed to assist that person. Needs identified on these assessments could be readily linked to the subsequent care plan. Huyton Hey Manor Residential Care Home DS0000021478.V271280.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 and 9 Residents do not benefit from a consistent system of care planning. Residents have their health needs identified and acted upon. The service provides a safe system of medication. EVIDENCE: A new system of care planning has been introduced. This change to the new format is ongoing and it is recommended in this report that a deadline of January 2006 is set for the completion of this process. The new care plans include a detailed statement of residents’ needs in relation to their health, social and personal care needs. Information on sampled care plans was directly linked to the original assessments in place. A total of seven care plans were examined. Some care plans have been signed by the resident confirming their agreement with the contents of the plan and others have not. It is required that all residents or their relatives have the opportunity to do this. In addition to this, not all care plans were reviewed on a monthly basis. This is also raised as a requirement in this report. All residents had a care plan presented in either format.
Huyton Hey Manor Residential Care Home DS0000021478.V271280.R01.S.doc Version 5.0 Page 11 The health needs of residents have been included within care plans. These include a running commentary of doctors’ appointments and visits by other medical agencies. In addition to this, weight monitoring and reference to continence is also included within these documents. Medication is stored in a portable, locked trolley which is turn is stored in a locked room when not in use. The room was noted to be locked at all times. In addition to this, controlled medication that has been prescribed is locked within a cupboard and is subject to separate medication records. These records evidenced that all administration of controlled medications had been signed and countersigned by staff. No residents self-administer at present and reasons for the reliance on staff to deal with medications are included within care plans. All records were noted to be appropriately signed. A refrigerator for the storage of items such as eye drops is also available. All medication records noted that when medications are received, signatures are recorded as well as the amount of medication received. A disposal record has commenced. This lists those medications to be returned to the Pharmacist and includes a signature from the pharmacist’s representative to confirm that these have been returned. A monitored dosage system is currently in use. Huyton Hey Manor Residential Care Home DS0000021478.V271280.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 Residents are satisfied with the standard of food provided by the home. EVIDENCE: Evidence for this standard rested on the comments made by residents as well as evidence from recent resident meetings minutes. It was clear that in the last two recent residents’ meetings that all individuals present had been consulted and had been asked for their views on the food provided. The minutes suggested that minor alterations to the menu had been suggested. Comments by residents relating to the food provided included: ‘The food is very nice’ ‘I can’t eat a lot but what I get is sufficient’ ‘I need supplements to my diet and I get these’ ‘Food is very good’ ‘I can’t fault the food’ ‘We get a choice’ ‘We have a breakfast that makes sure we get a good start to the day’ The inspection coincided with lunchtime. A large dining room is available with a serving hatch leading from the adjacent kitchen. This ensures that meals can be served as promptly as possible after being prepared.
Huyton Hey Manor Residential Care Home DS0000021478.V271280.R01.S.doc Version 5.0 Page 13 Huyton Hey Manor Residential Care Home DS0000021478.V271280.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Residents access to a clear complaints procedure and feel confident that their views would be listened to. Residents are not fully protected by the service’s policies and procedures in relation to abuse. EVIDENCE: A copy of the complaints procedure has been included in all bedrooms. Residents have had the presence of this procedure reinforced to them through residents meetings and this was evidenced through examination of the minutes of these meetings. The complaints procedure outlines the procedure for making a complaint, the timescale for investigation as well as the contact details for the regulator. The procedure does make reference to the National Care Standards Commission, the previous registration authority, as opposed to the Commission for Social Care Inspection, the current one. The telephone details are, however, correct and it is recommended that the name of the registering authority be altered when the procedure is next reviewed. The home has a system for recording complaints but has not received any since the last inspection. No complaints have been received by the Commission for Social Care Inspection. The Manager is aware of the procedure for the protection of vulnerable adults having a copy of this for staff reference in the main office. In addition to this, the home is aware of the process of making referrals to the Local Authority having dealt with an allegation in September 2005. A training video on abuse awareness has been recently obtained and will be shown to staff in due course.
Huyton Hey Manor Residential Care Home DS0000021478.V271280.R01.S.doc Version 5.0 Page 15 The service does not have a whistle-blowing procedure. This enables concerns that staff members have to contact the Manager to express any concerns they may have about any care practice they may witness. In addition to this, the absence of this procedure means that staff do not have information available to them outlining the role of the Commission for Social Care Inspection if any concerns are raised. This is raised as a requirement in this report. Huyton Hey Manor Residential Care Home DS0000021478.V271280.R01.S.doc Version 5.0 Page 16 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): 19,22 and 25 Residents live in a well-maintained and home-like environment. Call alarm systems are not consistently accessible to residents. The risk posed by hot water in areas used by residents should be reinforced and this is recommended in this report. EVIDENCE: A tour of the premises noted it to be well decorated, clean and free of offensive odour. The inspection coincided with the run up to the Christmas period and the home and festive decorations had been put in place. Residents are able to mobilise throughout the building independently or with some assistance from staff. A passenger lift provides access s to upper floors. The grounds of the home are accessible to residents. No CCTV cameras are in use at present. The same tour of the premises noted that a call alarm system is in operation. This was used on a regular basis throughout the visit enabling staff to attend to the needs of residents. In some bathroom and toilet areas, the cords had been tied up and were not available to residents who may use these areas. This is raised as a requirement in this report.
Huyton Hey Manor Residential Care Home DS0000021478.V271280.R01.S.doc Version 5.0 Page 17 A central regulation valve controls the water temperatures in the home. Water temperatures are still checked on a regular basis and records confirmed this. As a good practice recommendation, signs indicating that hot water presents a danger to residents should be included on all hand wash basins used by them as failsafe measure in case temperature exceed safe limits. Huyton Hey Manor Residential Care Home DS0000021478.V271280.R01.S.doc Version 5.0 Page 18 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 and 29 Staffing levels within the home supports the needs of residents. Recruitment procedures protect residents. A recommendation is made in respect of identifying the designation of staff on the staff rota. EVIDENCE: A duty rota is available outlining staff on duty at any week. Staffing levels on the day of the inspection included: 1x 1x 3x 1x 1x 1x Manager Deputy Manager Care Assistants Cook Domestic staff Maintenance staff This level of staffing meets the staffing notice issued by a previous regulator. The Manager reviews staffing levels periodically and uses a staffing formula devised by the Department of Health to do this. The dependency of each resident has been identified and staffing levels can change as dependency levels increase yet there is no reduction in staff from the four staff identified during the day and the three staff available at night. Minutes of staff meetings noted that staff are consulted about their workload and the dependency of residents. The Manager intends to become supernumerary to the staffing numbers in the near future to enable her to concentrate on administrative
Huyton Hey Manor Residential Care Home DS0000021478.V271280.R01.S.doc Version 5.0 Page 19 issues such as the changeover of information to the new care planning format. The staff rota does not include the designation of staff. It is recommended that designations are included. The home has experienced a low turnover of staff since the last inspection with the result that only one care assistant has been recruited of late. This file was examined and was found to contain two references, proof of the person’s identity, a record of their interview, a complete application form outlining the person’s experience and an application form for a police clearance check. Huyton Hey Manor Residential Care Home DS0000021478.V271280.R01.S.doc Version 5.0 Page 20 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): 33 and 38 The home does not fully assess the quality of care it provides to residents. Health and safety systems do not fully protect residents or staff. EVIDENCE: Resident’s meetings have been set up and two have occurred since the last inspection. Matters discussed in this included the general level of care offered to them, the standard of the food, forthcoming activities and the reinforcement of the complaints procedure. A newsletter has also been devised and is available throughout the building for residents to look at. The Manager and Deputy Manager were also able to arrange for residents to speak with the Inspector and to make other aware of the inspection itself. The last inspection report is also on prominent display. A regulation applied to care home states that a monthly inspection should be made by the Registered Person and that copies of outcomes be made available
Huyton Hey Manor Residential Care Home DS0000021478.V271280.R01.S.doc Version 5.0 Page 21 to the Commission for Social Care Inspection and the Manager. Reports were available to the Manager but only up to June 2005. It is required that copies of visits are made available to the Manager and the Commission for Social Care Inspection on a monthly basis so that the Manager can monitor quality within the Huyton Hey Manor. A number of records relating to health and safety were examined. Mandatory training has occurred and the Manager has obtained training aids on mandatory topics, which will be made available to the staff team. Accident records were examined and were noted to be appropriately completed. Fire records suggested that fire alarms had not been tested since October 2005 and the same was noted in the case of emergency lighting tests. It is required that when all fire detection tests take place as well checks to the emergency lighting system, that these tests are recorded to the required frequencies. Huyton Hey Manor Residential Care Home DS0000021478.V271280.R01.S.doc Version 5.0 Page 22 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X 2 X X 2 X STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X X 2 Huyton Hey Manor Residential Care Home DS0000021478.V271280.R01.S.doc Version 5.0 Page 23 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 OP7 Regulation 15 Requirement Evidence of the residents’ or their representative’s agreement with the content of care plans must be provided. Care plans must be reviewed monthly. A whistle-blowing procedure must be devised and made available to all staff. Call alarm cords must be accessible at all times. Copies of monthly inspections by the Registered Person must be made available to the Manager and the Commission for Social Care Inspection. Tests to the fire alarm and emergency lighting systems must be recorded after testing. Timescale for action 31/01/06 2 3 4 5 OP7 OP18 OP22 OP33 15 21 23 26 31/01/06 31/01/06 13/12/05 31/12/05 6 OP38 23 31/12/05 Huyton Hey Manor Residential Care Home DS0000021478.V271280.R01.S.doc Version 5.0 Page 24 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 2 Refer to Standard OP7 OP16 Good Practice Recommendations All care plans should be presented in the new format The complaints procedure should include reference to the Commission for Social Care Inspection as opposed to the National Care Standards Commission when it is next reviewed. The staff rota should include the designation of each staff member. Hot water signs should be put on display on those hand washbasins used by residents. 3 4 OP27 OP25 Huyton Hey Manor Residential Care Home DS0000021478.V271280.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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