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Inspection on 26/09/05 for Hyde Valley House

Also see our care home review for Hyde Valley House for more information

This inspection was carried out on 26th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

This was a positive inspection, feedback received was generally good and the standards of most aspects observed was high. Two requirements are made following this inspection.

What has improved since the last inspection?

Since the last inspection the home has revised and expanded the activity programmes available for its residents so as to meet their activity needs in a more person centred manner. Various works of refurbishment and redecoration have been completed throughout the home and other such works are ongoing. The home has an attractive and homely appearance, Use of the sensory room has increased since the last inspection with residents and their visitors enjoying using this room. A new Sanitisor system has been fitted in the homes laundry this to ensure protection against infection and MRSA. These new washing arrangements also protect the residents more delicate clothing from friction and high temperature damage. The requirements made at the last inspection have been met.

What the care home could do better:

The home should continue with the planned improvements to the residents activity programmes.

CARE HOMES FOR OLDER PEOPLE Hyde Valley House Hyde Valley Welwyn Garden City Hertfordshire AL7 4ND Lead Inspector Mrs Jan Sheppard Unannounced Inspection 26/09/05 10:00 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 Hyde Valley House DS0000019436.V249413.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. Hyde Valley House DS0000019436.V249413.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hyde Valley House Address Hyde Valley Welwyn Garden City Hertfordshire AL7 4ND 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) 01707 379 700 01707 379 760 hyde@quantumcare.co.uk Quantum Care Limited Elizabeth Anne Cook Care Home 46 Category(ies) of Dementia - over 65 years of age (46), Old age, registration, with number not falling within any other category (46), of places Physical disability over 65 years of age (46) Hyde Valley House DS0000019436.V249413.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th February 2005 Brief Description of the Service: Hyde Valley House is a care home providing personal care and accommodation for 46 older people, who may also have a physical disability or dementia. The home, which is run by Quantum Care, a voluntary organisation, is situated in a residential area of Welwyn Garden City, close to shops, pubs a post office and other amenities. The home provides accommodation in single rooms without en-suite facilities; these are located on two floors, which are both fully accessible by lift. The accommodation is arranged in three separate units each with their own lounge, dining room and small kitchen along with toilets and assisted bathrooms. There is a separate day care facility on the ground floor of the home. Hyde Valley has small gardens with flowerbeds patios and secluded sitting places that residents can easily access. Hyde Valley House DS0000019436.V249413.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced inspection of this inspection year and took place over one day when residents and staff were spoken with, records examined and a tour of the building undertaken. Time was also spent in the office looking at care plans staff files and other documents. Discussions were held with the manager and individually with a number of other staff members of all disciplines. The statements in this report reflect what was observed by the inspectors (2) on the day of this inspection and also from information gathered from the preinspection documentation completed by the manager and from the comments made by residents and relatives in their comment cards, which were completed earlier in the year. What the service does well: What has improved since the last inspection? Since the last inspection the home has revised and expanded the activity programmes available for its residents so as to meet their activity needs in a more person centred manner. Various works of refurbishment and redecoration have been completed throughout the home and other such works are ongoing. The home has an attractive and homely appearance, Use of the sensory room has increased since the last inspection with residents and their visitors enjoying using this room. A new Sanitisor system has been fitted in the homes laundry this to ensure protection against infection and MRSA. These new washing arrangements also protect the residents more delicate clothing from friction and high temperature damage. The requirements made at the last inspection have been met. Hyde Valley House DS0000019436.V249413.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hyde Valley House DS0000019436.V249413.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hyde Valley House DS0000019436.V249413.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4, & 5. Standard 6 is not applicable as the home does not offer Immedicate care. The information available to prospective residents and their families is comprehensive and informative enabling an informed decision about admission to be made. Recent problems with the unexpected admission of residents in the Prevention of Hospital Admission Scheme over the weekend period must be resolved so that the home can assure itself that it can fully meet the needs of all new residents. The atmosphere in the home is relaxed offering a welcoming environment to prospective service users. EVIDENCE: The home has a comprehensive pre-admission assessment procedure that is well documented. All prospective residents are visited by a manager either in their own home or other setting for a full needs assessment before being invited to visit Hyde Valley themselves. Hyde Valley House DS0000019436.V249413.R01.S.doc Version 5.0 Page 9 Care is taken to ensure that these visits are arranged so that the prospective resident is given time to meet other residents share a meal or some activities and that they are not in anyway rushed into making any decision about admission. The process of admission is also handled sensitively by the staff for the prospective residents families with sufficient information and time allowed for them to be able to assure themselves as to the suitability of the home to meet the needs of their relative. One resident and their visiting relative who spoke with the inspector confirmed that the manner in which their admission to the home was handled very carefully by the staff especially as the resident was transferring from another home which they did not like. The pre-admission information includes the Service Users Guide, a Statement of Terms and Conditions, information about the fees, the Complaints Procedure and a copy of the latest Inspection report. The home is a participant in the “ Prevention of Admission “ scheme operated by the local hospital. This involves the home offering an immediate placement for a fixed short term to offer respite and rehabilitation to a person who has been taken to hospital (A&E) and whilst in need of some care does not have the full care needs which necessitate hospital admission but who at that stage cannot return to their previous place of abode. The manager discussed the workings of this scheme with the inspectors and mentioned that whilst initially the scheme had worked well, more recently difficulties had arisen so that she was no willing to accept such applications on a Friday. These difficulties included incomplete or inaccurate care needs assessments which had resulted in the home taking residents whose care needs they could not meet. For admissions made on a Friday, the strict expectation that a multidisciplinary review must be undertaken within 48 hours could not happen and recent problems with GP cover where the resident had moved to another area and thereby lost the services of the GP with whom they were registered. A requirement is made that all residents however referred to the home must have a full needs assessment by the home which must ensure itself that all the conditions of admission can be met. Hyde Valley House DS0000019436.V249413.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): 7,8,9, and 10 Personal care and assistance offered to the residents is of a high standard thus meeting their individual needs whilst retaining their dignity and respect. Care staff are unobtrusive and sensitive in their approach. Care plans are comprehensive and are regularly reviewed this ensuring that changes to health and social care needs are recognised and met quickly. EVIDENCE: The care plans examined evidenced that these contain good detail are maintained up to date and are subject to regular review. Residents spoken with were aware of their care plans said that they did contribute to their compiling and knew that they were able to sign them if they wish. Clear recording of the residents likes and dislikes were seen where these affected the manner in which their care was delivered to them. Assessments made by the visiting Nurses and by the Falls Advisor were seen to be recorded as were the activity programmes arranged for each resident. Risk assessments were also seen to be subject to review. Hyde Valley House DS0000019436.V249413.R01.S.doc Version 5.0 Page 11 Residents confirmed to the inspectors that they felt well cared for “ its very good here, I’ve got no complains about the staff”, one said. A relative confirmed this “ We have no complaints about Hyde Valley House, the staff are always kind and helpful, My Dad is really spoilt here and he is happy”. Staff were observed to be adhering to the homes knock and wait policy before entering a residents room and in their dealings with the residents to be mindful of their dignity and were trying to enable them to retain as much independence as it was possibly safe for them to do. The home has good working relations with its local Doctors, the community nursing teams and with the associated paramedical services. Doctors and district nurses visit promptly and where required refer residents quickly for hospital assessment and treatment. Residents were seen to have equipment appropriate to meet their needs this being provided, on some occasions, following an OT assessment. A chiropodist visits regularly, the Falls Advisor makes an early assessment of all newly admitted residents and particular attention is given to the adjustment of the height of walking sticks and frames. On the day of this inspection no residents in the home were suffering from any pressure sores. The nomad medication system continues to be used in the home and the MAR sheet administration records examined were found to be accurately recorded. Staff who administer medication are all trained to do so and evidence of regular management checks of these records was seen. Medication is kept in separate medication trolleys, which are locked to the walls of each unit dining room. These were found to be neatly arranged with all non-dosseted medication kept in separate named containers one for each resident. A locked key cupboard is also kept on each unit. Controlled medication is stored separately and each resident has a separate controlled medication administration recording book. The manager discussed with the inspector the relative merits of the MDS monitored dosage medication storage and administration system. Hyde Valley House DS0000019436.V249413.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): 12,13,14 and 15 The home offers a varied activities programme, which tries to accommodate individual activity preferences. Feedback and suggestions are sought on all aspects this promoting autonomy and choice. Visitors are always welcome in the home and several were seen to be visiting on the day of this inspection. Most residents were complimentary about their food and said that choices were always available. EVIDENCE: The manager explained that over the past year since she has been in post she has tried to improve the range and quality of the residents activity programmes by more closely involving the regular carers in the home as well as by bringing in some specialist activity organisers for particular activities. The feed back indicated that the activities were now considered to be more fun Residents confirmed that they enjoyed the recent summer outings and the photos in the Homes entrance hallway demonstrated this. Communal singing, being taken into the garden, staff helping with a crossword, bingo and reminiscence talks were all mentioned as enjoyable activities. The home intends to recruit a part time activities organiser to lead and continue to promote this expanded and more varied programme, in the near future. Hyde Valley House DS0000019436.V249413.R01.S.doc Version 5.0 Page 13 The residents confirmed their satisfaction with their food. One commented that she enjoyed the home baked cakes whilst several others confirmed that choices were always available. The meals served during this inspection smelt delicious and looked appetising. Staff were seen to be enquiring of the residents as to their wishes for portion sizes and to be offering alternatives where requested. Where a resident required help with feeding this was seen to be being given in an unobtrusive manner and at a speed dictated by the resident. Hyde Valley House DS0000019436.V249413.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): 16,17 and 18 The home has a robust complaints procedure and follows the Adult Protection procedures as set out in the Hertfordshire joint agency guidelines. EVIDENCE: A copy of the homes complaints procedure is made available for all prospective and current service users. The complaints procedure makes reference to the Commission for Social Care. There have been no complaints since the last inspection. Residents questioned said that they knew about the complaints procedure, one resident explained that when something had gone wrong for her she mentioned it to her carer and the manager sorted it out quickly. Another resident mentioned to the inspector about the complaints box, which she said if she had a problem she would use. Staff confirmed that they had received training on adult abuse procedures and they were aware of the literature concerning the Hertfordshire Adult Protection Procedures, which are displayed in the home. Since the last inspection there has been one case concerning adult protection, which is ongoing and was seen to have been handled according to the guidelines. The home keeps records of any compliments received and two letters of thanks and complimenting the care given were shown to the inspector. Hyde Valley House DS0000019436.V249413.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 and 26 The home and its surroundings offer a pleasant, comfortable safe and homely environment for its service users. The home, with some minor exceptions, is clean with no odours and is well maintained and the bedrooms are personalised offering a homely, lived in feel. The home meets the space and environmental requirements for this standard. EVIDENCE: Hyde Valley House is an older purpose built residential care home that has over the years been well maintained and has benefited from some works of refurbishment and modernisation. All the bedrooms are for single occupation but none have en-suite facilities. However these appeared to be well personalised by the residents who confirmed that they were encouraged to bring small pieces of furniture, pictures and ornaments and most said that they had arranged their rooms in a manner which they liked and felt was homely for them. Hyde Valley House DS0000019436.V249413.R01.S.doc Version 5.0 Page 16 The home was generally found to be clean and there were no unpleasant odours. Some carpets on one unit were very stained and the corridor and some bedroom walls on another unit were seen to be in need of redecoration. Since the last inspection a number of works of redecoration have been carried out including the fitting of new flooring in one unit. The records showed that these works are ongoing demonstrating that a routine maintenance and improvement programme is being adhered to. The home has accessible gardens with patio areas containing several separate seating areas, which were observed to be being well used by the residents and their visitors on the day of this inspection. Hyde Valley House DS0000019436.V249413.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 and 30 The home is staffed by a stable group of experienced and well-trained staff who work well together and who appeared to be committed to their work. The home has robust recruitment procedures, which ensure the safety of the residents. One lapse was found in this procedure, which could compromise this safety. EVIDENCE: The home is fortunate in being able to retain a stable core group of workers many who have been employed at the home for many years and are experienced carers who appeared to be enthusiastic about their work and dedicated in promoting meeting the care needs of the residents in a competent manner. On the day of this inspection the staff on duty matched the numbers planned on the staff rota and appeared to be of sufficient numbers to meet the current needs of the residents. Staff confirmed that there are good opportunities for them to undertake training. Of the current staff, several are studying for NVQ level 2 qualification and 2 are currently studying for an NVQ level 3. The Manager has obtained NVQ level 4 and the Registered Managers award, the deputy manager the NVQ at level 3 and several of the care managers hold the NVQ 2 and the Assessors Award. The training needs of the home are determined following an individual training needs assessment of all the staff determined during their supervision meetings. An annual training programme is compiled for the home with clear records kept of attendances and achievements obtained. Hyde Valley House DS0000019436.V249413.R01.S.doc Version 5.0 Page 18 Residents spoken with were complimentary about the staff and the management of the home. One said the carers are “very kind they look after us very well”. The homes recruitment procedures with one exception are adequate to offer protection to the residents and records seen of recent interviews demonstrated that the appropriate procedures had been followed and checks of records had been made and retained on file. One record relating to a CRB check for one employee was found to be incomplete and despite the manager chasing for this with the appropriate authority this had still not been obtained. A requirement is made. Hyde Valley House DS0000019436.V249413.R01.S.doc Version 5.0 Page 19 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): 31,33,35,36 and 38 The home, which has a good reputation in its locality, is well run by experienced and well qualified staff who work well together as a team and are dedicated to enhancing the service provided. Close consideration to the health, safety and welfare needs of the residents is given and this results in a warm caring environment where the residents seemed happy and relaxed. EVIDENCE: The manager communicates a clear sense of leadership within the home and promotes a sense of belonging to its residents. Throughout this inspection it was noticeable that residents wanted to speak with her, “ she is very kind and often comes for a chat” one said another commented that her regular talks with the managers had helped her to settle in the home. Hyde Valley House DS0000019436.V249413.R01.S.doc Version 5.0 Page 20 The individual staff records demonstrated that they receive supervision at regular intervals and the records of the staff meetings evidenced that they are regularly consulted about the running of the home. Staff spoken with confirmed that they were well supported by the management and that they had good training opportunities. The home has appropriate procedures to ensure the safekeeping of any residents monies held by the home and the manager discussed with the inspector her thoughts on some changes that could be made to these procedures, which would enhance the individuality of these records. Each resident has a lockable facility in their own room in which to keep their valuables safe and all residents are offered a key to their own rooms. The home records showed that drills and appliance testing is carried out regularly. The records of water temperatures especially in wash hand basins in resident’s rooms showed that in some areas of the home the recommended maximum temperature was exceeded. The manager showed to the inspector the work order dated 1/9/05 with the agreement to replace the thermostatic valves throughout the home, this work to commence at the end of the month. Quality questionnaires are sent to residents, relatives and stake holders in the home on an annual basis and the results from these and results from the Annual Forum held in the home, (when the company directors visit to meet with relatives and residents), are used to compile the annual report about the home. Hyde Valley House DS0000019436.V249413.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 3 Hyde Valley House DS0000019436.V249413.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP29 OP3 Regulation 19(4)(a) (b)&(c) 14(1)&(2) Requirement Full CRB disclosures must be obtained for all staff this to protect the residents safety. It is a requirement that all residents admitted to the home have a full assessment of their care needs. Timescale for action 31/10/05 31/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hyde Valley House DS0000019436.V249413.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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. Extracts may not be used or reproduced without the express permission of CSCI Hyde Valley House DS0000019436.V249413.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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