CARE HOME ADULTS 18-65
Hydon Hill Cheshire Home Clock Barn Lane Godalming Surrey GU8 4BA Lead Inspector
Megan McHugh Key Unannounced Inspection 22nd May 2006 09:30 Hydon Hill Cheshire Home DS0000017618.V296683.R01.S.doc Version 5.2 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 Hydon Hill Cheshire Home DS0000017618.V296683.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 Adults 18-65. 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. Hydon Hill Cheshire Home DS0000017618.V296683.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Hydon Hill Cheshire Home Address Clock Barn Lane Godalming Surrey GU8 4BA 01483 860516 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) www.leonard-cheshire.org.uk Leonard Cheshire Mrs Janet Taylor Care Home 43 Category(ies) of Physical disability (33), Physical disability over registration, with number 65 years of age (10) of places Hydon Hill Cheshire Home DS0000017618.V296683.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Thirteen (13) places may be used for the provision of personal care only. Ten (10) places may fall within the category of Physical Disability (over the age of 65 years) PD(E). 5th September 2005 Date of last inspection Brief Description of the Service: Hydon Hill is a large establishment over one floor situated in a large wooded area of several acres of land in Godalming within 2 miles of the main town. There is ample parking for visitors. Service users have the use of patio areas all around the main building. The home is registered to provide nursing care for 30 service users and personal care for the rest of the service users. Altogether the home may accommodate a maximum of 43 service users. All bedrooms are single with the exception of the self-contained bungalow which can be used for two people. The home also offers several staff with accommodation on the site. There is an activities day centre, with a service user’s kitchen, computer room and sensory room, where service users socialise and learn new skills. Hydon Hill Cheshire Home DS0000017618.V296683.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first inspection for the year 2006-07 and was an unannounced inspection of the service. The inspection began at 10am and took place over six hours with the deputy manager assisting with the inspection process as the manager was day off. The home was assessed against the key national minimum standards for younger adults. The CSCI sent a pre-inspection questionnaire to the manager, which was completed and returned. This document produced information that is used in this report. The inspector also handed out several questionnaires and spoke to a number of service users to obtain feedback on how the home was operating. The feedback received was generally very positive and very complimentary of the services. Extracts of these comments are written in the report. The inspector discussed with staff about their experience of working in Hydon Hill. The inspector examined records and also toured the premises. Several service users were around the home, some in their bedrooms watching television, being attended by care staff, in the activities room painting and reading and having physiotherapy. There is a large wheelchair accessible kitchen in the activities room and this was used in the afternoon to bake some biscuits. The activities co-ordinator was able to explain the planning of this important development and explained how the service users enjoyed this kitchen and also the computer room, which is relatively new. The inspector wishes to thank the deputy manager, the staff and the service users who provided information and feedback on the home, which contributed to this report. What the service does well:
During the visit the inspector also spoke directly to several service users who stated that they were looked after and their needs were met. They were encouraged to mobilise around the home, some with electric wheelchairs or self-propelling ones. There was a good range of activities and physiotherapy services available. Many service users stated that the food was of a high standard and that they are always given plenty choices of what to eat. Other positive comments received included positive feedback about staff kindness, staff being cheerful and happy, service users being given choice in all aspects of their lives and many service users discussed their plans of care that they helped to develop. On the day of the inspection a service user was moving into the home and staff were observed to stay with the service user and walk around the home with them, introducing them to other service users and talking to them about the routine of the home and where everything was. Staff were also observed
Hydon Hill Cheshire Home DS0000017618.V296683.R01.S.doc Version 5.2 Page 6 assisting the service user move into their room and were seen helping the person unpack and move the furniture around the room so that the service user was comfortable and felt at home as soon as possible. What has improved since the last inspection? What they could do better:
The inspector noted that the nursing needs service users have complex needs and on discussions with staff this was confirmed. The nursing staff stated that they are very busy and often spend the whole shift out on the floor attending to dressings and catheter issues and do not have much time for documentation and other tasks. This issue was discussed with the deputy manager as it was noted that there are two nurses on duty in the morning but only one nurse on for the rest of the 24 hour period. There was a concern as to how the staff manage to complete their duties and what the home would do in the case of an emergency. This was discussed further with the registered manager a few days following the inspection and in light of the recent increased numbers of allocated nursing beds and no increase of nursing hours and requirement was made. Hydon Hill Cheshire Home DS0000017618.V296683.R01.S.doc Version 5.2 Page 7 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. Hydon Hill Cheshire Home DS0000017618.V296683.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hydon Hill Cheshire Home DS0000017618.V296683.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users had their full needs assessed as evidenced by records sampled which contained a full pre-admission assessment completed prior to admission to the home. EVIDENCE: Each of the records sampled contained a comprehensive pre-admission assessment and most had information from the previous home, GP and/or hospital discharge information for the individual. The assessments are then used to form the plan of care for the individual and any risk assessments. There was evidence of service users signing this information. Hydon Hill Cheshire Home DS0000017618.V296683.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans were well written with adequate relevant care information including service users input from their reviews. Service users’ right to make decisions was respected and risk assessments, for the individual and the home, supported these rights. EVIDENCE: The plans of care were sampled and the inspector looked at nursing and nonnursing service users records. The care plans offered a good range of information about the service users’ needs. There were nutrition and pressure sore assessments and activities preferred. Daily notes were maintained in good detail. It was pleasing to note that the care workers and team leaders are completing the non-nursing service users daily records and updating care plans. During the course of talking with service users they informed the inspector that they are involved with developing and reviewing their care plans. Some service users talked to the inspector about risk assessments and what they were and were not able to do and why. This was positive to note and showed that service users have a good input into their care.
Hydon Hill Cheshire Home DS0000017618.V296683.R01.S.doc Version 5.2 Page 11 Hydon Hill Cheshire Home DS0000017618.V296683.R01.S.doc Version 5.2 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides many activities; recreational, social and other; to try to meet service users lifestyles, interests and needs. The home encourages service users to maintain relationships with their significant others and make friends with others in the home. There is practical encouragement offered by the management of the home to uphold service users’ rights as valuable members of the community. The management of the kitchen and the catering arrangements are working well. EVIDENCE: There are open visiting hours to the home. Many service users have family and friends who are able to come and spend time with them. The activities room has a well-equipped computer room where service users are encouraged to keep in touch with friends and family (sometimes abroad) by email and accessing the Internet. The staff are reported as courteous to the family and friends who visited and also welcoming. Hydon Hill Cheshire Home DS0000017618.V296683.R01.S.doc Version 5.2 Page 13 There is a service users representative who has formed a committee of some 10 residents meeting regularly to discuss issues about the home. The committee often invited the manager to attend for specific times. Some service users help with fund raising and networking for the home. Many take part in community events to support the home such as sports events and fetes with other Leonard Cheshire homes and supporters. A new catering manager is now in place. There has been a lot of improvement in the standards of hygiene in the kitchen and the general layout is better organised to make good use of all the areas. The staff were complimentary of the new chef and stated that they were able to work together as a team to ensure good quality of their services. Only one negative comment was received in regard of the food, the other comments received were all positive about the quality and quantity of food provided. Two service users were observed to have ordered an alternative meal to the two on offer in the serving area. Hydon Hill Cheshire Home DS0000017618.V296683.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users received personal support as per their wishes and care plans. There are gaps in the provision of neurological input in the care of some service users. Medication was appropriately retained and administered and meets with the home’s policies and procedures. EVIDENCE: All service users had comprehensive care plans, which detailed how personal care was offered. Service users stated that they received care in a way they preferred and were given choices in regard of male or female staff assisting them. A requirement was made under Standard 19 for the home to provide specialist input from a neurologist. In the absence of a retainer GP practice, the home deals with several GP surgeries at the same time, which makes continuity of care very difficult. The home admits service users with very complex neurological needs and is currently lacking in specialist input in this field. The deputy manager stated that the home has been trying to obtain a specialist neurologist however have so far been unable to do so. The Commission acknowledges the work the home has put into trying to meet this requirement, however this shall remain a requirement and will be looked into at the next
Hydon Hill Cheshire Home DS0000017618.V296683.R01.S.doc Version 5.2 Page 15 inspection. The home has implemented specialised training for staff and staff indicated that this was ongoing. Also see Standard 35. The home has made a significant division between the non-nursing care service users and the nursing care service users. They are in the process of placing the medications and any other related items for non-nursing service users into a separate room. The Team leaders will have control of these medications and the nursing staff will not dispense any medication or nursing duties to non-nursing service users. The district nurses are now providing nursing support to service users who are in non-nursing beds. This has freed up the nursing staff to attend to allocated nursing needs service users. However recently the home and the Commission have agreed to increase the number of allocated nursing beds in the home, which has increased the demand on the nursing staff again. See further comments under Standard 33. The lunchtime medication round was observed and the staff on duty discussed with the inspector the home’s medication administration policy and procedure, which was in line with legislation. Hydon Hill Cheshire Home DS0000017618.V296683.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has procedures for dealing with complaints. Staff received training in the safeguarding of vulnerable adults (POVA). The home refers appropriately under the safeguarding vulnerable adults procedures. EVIDENCE: There is good communication established between staff and the service users involving social workers and relatives. Reviews are held regularly and care plans are updated to reflect relevant changes. Staff were observed dealing with service users courteously with patience and in a friendly manner. Service users’ complaints are taken seriously. There is evidence of this in the previous complaints handled by the home when clear records are maintained and the CSCI informed as appropriate. The staff had referred appropriately under the safeguarding vulnerable adults procedures. There is currently one matter not concluded being dealt with under those procedures. Hydon Hill Cheshire Home DS0000017618.V296683.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained internally and externally. The home is secure internally although it is rather isolated in its own grounds. The home was clean and hygienic. EVIDENCE: The home is a large institutional building which runs on the same floor thus easily accessible for all residents to mobilise. There is a main door with a receptionist during daytime hours. The main door is locked at night as, the home has in the past been accessed by uninvited guests unknown to the staff in charge. At the time of the inspection the side door near the activities area was open as it was broken, this was being fixed by an outside contractor at the time of the inspection. The home itself is not “homely” by the very nature of its purpose-built premises serving a large service user group, many with physical disability requiring a lot of equipment in their bedrooms such as specialist beds and hoists. However the management of the home does encourage personal belongings to be brought in to create individual styles in the bedrooms such as rugs, photographs, television, plants, etc… All the bedrooms seen were
Hydon Hill Cheshire Home DS0000017618.V296683.R01.S.doc Version 5.2 Page 18 personalised and one service user has been able to use money left to her to build on a small conservatory to her bedroom. The communal areas have reasonable furniture in generally good condition with large screen television and audio systems. Many service users are in wheelchairs or specialized recliners so do not use or need the furniture in the communal areas. The level of cleanliness was good in the areas inspected and the gardens were well maintained. Hydon Hill Cheshire Home DS0000017618.V296683.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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, 34 and 35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users are supported by competent and qualified staff, however the number of qualified staff on each shift over the twenty four hour period was not adequate to meet the complex needs and high dependency levels of service users. Staff training has improved and now includes training in specialist subjects in relation to the service users needs. Staff are well supported and supervised. EVIDENCE: During the course of the inspection the inspector noted that the nursing needs service users have complex nursing needs and on discussions with staff this was confirmed. The nursing staff stated that they are very busy and often spend the whole shift out on the floor attending to dressings and catheter issues and do not have much time for documentation and other tasks. This issue was discussed with the deputy manager as it was noted that there are two nurses on duty in the morning but only one nurse on for the rest of the 24 hour period. There was a concern as to how the staff manage to complete their duties and what the home would do in the case of an emergency. The inspector discussed this with the Registered manager following the inspection and raised concerns that even though the home had recently increased the number of nursing beds, they had not increased the nursing staff allocated to each shift.
Hydon Hill Cheshire Home DS0000017618.V296683.R01.S.doc Version 5.2 Page 20 The Commission therefore requires that more nursing hours to be provided and that the home provide a plan of action to the Commission to show how this is being met. The team leaders now have more responsibility and since the home has worked with the district nurses and the Commission and has identified specific nursing and non-nursing beds, this has helped to alleviate the extra demand on the nursing staff’s time for non-nursing service users. The numbers of care staff per shift was seen to be satisfactory. Staff discussed the training days they had attended and information from the pre-inspection questionnaire confirmed that staff have received specialist training in subjects that directly relate to caring for the needs of service users in the home. Staff stated that they receive regular supervision and some staff talked about the training they had received in order to be able to supervise other staff. Records confirmed that the plan is for all care staff to receive a minimum of six sessions of supervision in a twelve month period. Staff records sampled contained all the information as required by the Commission. Hydon Hill Cheshire Home DS0000017618.V296683.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home and their health, safety and welfare is promoted and protected. EVIDENCE: On the day of the inspection, the registered manager was not available however the inspection was undertaken by the deputy manager. Comments received from staff and service users, reflected that the home has a competent management team in place that were open and approachable to all. Many service users stated that they would talk to the manager or deputy manager should they have any problems. The deputy manager stated that she is the link between staff, service users and the management team. The home appeared to run smoothly and efficiently even in the absence of the registered manager. The home’s policies, procedures, records and training of staff indicated that the home does promote and protect the health, welfare and safety of the service
Hydon Hill Cheshire Home DS0000017618.V296683.R01.S.doc Version 5.2 Page 22 users. The Commission had one concern in relation to the numbers of registered nurses on duty through out the twenty four hour period and this was discussed under Standard 33. Hydon Hill Cheshire Home DS0000017618.V296683.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 2 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X X X X 2 X Hydon Hill Cheshire Home DS0000017618.V296683.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? 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 YA19 Regulation 12(1) Requirement The home must continue to work towards obtaining specialist input from a neurologist to ensure that the needs of service users are identified and met. The registered person must review the existing staffing arrangements including the numbers of staff to ensure there are sufficient and competent qualified nurses on duty at all times to meet the nursing needs and requirements of service users. Written proposals must be submitted to the CSCI providing details of the home’s actions to meet this requirement. Timescale for action 30/06/06 2. YA33 18(a), 13(4)(c) 12/06/06 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 Hydon Hill Cheshire Home DS0000017618.V296683.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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