CARE HOME ADULTS 18-65
Hydon Hill Clock Barn Lane Godalming Surrey GU8 4BA Lead Inspector
Kathy Martin Announced 5 September 2005
th 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 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 Stationary 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 h09-h58 s17618 Hydon Hill v241180 050905 stage 2.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Hydon Hill Address Clock Barn Lane, Godalming, Surrey, GU8 4BA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01483 860516 Leonard Cheshire Janet Taylor CRH N 44 Category(ies) of PD - Physical Disability registration, with number PD(E) - Physical Disability - over 65 of places Hydon Hill h09-h58 s17618 Hydon Hill v241180 050905 stage 2.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 15 beds providing nursing care for physically disabled people of either sex from the age of 18 years 29 beds for physically disabled people requiring personal care only, of whom up to 9 may be older people (over the age of 65 years). Level 4 NVQ Management to be obtained by 2005. Date of last inspection 12th April 2005 Brief Description of the Service: Hydon Hill is a large establishment over one floor situated in several acres of woods near Godalming (2 miles). There is parking for visitors. The home is registered for 15 nursing beds and the remainder as residential care for younger adults. All bedrooms are for single occupancy and there is a bungalow which can be used for two persons. The home offers staff accommodation on site. There is an activities centre providing a wide range of group and individual activities. Hydon Hill h09-h58 s17618 Hydon Hill v241180 050905 stage 2.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the second CSCI inspection carried out this year 2005-2006. This inspection was announced and therefore residents, staff, visitors and visiting professionals were advised beforehand. The home has now been assessed against all 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 CSCI also sent several questionnaires to obtain feedback on how the home was operating. These were distributed amongst residents, their visitors and visiting professionals. The feedback received was generally very positive and very complimentary of the services. Extracts of these comments are written in the next section of the summary. The inspection commenced around 10am. The manager was on annual leave and the deputy manager was present throughout. The inspector discussed with staff and residents about their experience of working and living in Hydon Hill. The inspector examined records and also toured the premises. Several residents were around the home, some in their bedrooms watching television, being attended by care staff, in the activities room playing scrabble and having physiotherapy. There is a large wheelchair accessible kitchen now installed in the activities room. The activities co-ordinator was able to explain the planning of this important development and explained how the residents enjoyed this kitchen and also the new computer room with the new technology. There were two residents observed using the new facilities that day. The inspector and the deputy manager had a lengthy discussion about the number of nursing beds and the nurses’ hours used on the residential beds, which is not proportionate. This will be looked at separately upon the manager’s return. The inspector required the home to conduct an urgent assessment of needs for all residents who currently received residential care as several of those were actually using nursing hours thus affecting the care of those who are there to receive nursing care. The inspector also investigated on the day, a recent complaint made to the CSCI about the health care needs of one service user. This was taken up separately with the providers. The inspector wishes to thank the deputy manager, the staff, the residents, the relatives and the visiting professionals who provided information and feedback on the home, which contributed to this report. Hydon Hill h09-h58 s17618 Hydon Hill v241180 050905 stage 2.doc Version 1.40 Page 6 What the service does well: What has improved since the last inspection? What they could do better:
This comment was raised by a visiting professional and discussed with the deputy manager who acknowledged that it was appropriate for the home to take this seriously. “Some patients are severely disabled and would be better cared for by a single medical provider and by a regular visit by a specialist in neurology”. A requirement was made for the home to ensure the provision of a neurologist to advise the staff on a regular basis as the home after all is meant to “specialise” in neurology. This comment was made by another visiting professional “ lack of knowledge on conditions of residents. Not pro-active with regards to further
Hydon Hill h09-h58 s17618 Hydon Hill v241180 050905 stage 2.doc Version 1.40 Page 7 assessments”. This was also discussed. There was a lack of specialist training for all staff in the home with regards to the “specialist” diagnoses that the home has to manage. A requirement was made for training to be improved to include those subjects to enable carers to understand the residents’ conditions and better care for their needs. Two recommendations were made in relation to the complaint investigated: 1. Provide a written communication letter to facilitate examination for all residents who attend the surgery from the residential client group. 2. Provide means for the escorting staff to call the home should they need to ask for help. Two of the seven requirements made at the previous inspection had not been met. These are urgently required to be actioned by the home: Requirement no. 6 related to the nursing care hours to be reviewed. The CSCI will take action with the provider upon the manager’s return from holidays. Requirement no. 7 related to the nurses who administer flu vaccines to be given training beforehand. It was further reminded to those registered nurses who were considering administering this vaccine as we are approaching that time of the year to ensure they received this training. Their nursing registration may be at risk if they fail to ensure they are trained to perform this task. It is the responsibility of both the nurses and the management of the home to ensure this requirement is met immediately. 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 h09-h58 s17618 Hydon Hill v241180 050905 stage 2.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Hydon Hill h09-h58 s17618 Hydon Hill v241180 050905 stage 2.doc Version 1.40 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 standard(s) EVIDENCE: This section was inspected during the last inspection in April 2005. The inspector was advised that there had been no changes since and the comments made then remained current in relation to this section. Hydon Hill h09-h58 s17618 Hydon Hill v241180 050905 stage 2.doc Version 1.40 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 standard(s) 6 Care plans were well written with adequate relevant care information including residents’ input from their reviews. EVIDENCE: The care plans offered a good range of information about their needs (although there is more on this in the next section of this report). There were nutrition and pressure sore assessments and activities preferred. Daily notes were maintained in good detail. It was a shame that the carers did not complete the care plans and daily notes for those residents who were not there to receive nursing care. By the very nature of the documentation it was seen as more clinical than social and should have been written very differently from those who received nursing care. However there will be a larger debate about the way the home operated in view of the nursing care hours spent. It is expected that in the future, the care plans for those who do not require nursing would be written in a very different style to reflect their specific lifestyles and social care. Hydon Hill h09-h58 s17618 Hydon Hill v241180 050905 stage 2.doc Version 1.40 Page 11 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 standard(s) 15, 16 and 17 The home encourages residents to maintain relationships with their significant others and make friends with other residents in the home. There is practical encouragement offered by the management of the home to uphold residents’ rights as valuable members of the community. The management of the kitchen is much improved and the catering arrangements are working well. EVIDENCE: There are open visiting hours to the home. Many residents have family and friends who are able to come and spend time with them. The activities room now boasts a well-equipped computer room where residents 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. There was a considerable time when residents were not able to have weekend activities due to a member of staff on long-term sickness. This has now returned to normal. Hydon Hill h09-h58 s17618 Hydon Hill v241180 050905 stage 2.doc Version 1.40 Page 12 There is a residents’ 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 residents 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. It was too soon to gain a good feedback from residents themselves as to how the food had been improved. The deputy manager explained that the nursing staff would work closely with the kitchen staff to establish a good working rapport and also involve the residents in their decisions. There were no adverse comments made to the inspector about the food. Hydon Hill h09-h58 s17618 Hydon Hill v241180 050905 stage 2.doc Version 1.40 Page 13 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 standard(s) 18, 19 and 20 Service users received personal support as per their wishes and care plans. The home needs to review its provision of nursing care to non-nursing residents. There are gaps in the provision of neurological input in the care of some residents. The medication assessment was requested for the CSCI pharmacist inspector to visit the home as there were issues relating to the returns of medication in line with the new legislation. EVIDENCE: All residents had comprehensive care plans, which detailed how personal care was offered. 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 residents with very complex neurological needs and is currently lacking in specialist input in this field. Many of the care staff had not been offered training in these either. A further requirement was made for the home to urgently address these issues and provide this training for all staff and also offer information for induction of staff. The deputy manager explained that with regards to Standard 20 (medication), there are issues that needed to be discussed in line with the new legislation
Hydon Hill h09-h58 s17618 Hydon Hill v241180 050905 stage 2.doc Version 1.40 Page 14 about returns of unused medication. The CSCI inspector has requested a pharmacy inspection as a result. Hydon Hill h09-h58 s17618 Hydon Hill v241180 050905 stage 2.doc Version 1.40 Page 15 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 standard(s) 22 and 23 The home has procedures for dealing with complaints. Staff received training in the protection of vulnerable adults (POVA). The home refers appropriately under the POVA procedures. EVIDENCE: There is good communication established between staff and the residents involving social workers and relatives. Reviews are held regularly and care plans are updated to reflect relevant changes. Staff were observed dealing with residents courteously with patience and in a friendly manner. Residents’ 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 POVA procedures. There are currently two cases not concluded being dealt with under those procedures. The CSCI received a complaint mainly about the health care needs of a resident, which was investigated. Two recommendations were made as a result as several items of the complaints were substantiated. The CSCI will follow these separately with the home. Hydon Hill h09-h58 s17618 Hydon Hill v241180 050905 stage 2.doc Version 1.40 Page 16 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 standard(s) 24 The home is well maintained internally and externally. It is a large institutional building, which offers large open communal spaces and wide corridors for wheelchairs. Many residents are actually wheelchair bound and mobilise around the home unaided. The home is secure internally although it is rather isolated in its own grounds. 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. The local police had made some suggestions to improve the security and access to the grounds at night including the installation of CCTV cameras. The home itself is not “homely” by the very nature of its purpose-built premises serving a large residents 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
Hydon Hill h09-h58 s17618 Hydon Hill v241180 050905 stage 2.doc Version 1.40 Page 17 rugs, photographs, television, plants, etc…The communal areas have reasonable furniture in generally good condition with large screen television and audio systems. The level of cleanliness was good in the areas inspected and the gardens were well maintained. Hydon Hill h09-h58 s17618 Hydon Hill v241180 050905 stage 2.doc Version 1.40 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 The evidence gathered during this inspection did not demonstrate that the staff received adequate training in specific subjects to enable them to understand the complex needs of residents to appropriately care for their needs. The requirement made at the last inspection for the nurses to be provided with training before they administered flu vaccines was not actioned. EVIDENCE: The training records were scrutinized and it was disappointing to note that only two sessions in Multiple Sclerosis and Epilepsy were programmed for the staff this year but not actually attended by many. This needs urgent attention and a requirement has been made for the providers to include specialist training in neurological disorders in both the induction training and thereafter for all staff. It is imperative that staff understood the residents’ conditions to be able to care for their needs. Also disappointing was that a requirement made in April this year requiring nurses who administered flu vaccines to attend training was not actioned. The inspector asked when this training was planned for and no dates had been decided whilst we are approaching the time when flu vaccines would be due to be administered. It is a reminder that all registered nurses have to abide by their Nurses and Midwifery Council (NMC) codes of conduct, which clearly states that they are accountable for their own practice. The management of
Hydon Hill h09-h58 s17618 Hydon Hill v241180 050905 stage 2.doc Version 1.40 Page 19 the home should not be condoning poor practice and therefore are urged to ensure that nurses are offered this training urgently to ensure residents’ safety is not jeopardised. The other training offered included health and safety, moving and handling, basic food hygiene and POVA. Hydon Hill h09-h58 s17618 Hydon Hill v241180 050905 stage 2.doc Version 1.40 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 The home welcomes feedback from the residents themselves and there is consultation with the residents’ committee regularly when changes are planned. The staff are invited to attend their meetings on a regular basis. Residents play an important role in the running of the home. EVIDENCE: There was evidence that residents’ views were respected and taken seriously. The home encouraged the residents’ committee, which met regularly. The manager and staff are only invited when the committee requested this to happen. Any proposed changes are discussed with the chair of the committee on a regular basis. Several residents helped with fundraising and attended community events with other Leonard Cheshire homes for networking. The home also receives a Regulation 26 visit by the Regional manager who then reports on his findings about how the home operated during these monthly, unannounced visits and residents’ input is also included in these reports.
Hydon Hill h09-h58 s17618 Hydon Hill v241180 050905 stage 2.doc Version 1.40 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 x x x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x x Standard No 11 12 13 14 15 16 17 x x x x 3 3 3 Standard No 31 32 33 34 35 36 Score x x x x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Hydon Hill Score 3 1 x x Standard No 37 38 39 40 41 42 43 Score x x 3 x x x x h09-h58 s17618 Hydon Hill v241180 050905 stage 2.doc Version 1.40 Page 22 Are there any outstanding requirements from the last inspection? yes 2 requirements remained unmet 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 19 19 Regulation 12 (1) 14 (2) Requirement The home must provide specialist input from a neurologist Conduct a re-assessment of needs for those residents for whom the home is not registered to provide nursing care. Provide adequate and relevant training for all levels of staff in specialist topics relating to residents conditions especially those with complex neurological conditions. Timescale for action 31/10/05 31/10/05 3. 19, 35 18 (1) (a) 31/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 36 36 Good Practice Recommendations Provide a written communication letter to facilitate examination for all residents who attend the surgery from the residential client group. Provide means for the escorting staff to call the home should they need to ask for help. Hydon Hill h09-h58 s17618 Hydon Hill v241180 050905 stage 2.doc Version 1.40 Page 23 Commission for Social Care Inspection 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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