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Inspection on 14/06/05 for Hylands House

Also see our care home review for Hylands House for more information

This inspection was carried out on 14th June 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

The home makes sure that a written assessment of what a person needs is carried out before it offers them a place. Staff see written plans for the care of each resident and these plans are checked by senior staff every month to make sure they are still right. Staff treat residents with care and respect and get to know them. Residents can continue to be looked after in the home when they are dying. The home is in a good position and residents who can get out and about, can go into the town centre. Some activities are put on for people who cannot get out. The food is good and cook takes an interest in giving people what they like and what they need. The house itself is well kept, clean and tidy and the garden is nice. Relatives and friends are made welcome.

What has improved since the last inspection?

The home has improved its service user guide. This tells residents and prospective residents the service that they can expect. Improvements have been made in making an assessment of how people need to be looked after when they come to the home.

What the care home could do better:

When a resident is terminally ill and in their last weeks/days of life the home should write a special care plan to direct staff how to look after them. The right approach should not be passed on to staff just by word of mouth. The home needs to take better care that residents personal information is not on view to visitors. Personal information should not be recorded in a way that would prevent a resident being able to exercise their legal right to read it themselves. Staff need to be brought up to date with the Warwickshire wide agreed procedure for how to act in the case of any allegation or suspicion that a vulnerable adult is being abused. These are things that the home was told to do at the last inspection. The home should put copies of the contract that residents sign for their care and accommodation in their care files.

CARE HOMES FOR OLDER PEOPLE Hylands House Warwick Road Stratford On Avon Warwickshire CV37 6YW Lead Inspector Deirdre Nash Unannounced 14 June 2005 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 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. Hylands House E53 S4247 Hylands House V233945 140605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hylands House Address Warwick Road Stratford On Avon Warwickshire CV37 6YW 01789 414184 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) Mr Hamish Barton Mrs Rita Finlay Care home 19 Category(ies) of Old age (19) registration, with number of places Hylands House E53 S4247 Hylands House V233945 140605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 04 December 2004 Brief Description of the Service: Hylands House is registered for 19 older people requiring personal care. The home does not provide nursing care other than that available from the local community nursing teams. The home is set close to the town centre of Stratford Upon Avon with all the town’s facilities close at hand. The home is located close to a busy main road out of the town. Local and national buses provide good transport links. The railway station is about 15 minutes walk away. Hylands House is an adapted former hotel with service users’ accommodation on the ground and first floor. A shaft lift is provided which enables access to all but one bedroom in the main building without having to negotiate any stairs. The home also has an annexe consisting of four bedrooms, all of which can be reached via the stairs or a stair lift. There is a choice of two linked sitting areas on the ground floor and an integral dining area. A conservatory has also been added to provide an additional sitting area. The conservatory leads off from the large lounge. In addition seating is provided in the reception area. Hylands House has a no smoking policy with the exception of some outside areas. Car parking is available to the rear of the property. Hylands House E53 S4247 Hylands House V233945 140605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspector arrived without notice and toured the home with the Deputy Manager. Four staff and three residents were spoken to about the home and the Inspector looked at records including the care files of four residents. What the service does well: What has improved since the last inspection? The home has improved its service user guide. This tells residents and prospective residents the service that they can expect. Improvements have been made in making an assessment of how people need to be looked after when they come to the home. Hylands House E53 S4247 Hylands House V233945 140605 Stage 4.doc Version 1.30 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. Hylands House E53 S4247 Hylands House V233945 140605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Hylands House E53 S4247 Hylands House V233945 140605 Stage 4.doc Version 1.30 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 standard(s) 1, 2, 3 Residents have their needs assessed prior to admission. The home does not admit people that it cannot properly look after. EVIDENCE: The home has a statement of purpose and a service user guide. Charges vary according to the size of the room. The home was carrying five vacancies. The Inspector saw a sample contract in the service user guide but there were no completed contracts in the three care files looked at. There should be. There were needs assessments on file for each of the three residents looked at and also a written plan for their daily care and support. Hylands House E53 S4247 Hylands House V233945 140605 Stage 4.doc Version 1.30 Page 9 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 standard(s) 7, 8,9,10,11 The homes approach to care planning is routine, not sufficiently designed to guide staff in their practice and staff are relying on word of mouth directions. Residents could experience an inconsistent approach to their care at critical times. EVIDENCE: Service user plans for three residents were looked at. There was evidence that each section of the plan is reviewed monthly and that the plans were put together with the involvement of the residents and or their family. One resident was later visited in her room and was described by staff as being in the terminal phase of life. Her written care plan did not show that this change had happened. Although there was no evidence that she was being given anything other then good care there was no revised care plan to direct staff under the change in her condition and needs. There should be. Although staff said that she asked whenever she wanted a drink and they were very attentive there was no record being kept to monitor this resident’s fluid balance. There should be. The home was told to do this straight away. Hylands House E53 S4247 Hylands House V233945 140605 Stage 4.doc Version 1.30 Page 10 There were shortfalls in the recording of administration of medication and no evidence of the policy on the administration of medication that the home was told about at the last inspection. These things must be put right. Care plans for personal care are displayed on bedroom walls where visitors can see them; a salesman was dealt with by staff in the general office where residents’ names are clearly displayed on their care files on an open shelf. Residents can spend their final days in their rooms and are cared for with dignity and propriety. Staff, however reported using ‘common sense’ in the care of a dying resident when asked by the Inspector how they knew how to care for her. Asked if everyone else on the team did the same a member of staff replied ‘I don’t know’. Absence of a written updated care plan is already referred to above. The home was told to contact a palliative care expert to make sure staff were up to date in their skills and knowledge in this area and for training in writing a plan of care. Hylands House E53 S4247 Hylands House V233945 140605 Stage 4.doc Version 1.30 Page 11 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 standard(s) 13, 14, 15 Daily life in the home takes into account what individual residents like. Residents are not treated as a group. EVIDENCE: A resident spoken to said that he had just come back from spending an afternoon in town. A game of Bingo with prizes took place in one of the lounges while the Inspector was at the home. Visitors were in the home and staff say that regular visiting relatives and friends are given the front door entry code. There was no evidence of a list of individuals’ personal possessions brought into the home. The home was told to do this at the last inspection. Residents spoken to all said that the food served by the home is very good and a conversation with the cook showed that she takes a creative and inclusive approach to residents dietary needs and preferences. Hylands House E53 S4247 Hylands House V233945 140605 Stage 4.doc Version 1.30 Page 12 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 standard(s) 18 There are some gaps in the homes policies and written procedures. They are not robust enough to protect residents. EVIDENCE: The home has a written ‘whistle blowing’ policy, the Department of Health Guidelines on the protection of vulnerable adults from abuse was on file but not the Joint Warwickshire wide agreement. Staff spoken to all said that they felt confident about reporting any concerns that they had about residents well being and treatment to the manager but none knew the locally agreed correct procedure for responding to an allegation or suspicion that a resident was being abused. The home was told to act on this at the last inspection. Hylands House E53 S4247 Hylands House V233945 140605 Stage 4.doc Version 1.30 Page 13 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 standard(s) 19 Residents enjoy a well kept and pleasant home at the centre of a lively town. EVIDENCE: The home is in the centre of Stratford on Avon and was clean, well maintained and tidy throughout. The garden is well laid out and kept. Hylands House E53 S4247 Hylands House V233945 140605 Stage 4.doc Version 1.30 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 0 EVIDENCE: Hylands House E53 S4247 Hylands House V233945 140605 Stage 4.doc Version 1.30 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32, 37 The home is facing a period of significant change. Continuity of care of residents could become affected. EVIDENCE: The long standing registered Manager and also the Deputy Manger are retiring before the end of the summer. The home is registered to four owners, all family members one of whom, the Inspector was told, Mr Hamish Barton sadly died in May 2005. A new manager had been offered the position with a view to start in August 2005. An application to register this manager must be made to the Commission. Hylands House E53 S4247 Hylands House V233945 140605 Stage 4.doc Version 1.30 Page 16 The home was carrying five vacancies at the time of inspection and seven a month later. It is going through a period of big change and although there was no evidence that the quality of life or care of the remaining residents is affected the registered provider must make sure that staff continue to get the leadership and support that they need over the coming months. Residents records seen were in good order but some records such as the handover book and record of medical visits contained information about more than one resident on a page. They should not. Hylands House E53 S4247 Hylands House V233945 140605 Stage 4.doc Version 1.30 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 2 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 2 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 3 3 x x x x 2 x Hylands House E53 S4247 Hylands House V233945 140605 Stage 4.doc Version 1.30 Page 18 yes 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 OP2 Regulation 14 Timescale for action The registered person must 1st ensure that a copy of the November contract/terms and conditions for 2005 care and accomodation in the home is kept on each residents file The registered person must 1st ensure that service user plans September are revised/re written to direct 2005 staff when an individuals condition changes. The registered person must Immediate ensure that a fluid balance chart (complied) is put in place for the resident identified at the inspection. The registered person must 1st ensure that the administration of September medication is carried out in line 2005 the latest Royal Pharmaceutical College Guidelines The registered person must 1st October ensure that a clear and detailed 2005 policy in place for the receipt, recording, storage, handling administration and disposal of medicines.(compliance date 28/02/05 not met) The registered person must 1st ensure that senior staff receive November updated guidance and training 2005 on palliative care from a Version 1.30 Page 19 Requirement 2. OP7 15 3. OP8 12 4. OP9 17 5. OP9 13 6. OP11 12 Hylands House E53 S4247 Hylands House V233945 140605 Stage 4.doc specialist practitioner. 7. OP14 17 The registered person must ensure that a list of residents possessions is kept on file (compliance date 28/02/05 unmet) The registerd person must ensure that the adult protection policy is reviewed and updated to contain information regarding the process followed by Warwickshire Social Services in respect of any investigation (compliance date 28/02/05 unmet) The registered person must ensure that staff receive up to date training in respect of adult protection matters (compliance date 28/02/05 unmet) The registered person must ensure that personal information recording systems in the home are compatible with the current legisalation. The registered person must ensure that an effective quality assurance and monitoring system is put in place, seeking the views of sevice users.(compliance date 30/06/05 not inspected) The registered person must ensure that the results of service user surveys are published and made available to current and prospective service user, their representatives and the Commission (compliance date 30/06/05 not inspected) 1st September 2005 1st November 2005 8. OP18 12 9. OP18 13 1st December 2005 1st November 2005 30th June 2005 10. OP37 12 11. OP33 24 12. OP33 24 30th June 2005 13. Hylands House E53 S4247 Hylands House V233945 140605 Stage 4.doc Version 1.30 Page 20 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. 3. 4. 5. 6. 7. Refer to Standard OP7 OP7 OP11 OP21 OP26 OP37 OP12 Good Practice Recommendations A policy is writtenso that all care staff are clear when to refer tissue viability issues to suitable professionals for advice and/or management Residents with an increased risk of tissue viability problems are assessed at least weekly with evidence in the care plan to support this The policy on death and dying is further developed in respect of making it more person centred. Any future develoment of the home involves the installation of a sluice room. Consideration should be given to moving the laundry so it is more appropriate to the demand and easily accessible for staff to undertake their duties Service users should be provided with information to contact organisations that can offer advocacy services Residents meetings should be held as appropriate Hylands House E53 S4247 Hylands House V233945 140605 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Imperial Court Holly Walk Leamington Spa CV32 4YB 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 Hylands House E53 S4247 Hylands House V233945 140605 Stage 4.doc Version 1.30 Page 22 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!