Inspection on 24/05/06 for Hylands House

This inspection was carried out on 24th May 2006.

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

Other inspections for this house

Hylands House 14/09/05

Hylands House 14/06/05

Hylands House 07/12/04

Hylands House 13/07/04

Hylands House 24/01/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hylands House Warwick Road Stratford On Avon Warwickshire CV37 6YW Lead Inspector Deirdre Nash Key Unannounced Inspection 24th May 2006 11:55 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 Hylands House DS0000004247.V296374.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 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 DS0000004247.V296374.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hylands House Address Warwick Road Stratford On Avon Warwickshire CV37 6YW 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) 01789 414184 01789 414383 hylandshouse@fsnet.co.uk Mrs A Barton Mrs F Roebuck, Mrs Sheila Sandle Elaine Yvonne Gibbs Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Hylands House DS0000004247.V296374.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Elaine Gibbs must achieve the NVQ 4 / Registered Managers Award by April 2007. 14th September 2005 Date of last inspection 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 towns facilities close at hand and 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 floors. A shaft lift is provided which enables access to all but one bedroom in the main building without having to negotiate any stairs. The lift however is too small to safely hold someone in a wheelchair plus another person. The home therefore does not admit people who need constant use of a wheelchair. 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 DS0000004247.V296374.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection covered the KEY National Minimum Standards. We looked at all of the information that we have received about this home and kept on our records over the past twelve months. The provider organisation has had appropriate contact with us about the home during that time and kept us informed. After the last inspection in September last year, we asked them to send us an action plan detailing how they were going to improve the things that we pointed out as being below standard and they did so. We sent the home a questionnaire in March to fill in and bring us up to date with facts and figures about the home. It was properly filled in and sent back to us in good time. Comment cards were also sent to be distributed to relatives and to the service users to find out their views about the home. Ten of these have been completed and returned to us and those views are reflected in this report. The Inspector called on the home without notice at noon mid week, spoke with some the residents, spoke to staff, spoke to some friends visiting a resident, spoke to the manager and one of the owners, looked around the home and looked at records. The care of a sample of four particular residents was ‘tracked’ this way to see if the home is providing a service that meets the national minimum standards. What the service does well: What has improved since the last inspection? There have been considerable improvements made to written plans of care for each resident since the last inspection. Staff are now looking after people in a consistent way. The owners have invested in improving the interior of this old house to make it more comfortable for disabled people. Investment has been made in staff training and in line with government targets half of the care staff now hold a qualification. Hylands House DS0000004247.V296374.R01.S.doc Version 5.2 Page 6 Written policies and procedures have been put in place or updated and this will help staff to continue to provide a professional approach to caring for residents. Staffing levels have increased a little and this allows more time to spend with residents on leisure activities and occupation. A considerable amount has been achieved in the past year in modernising the systems and quality of care at the home. The home is now fully occupied and there is a waiting list. One resident said ‘oh they are very good to us here.’ 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 DS0000004247.V296374.R01.S.doc Version 5.2 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 Hylands House DS0000004247.V296374.R01.S.doc Version 5.2 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): 2, 3, 4, 5. The outcome for this group is good. The manager admits people to the home only after their needs have been assessed and the limitations imposed by the building are taken into account. Residents live in a home that can meet their needs. EVIDENCE: Current scale of charges is £370-580 weekly. Inspection of care files of three residents admitted recently and one longer standing resident show social services, Health Trust or the homes own initial assessment of their needs. One resident with visual impairment had her particular needs assessed. This means that the needs of each prospective resident are clearly known to the manager before she decides that the home can look after him or her properly. Hylands House DS0000004247.V296374.R01.S.doc Version 5.2 Page 9 One resident spoken to confirmed that she had a gradual admission to the home from a hospice. Discussion with staff confirmed that the home arranged an agreed transfer to a specialist unit for a resident whose needs it could no longer meet. The manager reports that the statement of purpose now makes it clear that the home is not structurally suitable for any one who needs permanent use of a wheelchair. A random sample of one contract/statement of terms and conditions was seen. It was clearly set out and stated what was not included in the fees for care and accommodation. This means that residents and prospective residents know their rights and what they have agreed to and are paying for. Hylands House DS0000004247.V296374.R01.S.doc Version 5.2 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, 10, 11 The outcome for this group is good. Residents have written plans for their social and health care and staff are familiar with those plans. Residents receive good quality and consistent care from a team. EVIDENCE: Inspection of five service user plans including two recent admissions to the home supported how staff that were asked, described the needs of those individuals. Care plans are linked to written risk assessments so that peoples safety is managed as far as possible without eroding their independence. One plan showed how the home supports an individual to attend a day hospice. Daily and nightly records about the well being of each resident are made by staff and reviewed by the manager. This means that residents well being over time is monitored and that staff returning from leave can catch up with any changes. These care plans are now useful day to day documents and better direct staff in caring for residents consistently and as a team. Hylands House DS0000004247.V296374.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 14, 15. The outcome for this group is good. Staff address the well being of each resident as an individual and meals and mealtimes make a positive contribution to this. Residents enjoy a fulfilling lifestyle within the limitations of their condition and needs and are not treated as a group. EVIDENCE: Observation made over six hours showed that the well being of residents was generally high against the recognised psychological and behavioural indicators. Staff were seen compensating for a dip in the well being of two residents during the day by offering some comfort and suggesting some activity. One staff member said to a resident who became suddenly distressed, ‘lets try to think of something that makes you feel happy’. A volunteer came into the home to read to residents in the lounge. Some residents chose to keep to their rooms for the afternoon, another went out to lunch with friends and then entertained them in her room. There was a gentle shift of scene and movement going on in the house all afternoon. Hylands House DS0000004247.V296374.R01.S.doc Version 5.2 Page 12 Lunch was well cooked, presented and served. One resident was helped to eat by staff sensitively. One care plan showed a resident to be vegetarian. She and the Inspector were given a hot vegetarian meal that had been completely made in the kitchen. Puddings and cakes are made in the kitchen, residents were offered a range of soft drinks and one had a glass of wine. The meal was leisurely and some residents chatted with each other through it. The home is commended for this. Kitchen staff recently received a local environmental health Award. A resident confirmed the manager’s statement that individuals can get up and go to bed when they wish to. Hylands House DS0000004247.V296374.R01.S.doc Version 5.2 Page 13 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, 18 The outcome for this group is good. Resident’s views are heard and they are safeguarded by clear policy and procedures. EVIDENCE: Residents spoken to said that they felt able to approach the manager if they had complaints or concerns and that she makes a point of talking to people every day. The complaint policy and procedure was on the wall in the lobby for residents, relatives and visiting professionals to see. The home has received no formal complaints since the last inspection and the Commission has received none about the home. The manager dealt properly within the Warwickshire wide agreed protocol, with one potentially abusive incident between two residents earlier this year. She reports however that staff left it for her to return from leave to refer this to social services. Staff have undertaken abuse awareness and adult protection training since the last inspection. Senior care assistants need to feel confident enough to make POVA referrals in the manager’s absence. A requirement is made under section 6 below about the use of staff supervision sessions. Hylands House DS0000004247.V296374.R01.S.doc Version 5.2 Page 14 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, 26. The outcome for this group is adequate. The home is investing in and making good progress towards improving the layout of the house for the safety and well being of residents but safe access to and use of the garden remains a problem. Many residents are confined in doors unless accompanied out. EVIDENCE: The manager described a clear plan for improving the layout of the home and is confident of the owners’ support. The owners have invested a lot of money in the home in the last six months. The new fire alarm system and the new call system are installed although not yet operational. There are plans to get rid of the ‘up and over staircase on the first floor for safer and less confusing access to a bedroom. Safe access to the garden and security of the garden remains a stubborn problem given the configuration of the land and the existing structure of the house. Hylands House DS0000004247.V296374.R01.S.doc Version 5.2 Page 15 The manager reports that she is working on a solution and the Inspector reminded the owner that this does need to be tackled as residents are effectively confined indoors unless supervised. One current resident at least, would prefer to spend much of his time sitting out of doors. Risk assessments for restricting access to the garden were seen in each care plan looked at so the home is holding itself to account for this restriction on liberty. The manager reports that she made many attempts to get a professional to access the internal environment and make recommendations as required at the last inspection but had no success. She has proceeded on her own assessment and this at least has produced some progress to making the home safer and more comfortable for frail residents. A number of bedrooms have been redecorated recently with new carpets and work was seen to be in progress to put in a new bathroom and toilet on the ground floor near the communal rooms. This will avoid residents ‘queuing’ at certain times of the day and help people to continue to manage their own continence. An office on the ground floor for the manager is being remodelled to make it more accessible to residents and visitors. A new laundry room is being fitted out to the side of the property and this should be easier for staff to get to and use than the existing location. Hylands House DS0000004247.V296374.R01.S.doc Version 5.2 Page 16 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, 30, The outcome for this group is adequate. Staffing levels have increased and this means that residents get more attention in the afternoons and early evenings. Records showing that staff recruitment procedures are thorough enough to protect vulnerable residents are still not all in place. Residents may be exposed to people who are not suitable to look after them. EVIDENCE: There were three staff on duty during the morning and early afternoon plus the cook, cleaner, manager and handyman. Three staff were on duty from 2.30pm. The manager reports that this level drops to two at 8pm until 7.30 next morning. The staffing level for afternoons and evenings is an improvement from what was found at the last inspection but there are also more residents than there were. However this does means that residents can be assisted and encouraged with occupation and activities in the lounge or garden during the afternoon while other staff look after those who need to keep to their rooms upstairs. Hylands House DS0000004247.V296374.R01.S.doc Version 5.2 Page 17 A random example of one recent staff appraisal was seen. The manager reports that she carries out regular one to one supervision of staff on the floor while they are working. This is very positive as it means that the manager sees exactly how individual staff are putting residents care plans into day to day action and it improves consistency within the team. However some one to one sessions need be recorded and they should cover policy and procedure topics including how to act in the absence of the manager when necessary. The manager has devised a written format for this and it must be put into action now. Staff have undertaken a range of appropriate training over the past few months and 50 are now qualified at NVQ Level 2. This meets the national target, is very good progress and will contribute to a professional approach to caring for residents. Volunteer workers have not undergone a criminal records bureau standard disclosure as was required at the last inspection. The manager was told to make sure that this is done immediately for the protection of residents. The home will not be warned again about this and enforcement action will be taken if this breach of regulation continues. The files of two very recent recruits to the staff team were inspected. One did not contain any references and the other contained only one. The manager reports that she has seen two references for each. The Commission has not been intentionally misled by the home in the past and accepts this statement as true but they must be found and kept on file. All other proofs and documents required for the protection of vulnerable people were in the files including recruitment interview notes. Hylands House DS0000004247.V296374.R01.S.doc Version 5.2 Page 18 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, 32, 33, 35, 36, 37, 38 The outcome for this group is good. There is effective management and leadership in the home and the owners have invested in improvements. Residents are benefiting from a professional and modern approach to running the home and have confidence in its future. EVIDENCE: The manager is registered with us. Residents spoken to confirmed that she is approachable and present. Records and observations show that the systems and quality of care in the home have been modernised in a short time. Staff observed working with residents were kind, purposeful and confident and were able to talk about their role in residents lives as caring professionals. The home is commended for this. Hylands House DS0000004247.V296374.R01.S.doc Version 5.2 Page 19 The owner visits regularly at the moment as work is going on with the fabric of the house. The Inspector took the opportunity to remind her that one visit each month must be put in short report form and sent to the Commission. This shows us that the Provider knows what is happening in the home. A considerable financial investment is being made in improving the home and residents reported that they were reassured by the owner attending a residents’ and relatives meeting and confirming that the home is continuing in business. The home is full and the manager reports that there is a waiting list. Residents are a mixture of privately and publicly funded service users and the increase in referrals from social services shows confidence in the home and its future. A quality survey was undertaken at the end of 2005 and a short report of the results must now be sent to the Commission so that we can be confident that residents are consulted about the way that their home is run. Residents confirm that there are regular residents meeting held. The requirements and recommendations of the Fire Officers report and the environmental Health officers report this year have been acted upon. The manager has complied with all but part of one requirement from the last and previous Care Standards inspections. All records seen were in good order and properly stored. New written policy and procedure documents were seen for a wide range of relevant topics and these can now be used to guide staff and increase the consistency and professionalism of the care that they give residents. The carpet on the dining room/lounge floor is rucked in places and mobility aides are getting caught. The coconut mat at the front door has worn low in the recess. These will cause residents to fall. Most residents in the home are unsteady on their feet. The floors must be made safe. Hylands House DS0000004247.V296374.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 3 3 x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 2 x x 2 3 2 Hylands House DS0000004247.V296374.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP18 Regulation 19 Requirement Timescale for action 01/06/06 2 OP19 23 3 OP29 19 4. OP33 24 The registered person must ensure that all volunteers that work in the home have CRB Disclosure certificates at the appropriate level (01/11/05 not complied) Now Immediate The registered person must 01/10/06 ensure that the external grounds of the home are made safe for residents to use unaccompanied should they wish. A plan must be drawn up to achieve this. The registered person must 01/06/06 ensure that all proofs and documentation required by law are obtained on all staff that work in the home. (Immediate at last inspection, substantively met) Immediate again The registered person must 01/08/06 ensure that the results of service user surveys are sent to the Commission (compliance date 30/06/05 part of requirement, substantively complied with) Hylands House DS0000004247.V296374.R01.S.doc Version 5.2 Page 22 5 OP33 26 6 OP36 18 7 OP38 13 The registered person must visit the home at least once a month unannounced to monitor the general welfare of the residents and send a short written report to the Commission for Social Care Inspection. The registered person must ensure that staff receive one to one supervision sessions with their manager that are recorded and include instruction on policy so that staff left in charge of the home in the managers absence are confident about responding to incidents. The registered person must ensure that the floor covering in the lounge/dining room and the front door mat are made safe. 01/07/06 01/07/06 01/06/06 Hylands House DS0000004247.V296374.R01.S.doc Version 5.2 Page 23 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. Refer to Standard OP21 Good Practice Recommendations Any future development of the home involves the installation of a sluice room. Hylands House DS0000004247.V296374.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Leamington Spa Office 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 DS0000004247.V296374.R01.S.doc Version 5.2 Page 25 - 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!