Inspection on 17/01/07 for Iris Hayter House

This inspection was carried out on 17th January 2007.

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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Iris Hayter House 03/09/07

Iris Hayter House 14/02/06

Iris Hayter House 26/07/05

Iris Hayter House 28/02/05

Iris Hayter House 26/08/04

Iris Hayter House 17/02/04

Iris Hayter House 14/08/03

Iris Hayter House 15/08/02

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

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Iris Hayter House 43 Sandford Road Littlemore Oxfordshire OX4 4XL Lead Inspector Mike Murphy Unannounced Inspection 17th January 2007 10:00 Iris Hayter House DS0000013093.V325471.R02.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 Iris Hayter House DS0000013093.V325471.R02.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 and 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. Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Iris Hayter House Address 43 Sandford Road Littlemore Oxfordshire OX4 4XL 01865 749560 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) info@response.org.uk Response Organisation Mrs Rachel Bronwyn Whitehall Care Home 13 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (13), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (13) Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of persons that may be accommodated at any one time must not exceed 13. Date of last inspection Brief Description of the Service: Iris Hayter House is a large bungalow located on the outskirts of Oxford city. The accommodation comprises of a number of communal areas (lounges and a dining room) with each resident having their own bedroom. The home provides 24-hour support to 13 people who have mental health support needs. The majority of residents have been discharged from a hospital setting and continue to require support and accommodation. The staff provide close and continued links with individuals community mental health teams and all relevant professionals, i.e. psychiatrists, community psychiatric nurses (CPN) and social workers. All residents receive support to develop an individualised care programme. Residents are encouraged to use local community facilities. Fees at the time of this inspection ranged from £475 to £700 per week. Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted in January 2007. The visit to the service took place on 17 January 2007 and was carried out between 10:00 and 18:00 hours by one inspector. The inspection methodology included consideration of information supplied by the registered manager in advance of the inspection, discussion with the registered manager, service users and staff, examination of records (including care plans), a walk around the building and grounds, and consideration of information provided by health and social care professionals. At the time of the inspection there were 13 residents in the home. Of these nine were aged over 70 years, two were aged between 60 and 70, and two aged between 50 and 60 (Source: pre- inspection questionnaire). The inspection visit was conducted using the ‘Adults (18-65)’ standards. This report has been written with reference both to the ’18-65’ standards and those which apply to ‘Care Homes for Older People’. The home has good processes for assessing the needs of prospective residents and ensuring that it can meet those needs before admission. The home provides a highly supportive environment for older residents with severe mental health problems. It liaises well with health services in the community, in particular with general practitioners (GPs) and the local Community Mental Health Team (CMHT). The staff team are experienced and maintain a positive and supportive relationship with residents. The home is a bungalow and all areas of the building are accessible to residents. Handrails, grab rails, a mobile hoist and a chair hoist in one bathroom are provided for the benefit of residents when required. Showers are available where preferred. The building is generally in good condition and some areas have been refurbished over the past couple of years. Nine of the eleven bedrooms are single, two rooms are shared. There is a small garden which is used by residents in warmer weather. At the time of this inspection on a cool January day, residents seemed happy sitting in one of the two lounges (one non-smoking, the other where smoking is allowed) watching television, chatting, reading or just observing home life. It was reported that participation in activities had declined recently. This needs to be explored by managers since it will not be in the longer term interests of residents’ health to remain so relatively inactive. It is acknowledged that there may not be an immediate solution; activities which might be acceptable to residents in their mid-fifties may not suit those in their late seventies. There are a range of factors to be considered with this service user group and external advice should be obtained where required. Overall however, this home is providing its residents with a safe and comfortable place to live, the staff provide assistance and support where needed, and the residents seemed genuinely content living there. Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The home should conduct a reappraisal of the activities on offer with the aim of designing a programme which takes account of varying individual and group Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 7 needs. Residents will gain social and health benefits from a wider range of activities. All staff should attend the organisation’s training on the protection of vulnerable adults as soon as practicable. This will strengthen the home’s arrangements for the protection of residents. The checklist in which Schedule 2 information is listed should be available in the home from the day on which a member of staff starts work. This will provide evidence that all pre-employment checks aimed at protecting vulnerable residents have been carried out. It is recommended that the registered manager obtain a copy of the certificate of safety for the fixed wiring in the home. This should be retained for inspection. This provides evidence that Response is fully meeting its responsibilities to maintain a safe environment for residents, staff and visitors. 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. The summary of this inspection report can be made available in other formats on request. Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 4 (18-65) 3, 4,5 and 6 (OP) Quality in this outcome area is good. Prior to admission the needs of prospective residents are assessed by an experienced manager to ensure the home can meet those needs and to minimise the chances of admitting a person whose needs it cannot meet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three people have taken up residence since June 2006. Referrals to the home are organised through community mental health teams and would usually have had their needs assessed by a care manager under care programme approach (CPA) arrangements. Some new residents may already have been receiving support from Response through their supporting living schemes elsewhere in Oxford and would have been admitted following a change in their needs. Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 10 The files of two of the three new residents were examined. Prospective residents have their needs assessed by the registered manager. The assessment is comprehensive and is recorded on a ‘Combined Assessment Pack’ form. This includes assessment of the person’s history, personal skills, financial status, personal abilities, mental health needs, and risk. A ‘Needs Assessment Form’ is also completed which includes information on the person’s like and dislikes, medication, general health, social needs and social relationships. This is a thorough assessment process. The registered manager liaises with other health and social care professionals as required. Initial acceptance of a referral after assessment would normally lead to the prospective resident being invited to view the home. This may include or be followed up by an invitation to lunch to meet current residents. Acceptance by both parties leads to admission and a review of the position at six weeks or so. The outcome of the assessment informs the decision on whether the home can meet the prospective residents needs. Since the last inspection in February 2006 the home has not admitted someone whose needs it cannot meet. A resident admitted in mid 2006 said that the home suited his position at present. He said that he found the level of support about right and was quite settled there for the time being. The home does not offer Intermediate Care therefore Standard 6 (OP) does not apply to this service. There is no equivalent in the 18-65 standards. Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 (18-65) 7 and 14 (OP) Standard 33 (OP) has been assessed under ‘Conduct and Management of the home’ below. Quality in this outcome are is good. A comprehensive care plan is in place for each resident. Care plans include risk assessments and evidence of liaison with health and social care agencies in the community. The views of service users are sought through regular meetings and an annual survey. These activities aim to ensure that residents’ needs are met, that their independence is supported, and that residents can influence life in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A service user plan is in place for each resident. Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 12 The plans examined were comprehensive and in good order. Plans included the following sections: a description of the resident, monthly weight, a Barthel Assessment of needs (a standardised tool for assessing daily living skills and independence), the needs assessment and combined assessment forms mentioned in the previous section, risk assessments, and notes on personal abilities. A care plan is drawn up based on the information in each section. Care plans are typed and include (among others) personal care, mental health, communication, social networks, and safety. One care plan was informed by some very good notes from a linked supported living project. The care plan includes liaison with CPA care managers. 6 of 13 residents had care managers who were responsible for co-ordinating the wider community care plans of those individuals. Care plans are reviewed in the home monthly. Only residents on the CPA have regular multi-agency reviews. Files included correspondence with relevant healthcare professionals. The notes written daily by home staff were surprisingly brief for this type of service and mainly consisted of accounts of physical care given. They did not include the range of care or interactions with residents which staff were observed to participate over the course of this inspection visit. Risk assessments are in place and those examined included smoking, falls, and getting off of buses. Staff were also aware of the risks for many residents of going out of the home alone. Staff support residents in maintaining their independence. Information on advocacy organisations was on display on a notice board in the dining room. Advocacy is also mentioned in the complaints procedure and service user’s guide. The manager reports that house meetings are held quarterly (although only the notes of the October 2006 meeting were immediately to hand during this visit) and residents’ views are also sought in the annual survey in which the ‘Questionnaire on Living in the Home’ is completed. The organisation hold a service users forum in which the home is represented. Residents seemed quite happy with the home and many were complimentary about the service provided. Staff appeared to have a supportive relationship with residents and were observed to encourage residents to decide for themselves what they would like to do. Resident respondents who returned questionnaires were positive in their views of the home. Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. 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. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 14 12, 13, 15, 16 and 17 (18-65) 12, 13 and 15 (OP) Quality in this outcome are is adequate. Residents in this home encompass a wide range of age and ability and are well supported by the service it provides. However, the level of participation in activities is reported to have declined in recent months and the home needs to conduct a reappraisal of its social and leisure activities. Otherwise residents may not be provided with opportunities to maintain and develop their personal interests and skills. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents in the home are of an older age group and tend to be less active – 9 of 13 were aged 70 and above on the day of the inspection visit. It was reported that although residents used to attend a range of activities in the community they have gradually withdrawn from these over time. Such activities used to include ‘The Railway Lane’ club in which four or five residents would attend for the day and play board games, quizzes, bingo and other activities. Two or three residents used to go to another Response house for lunch and games on Thursdays but have now ceased to attend. One resident talked of gradually returning to employment. The manager indicated a willingness on the part of the home to work with other agencies in the community in supporting a resident with such aspirations to begin working towards that goal. For the majority of residents in this home Standard 12 of the 18-65 standards will not apply. The home has two televisions, DVD/video players, board games, books and newspapers. Some residents occasionally like to knit. Some residents used to go on holiday to Bournemouth but are reported to have not shown much interest recently. Response organises Christmas parties at different houses and some residents have attended those. The home had a minibus. However, in 2006 it was set on fire by vandals. It was regularly used to take residents out to lunch at a local pub on Sandford Lock, to garden centres or to a riverside pub in Witney. It is to be hoped that it will be replaced in 2007. Most residents now lead a relatively sedentary life, watching TV, smoking or knitting. Some go shopping with staff at the nearby Cowley shopping centre. There is a payphone for resident’s use in the entrance hall. Some residents have retained links with their families and one resident goes home every weekend. The residents’ seemed quite happy with life in the home. On the day of inspection most sat watching TV in either the smoking or non-smoking lounge, Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 15 some occasionally read a newspaper or magazine, chatted or just observed home life. Residents were positive in their views of the home. They said it was “a good home”, that everything was “all right”, that it was “fine”, a “good place, I feel well supported”. One resident said that he appreciated the kitchen being open all day. This aspect of the home’s life was discussed with the registered manager. The manager confirmed that activity had declined as residents had grown older. Many residents had shown less interest in going out, in participating in games or in any organised activity. The manager encouraged stimulation by staff sitting and chatting, encouraging activity (such as knitting) or encouraging residents to make hot drinks for themselves. She wasn’t sure if the decline in interest in day clubs would continue. The manager had acquired a package aimed at providing activities in residential and care homes and was intending to address this with the new deputy manager who was due to take up post in the near future. It was agreed there was an issue to be explored here, but also that there was unlikely to be a simple ‘one size fits all’ answer. According to information supplied by the manager the ages of residents at the time of this inspection ranged from 55 to 90. The median age was 76. The range of ability varied widely as well. Ability is influenced by a range of factors, particularly in a specialist service such as this. The falling off in interest in activities needs to be addressed by managers taking account of those factors. Some residents have retained links with their families and one resident goes home regularly at weekends. Residents may see friends, relatives and others in private if they wish. There is a pay phone for residents use. Residents follow their own daily routines as agreed in their care plan and in accordance with house routines, such as mealtimes. Most residents tend to get up early. As indicated above, interest in activities has declined recently and many residents now appear content taking life at an easier pace. Staff do not enter residents rooms without permission and do not open mail addressed to service users. On the day of this inspection visit staff were noted to be responsive to the needs of residents. It was felt that a positive relationship existed between staff and residents. Meals are prepared by staff in the home. It has recently appointed a care worker whose main responsibility is to prepare and cook lunch, the main meal of the day. Breakfast is served between 6:00 and 10:00 am and consists of cereals, toast, and preserves, boiled eggs, bread and beverages. Lunch is served between 12 noon and 1:00 pm. It consists of a main course accompanied by vegetables, followed by dessert. Sample choices in the menus supplied included; Roast Beef, Yorkshire Pudding, Vegetables followed by Peaches and Ice Cream (Sun), Gammon, Creamed Potatoes, Peas followed by Fruit and Cream (Tue), and Shepherds Pie, Fresh Vegetables followed by Swiss Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 16 Roll and Custard. On Friday residents are offered ‘Choice from Chip Shop, Choice of Pudding, Drinks’. The evening meal is served between 5:00 and 6:00 pm and is a lighter meal. Sample choices from menus supplied included Sandwiches and Fruit or Cakes (Sun), Cheese Salad or Rolls followed by Jelly and Fruit (Sat), or Eggs on Toast followed by Angel Delight (Wed). A snack supper is served with drinks between 8:00 and 9:00 pm. This may include filled rolls, malt loaf, or cheese and biscuits. It was noted that on the day of inspection the main choice for lunch was Toad in the Hole with Vegetables while for the evening meal the main choice was Sausage Rolls. While the residents enjoyed both it did not seem to be the healthiest of selections on the same day. Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21 (18-65) 8, 9, 10 and 11 (OP) Quality in this outcome are is good. Guidance and support is provided to service users when required. Arrangements for liaising with healthcare services in the community and for the control and administration of medicines appear satisfactory. This ensures that service users receive appropriate support in meeting their healthcare needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents and staff interact well together. Staff were observed to be attentive, supportive and to adapt their approach to different residents. Staff turnover is reported to be low and the staff and residents appear to know each well. Resident’s preferences appeared to be taken account of. Personal care is Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 18 provided in the resident’s bedroom or in bathrooms. Individual preferences are taken into account. All residents are registered with a GP and personal files included evidence of contact with GPs and other health services in the community. The community mental health team (CMHT) are a key resource to the home. Specialist mental health services are accessed through the CMHT and it also used to access podiatry, dentistry and an optician. District nurses are accessed through the GP. Tissue viability nurses and special equipment (such as pressure relieving mattresses) are arranged through district nurses. Four GPs and one CPN respondents who returned questionnaires were all positive in their views of the home. None had received any complaints about it. All expressed satisfaction with communications, with a senior member of staff being available to confer with, with staff understanding of residents’ needs, and the majority with their advice being incorporated into the care plan (one GP answered ‘I’ve never asked’). All thought that medication was appropriately managed in the home. The organisation has a policy governing the administration of medicines. The administration of medicines is included in the staff training programme. Training takes place at the head office and staff competence is assessed by the manager. A copy of the 2003 Royal Pharmaceutical Society Guidelines on the storage, control of medicines in care homes was available for staff reference. At the time of this inspection no resident was administering his or her own medicine. The manager said that this would be easy to arrange if necessary. Medicines are prescribed by GPs and are supplied by a nearby Sainsbury’s pharmacy. Most tablet medicines are supplied in individual dosset boxes (a container which is a hard plastic grid with clear plastic windows that are labelled with the days of the week) and are delivered weekly. There is a record of medicines returned to the pharmacy. Medicines are stored in a portable metal cabinet which is kept in the office when not in use. Medicines requiring cool storage are kept in the fridge in the kitchen. The manager said that the home has considered whether to obtain a medicines fridge but it is felt that the small amount of medicines requiring such a facility and the relatively infrequent need would not justify the cost. The alternative is to continue storing such medicines in the fridge. These must be stored in an individual container, preferably lockable (such as a small metal cash box). Two MAR (Medicines Administration Records) sheets were checked and appeared to be in order. The home has a policy to guide staff caring for a resident who is dying and in the event of death. The policy is essentially a statement of the standard (standard 21 (18-65) or 11 (OP)) with some additional paragraphs towards the end. Staff have experience of such events and the organisation provides training on loss and bereavement. The home liaises with the resident’s GP, district nurses and other healthcare services (such as the ‘Respiratory Care Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 19 Team) as required. The welfare manager liaises with social services where necessary. The event is discussed with staff at supervision. Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 (18-65) 16 and 18 (OP) Quality in this outcome are is adequate. The home has a policy and procedure for recording and investigating complaints. It has a framework of policy, reporting arrangements and staff training with regard to the protection of vulnerable adults (POVA). Together, these aim to protect residents from abuse and to ensure that complaints are properly investigated. However, some staff had not yet attended POVA training and this potential weakness in staff knowledge could place residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy, this is available in the office and a copy is also available for residents in the lounge. The home retains a record of complaints. No complaints are recorded as having been received since the last inspection and CSCI has not received any complaints about this service during this period. A resident was asked to whom she would complain if dissatisfied. She said that she would complain to the manager but was keen to add that she no complaints at all about the home. The home has a policy governing practice with regard to the protection of vulnerable adults and abuse. The subject is included in the staff training Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 21 programme. Staff spoken to expressed confidence in the manager of the home and of the wider organisation to thoroughly investigate any reports of abuse. However, staff seemed rather unclear on the organisation’s policy and procedure, were not aware of current local joint statutory agency arrangements or of alternative reporting channels outside of the organisation. Information on advocacy organisations is available if required. The home’s arrangements for the management of residents’ finances appear satisfactory (see narrative under ‘Conduct and Management of the home’ below). All residents are registered to vote; three are reported to have done so at the last election. Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 (18-65) 19 and 26 (OP) Quality in this outcome are is good. The home is located in a residential area which is served by public transport. The home is a large bungalow which is comfortably furnished, it has adaptations to assist residents with mobility problems, and appears to meet the needs of current residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is located in Littlemore, a residential area which is just over four miles from the centre of Oxford. The area is served by buses (hourly service Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 23 reported). There is some car parking to the front of the home and in nearby streets. The home is a large detached bungalow set in its own grounds. There is a small sheltered garden to the rear. The garden had seating and a barbeque area on a patio which is reported to be frequently used in good weather. This inspection took place on a cool January day and the garden furniture and barbeque were wrapped up for the winter. Entry to the home is controlled by staff. The accommodation is on one level and all areas are accessible to residents. The accommodation consists of an entrance hall, staff office, one lounge – non-smoking, a conservatory – for residents who wish to smoke, dining room, kitchen, laundry room, nine single bedrooms and two double bedrooms, two bathrooms (one with chair lift), two showers and five WCs. Bedrooms are furnished with a bed, bedside table, wardrobe, and seating. Each bedroom has a sink but none have en-suite facilities. The individual sleeping areas in the shared rooms were separated by curtain. The lounge, dining room and conservatory were comfortably furnished. It was noted that a box of disposable gloves had been left out in the hallway. This practice is unlikely to be in keeping with the ethos of such a home. The home was generally tidy, in good order and all areas visited were clean. The general state of décor was good but the home will require an ongoing programme of refurbishment in order to continue to provide a comfortable home for residents. The kitchen has been refurbished over the past year or so and standards of cleanliness were high despite the fact that it was visited just before lunch and while the evening meal was being served. The laundry room seemed rather small but is considered adequate for current needs. It is equipped with a washing machine and a dryer. One bathroom has a chair lift to assist residents. A mobile hoist is available when needed. Hand rails are in place around the home. All areas appeared wheelchair accessible. The residents seemed very comfortable with the accommodation. A high proportion of residents smoke cigarettes and on the day of inspection the smoking lounge seemed to be the most popular location in the house. Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 (18 – 65) 27, 28, 29, 30 and 36 (OP) Quality in this outcome are is good. Staffing levels appear satisfactory and the home, in conjunction with the organisation’s training department, provides training and staff development across a range of subjects. This helps to ensure that there are sufficient numbers of appropriately trained, supervised and supported staff to meet residents’ needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was fully staffed having less than ten hours of staff time vacant. This is considered marginal and allows the home a useful degree of staffing flexibility on occasions. Staff qualities are assessed on appointment and the staff training and development programme develops the skills and qualities Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 25 required for the work. The organisation has an Equality and Diversity Advisor and it was noted that training on equality and diversity was being advertised in the office. The home is currently not achieving the 50 target for NVQ training but expects to achieve it very soon. At the time of the inspection four staff have achieved NVQ2, two were currently undertaking training and two were registered to start in the near future. The manager is not included in these figures. The manager said that the home has a low staff turnover and the current team are experienced and have worked together for some time. The staff establishment allows for three staff in the morning, three in the afternoon (until 19:00 hours), two in the evening, and one awake plus one sleep-in at night. The manager generally works between 08:00 and 16:00 hours. A housekeeper works between 09:00 and 15:00 four days a week. One worker who has a lead responsibility for cooking works between 09:30 and 14:30 hours. This staffing is considered sufficient for the current needs of residents. A deputy manager had recently been appointed but had not yet taken up position. This is a new post, located in a key position in the home’s staffing structure. Staff recruitment is managed from the human resources (HR) department at head office. The manager is involved in the appointment of staff to the home. Staff appointed on the basis of a POVA first check in advance of receipt of an enhanced CRB certificate do not work unsupervised. Staff files are retained at head office and as agreed at the last inspection the home is supplied with a checklist which lists the documents required to conform to Schedule 2. A copy of the relevant checklist had not yet been received in the home for a recent appointment. It was said to be still with the HR department. It is important that the list is available in the home from the first day on which a new member of staff starts work with residents. In addition to confirmation of references and health status the checklist should state the date a POVA First check was received and the level of CRB and date received by the organisation. Since the registered manager is involved in staff appointments it is assumed that she would have access to information which would enable her to check an applicants full employment history, the relationship of referees to the applicant, and the reasons why an applicant left a previous position which involved working with vulnerable adults or children (verified where practicable). Response is an ‘Investors In People’ accredited organisation and the HR manager has a lead responsibility for staff training and development. Newly appointed staff attend a comprehensive induction programme and all staff have access to training course on a wide range of subjects over the course of the year. Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 26 Training has included the mandatory subjects of fire safety, first aid, food hygiene and infection control. It has also included medicines administration, protection of vulnerable adults, managing falls, professional boundaries, equality and diversity, bullying and harassment, crisis management and personal safety. Staff are supported in pursuing NVQ’s. A system of personal supervision is in place. Meetings are planned and recorded and the process is structured but time is allowed for discussion of anything else a member of staff might wish to discuss. All care staff receive supervision every two months. All care staff have an appraisal once a year. Staff spoken to on the day of the visit seemed satisfied, comfortable and confident in their work and confirmed access to training, supervision and appraisal. Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 28 37, 39, 42 and 43 (18-65) 31, 33, 35 and 38 (OP) Quality in this outcome are is good. This judgement has been made using available evidence including a visit to this service. This is a well managed home in an organisation which has good arrangements for consulting residents. Residents should benefit by having their views taken into account and through having influence on the delivery of the service. Arrangements for health and safety appear thorough and aim to ensure the safety of residents, staff and visitors. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered is experienced and well qualified. The manager has held the post for six years. She has acquired NVQ at levels 2, 3 and 4 and the Registered Manager’s Award (RMA). Over the past year the manager has attended training events in managing teams, managing change, management styles, professional boundaries and a first aid update. The manager is an NVQ assessor and mentor to staff undertaking the Certificate in Mental Health Care Studies at NVQ equivalent levels 2 and 3. Response carries out an internal organisation wide quality assurance exercise once a year. To date the survey has not included external stakeholders. This was conducted in September 2006 and is the third year in which it has been carried out in this home. The survey looks at the following features of the service: catering and food, personal care and support, daily living, premises, and management. The results are recorded on a four point rating scale which range from ‘Very Satisfied’ to ‘Not satisfied at all’. The questionnaire includes space for free text on two questions: ‘Is there anything you don’t like about the service?’ and ‘What can we do to improve the service?’. All residents are involved. The results are collated, analysed and reported on by the manager. The manager said that a copy of the results are sent to CSCI, a copy is posted on the residents notice board and they are discussed at a house meeting. It was reported that the one item needing action from the 2006 survey were reports that meals are rushed on occasions. Residents are consulted through quarterly house meetings and the organisation hold a quarterly Service Users Forum. The home has four representatives who attend. Arrangements for maintaining safe working practices appear satisfactory. The home has public liability insurance to June 2007, the certificate of which is appropriately displayed. The Health and Safety Executive workplace poster is on display in the office. Response has a health and safety policy and health Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 29 and safety committee. The manager is the home’s representative on the committee. Staff are trained at basic and update levels, training courses being offered at various times throughout the year. The subject is included in NVQ training and more advanced training, which may include distance learning modules, is on offer for more experienced staff. The organisation has recently issued all staff with a copy of a commercially produced booklet on health and safety matters (‘Health and Safety at work in registered care and nursing homes ‘ produced by Scriptographic publications). The manager said that this will be discussed with staff at individual supervision sessions. Systems are in place for recording accidents and incidents. Examination of these records showed that a number of residents had experienced falls. The manager said that staff have received training in falls risk assessment and management and that the home had been visited by the falls team who are based in Witney. The environment is all on one level and grab rails are in place around the home to support residents at risk of falling. COSHH (Control of Substances Hazardous to Health) materials are stored in a locked cupboard when not in use. A poster on COSHH is on display in the office. The manager reported on a range of health and safet matters in the preinspection questionnaire and this was updated during the visit to the home. This included the most recent visit by a fire officer, contracters checks on fire safety equipment and emergency lighting, fire risk assessment, fire training for staff, fire drills, and routine fire safety checks in the home. These were in order and are particularly important in a home in which a large number of residents are smokers. The report also covered checks on gas equipment, portable electrical appliances, maintenance of hoists (one mobile and one fixed in a bathroom), emergency call system and the contract for the disposal of soiled waste. These appeared to be in order with the exception of one item, a copy of the certificate of safety for the home’s fixed wiring. The manager thought that this was probably with the housing association which owns the home and she undertook to obtain a copy. Of note is the inspection by the environmental health officer in October 2006 who, the manager reports, commended the home on standards of cleanliness ad hygiene in the kitchen. The arrangements for dealing with residents finances appear satisfactory. Staff practice is governed by the policy and procedures of the organisation. The welfare officer acts as appointee on behalf of residents where necessary. An account is opened for each resident. Statements of account are issued Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 30 quarterly or more often if requested. Capital sums are invested in an interest bearing account. An amount of cash is held in the home for each resident. All transactions are recorded and receipts are retained. The balance for two residents were checked at the time of the visit and were found to be correct. The home’s arrangements are audited monthly by the welfare manager. A number of residents decide to spend a proportion of their money on cigarettes. It has been agreed that these can be bought in bulk because of the price advantage and the costs apportioned according to consumption. Receipts and records are retained and this too is subject to audit. The home appears to be well supported by the organisation. Insurance cover is in place. Lines of accountability both within the home and to the larger organisation are clear. A business plan was not available for this inspection but the manager said that the home’s future development, along with other services, will form part of the organisation’s larger development plan covering the next three to five years. Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 31 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 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 2 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT Standard No Score 37 4 38 X 39 3 40 X 41 X 42 3 43 3 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Iris Hayter House Score 3 3 3 3 DS0000013093.V325471.R02.S.doc Version 5.2 Page 32 No 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 YA14 Regulation 16(2)(n) Requirement The registered manager is required to conduct a thorough reappraisal of the range of activities available to residents. The process should take account of individual and group needs. Timescale for action 31/03/07 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 YA23 YA34 Refer to Standard YA20 Good Practice Recommendations It is recommended that on occasions where medicines are required to be stored in a refrigerator that such medicines be stored in a sealed container. It is recommended that all staff attend the organisation’s training on the protection of vulnerable adults as soon as practicable. It is recommended that the checklist in which Schedule 2 information is recorded be amended to state the level of CRB and the date on which a POVA and CRB certificate is received. DS0000013093.V325471.R02.S.doc Version 5.2 Page 33 Iris Hayter House 4 5 YA34 YA42 It is recommended that the checklist in which Schedule 2 information is listed be available in the home from the day on which a member of staff starts work. It is recommended that the registered manager obtain a copy of the certificate of safety for the fixed wiring in the home. This should be retained for inspection. Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. Iris Hayter House DS0000013093.V325471.R02.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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