Inspection on 10/03/09 for Little Hayes Care Home

This inspection was carried out on 10th March 2009.

CSCI found this care home to be providing an Adequate service.

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

Little Hayes Care Home 22/12/09

Little Hayes Care Home 07/10/08

Little Hayes Care Home 15/01/08

Little Hayes Care Home 29/06/07

Little Hayes Care Home 07/03/07

Little Hayes Care Home 20/04/06

Little Hayes Care Home 15/09/05

Little Hayes Care Home 27/06/05

Little Hayes Care Home 12/11/04

Little Hayes Care Home 24/06/04

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Henry Nihill House

Birchwood

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Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 20/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Little Hayes Care Home 29 Hayes Lane Kenley Surrey CR8 5LF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alison Ford     Date: 1 0 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Little Hayes Care Home 29 Hayes Lane Kenley Surrey CR8 5LF 02086606626 02086682449 littlehayes@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Diplotec Ltd care home 50 Number of places (if applicable): Under 65 Over 65 10 40 dementia old age, not falling within any other category Additional conditions: 0 0 Daytime staffing levels would have to be:- 4 Qualified nurses and 8 care assistants between 8:00am and 2:00pm. 3 Qualified nurses and 7 care assistants between 2:00pm and 8:00pm. Nighttime staffing levels would have to be: - 2 Qualified Nurses and 3 Care assistants between the hours of 8:00pm and 8:00am. Date of last inspection Brief description of the care home Little Hayes is a 50-bed home, which offers nursing care to the elderly. The home is situated in Kenley, an attractive semi-rural area that is in close proximity to a mainline rail station and good road and bus links. The only potential difficulty with access is that the visitors on foot would have to climb a short, but steep hill to the home. The home offers 36 single bedrooms and 7 double bedrooms over two floors, some with en-suite facilities. There are two passenger lifts for ease of access although the home is very spread out in its layout and it is quite disorientating at first. There are various communal areas available for all of the residents and a garden. The stated aim of the home is to provide its residents with a secure, relaxed and homely environment in Care Homes for Older People Page 4 of 27 0 7 1 0 2 0 0 8 Brief description of the care home which their care, well being and comfort is of prime importance. Copies of the Statement of Purpose for the home and the latest inspection report can be requested from the home. Inspection reports can also be obtained from The Commission for Social Care Inspection via the internet. At the time of this latest inspection fees ranged from £390 - £680 depending on the room occupied and the dependency of the resident. These and any extra charges payable would be discussed prior to admission. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This report follows an unannounced visit to the service by two inspectors. The last inspection, in October 2008, resulted in us making several requirements and there had also been a series of safeguarding issues raised which were being addressed according to local authority procedures. It was acknowledged that a new manager had just been appointed to the home and the Care Home Support Team began working with them to improve the outcomes for the people who were living there. During this time the admission of people who are funded by the local authority has been restricted. At this visit we concentrated on looking at the progress the home had made in Care Homes for Older People Page 6 of 27 complying with the requirements we made. We also considered notifications that we had received about the home and comments from people who use the service. We walked around the home and spoke with several of the people who live there and also to some of the members of staff on duty. We looked at the documentation that the home is required to keep as evidence of its commitment to the health and safety of residents and staff, including care plans, medication records and staff files. The home had previously sent us their Annual Quality Assurance Assessment, which tells us how they are delivering their service and about their plans for the future, and also an action plan outlining how they intended to comply with the requirements that we set. What the care home does well: What has improved since the last inspection? What they could do better: The overall rating for the service was influenced by the fact that we found medication left in the office which was unlocked. Some of the residents in this home walk around and come into the office and we considered that there could have been a risk to their safety. We have referred this concern to The Commissions enforcement team. Some residents told us that they would appreciate more to do in the day and we discussed this issue with the manager. Although there are some structured activities in place they are quite limited and she has recognised this and is hoping to appoint someone who will fill the role of activities coordinator. Care Homes for Older People Page 8 of 27 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Anyone who moves into this home would have their care needs assessed to make sure that it was a suitable place for them to live in and they would be happy there. They would be encouraged to visit the home prior to admission if they were able to and to involve their families in the process as well. Evidence: This standard assesses the ability of the home to provide the support and services that people need to make sure that they will be happy living there. No new admissions have been made to the home since the last inspection. However, at that time we saw that any one thinking of coming to live in the home would have had an assessment, undertaken by a senior member of staff, before they moved in to make sure that the home was suitable for their needs. For people who are funded by the local authority there would also be an assessment from their Care Manager. Care Homes for Older People Page 11 of 27 Evidence: Relatives would be encouraged to be involved in the admission process and both they and the potential resident would be able to visit the home to see if it was suitable. We also saw that there was good information available from the home in the way of a Service User Guide.This document explains what residents can expect from the home.They would also be able to see the homes Statement of Purpose, which explains their aims and objectives, and a copy of the latest inspection report. The home does not offer intermediate care so this standard does not apply. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are generally having their health care needs met in a way which suits them and they are treated with dignity and respect. However, they may be at risk from the way that medication is handled in the home. Evidence: Each resident has an individual care plan which identifies where they need support to help them in their daily lives. We looked at five of them during our visit and could see that they have improved considerably since the last visit we made. The Care Home Support Team have also helped staff to ensure that the plans are a useful working document. They are more informative and we noted that residents and their families are being encouraged to become a part of the planning process. This helps to make sure that they are able to influence the way that they receive their care. Residents problems and the support that they need have been identified and the plans are reviewed regularly to ensure that any changes are noted. Risk assessments are in place where they are needed and factors which might lead to the formation of pressure sores are monitored carefully.Nutritional Assessments are in place as well. Care Homes for Older People Page 13 of 27 Evidence: At the last inspection we highlighted flaws in the way wound care was being managed in the home. This too has now improved, records are more detailed and provide evidence of the care that is being given. We had previously raised serious concerns about the medication storage and records in the home. We were pleased to note that generally this has improved. The clinical room has been refurbished, it was neat and tidy, and a new fridge has been purchased. There was no evidence of out of date medication and record sheets had been completed properly. Unfortunately the rating of this standard has been affected by a potentially serious incident that was observed. When we arrived in the home there were some bags containing empty medication cassettes in the office awaiting collection by the pharmacy. However, there were also two cassettes full of medication as well. The office door was not locked and we noted that there are some residents who walk around the home and also come into the office. Leaving medication there could, potentially,have been a risk to residents. Also, unwanted medication should not be being returned to the chemist, the home has a private contact for this in line with current regulations and there were no records available relating to the returns. In addition to the requirements that we have issued relating to these concerns, we have also referred the matter to the Regional Enforcement Team. We consider that residents are always treated with dignity and respect in the home. People that we spoke with said that staff were kind and caring, one lady told us I am very well looked after, and the staff are so kind and nice, they are really caring. Those that we observed were treating residents very kindly and were welcoming toward us. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents consider that, generally, life in the home suits them although some of them would appreciate more to do. Evidence: The people who were able to talk to us when we visited seemed to consider that generally life in the home suited them. They are able to choose how they spend their days, the food that they eat and the clothes that they wear. They all looked happy and well cared for. There is a limited range of activities organised for them to join in with and some people did tell us that they would have appreciated more to do. The homes manager is aware of the need to look at these issues and has plans to employ someone to help to do this. We saw that people are able to bring personal possessions in with them when the move in to help make their rooms more homely, many of them have ornaments and pictures or small items of furniture. The people that we spoke with said that they usually enjoy their meals although one gentleman did say its not the type of food that I am used to. We would suggest that Care Homes for Older People Page 15 of 27 Evidence: residents should be given the opportunity to voice their comments about the meals perhaps through the occasional questionnaire or an item at the residents meetings. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaint and concerns are now being responded to in a timely manner and incidents that have occurred are now being reported to us. The home has procedures in place which help to protect residents from abuse. Evidence: Although the home has always had a clear and accessible complaints procedure in place, at the last inspection we raised concerns about how any concerns were actually being handled. We found that responses had not always been timely. Also we were not always being notified of incidents that had occurred in the home. Since that time two concerns have been raised and addressed under local authority guidelines and were both judged to be unsubstantiated. However, there still seemed to be a reluctance to always inform us of incidents that affect the health and welfare of people who use the service. These notifications help to provide us with evidence that the home acts swiftly to investigate any allegations and ensure the safety of residents. The information is also essential to help us plan our inspection activity and to monitor the wellbeing of people who are living in the home. The homes manager has assured us that this issue has been adressed and that notifications are being sent to us as required by the regulations. To help protect the people in the home, from those who have been judged as being unsuitable to work with vulnerable adults new staff are not employed without Care Homes for Older People Page 17 of 27 Evidence: clearance having first been obtained from the Criminal Records Bureau. We saw the evidence of this when we looked in staff files. Staff have recently attended training sessions about adult abuse awareness and those we spoke with were able to tell us how they would report any concerns that they might have. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The redecoration and and refurbishment programme for the home is continuing in order to ensure that the home remains a pleasant place for the people who live there. The home was warm, clean and cosy on the day of the inspection. Evidence: At the last inspection it was noted that there had been a considerable amount of work undertaken to improve the home for the people who live there.This is continuing and we saw that the clinical room had been upgraded, retiled and new storage facilities provided. Residents now have a choice of communal areas to sit in or to entertain their visitors and these could also be used to provide different activities. Their bedrooms are appropriately furnished and most people have added their possessions from home in order to personalise them. The outside of the home still needs attention and we have been told that this is planned for the future. On the day of the visit the home was clean and free from any malodour. Care Homes for Older People Page 19 of 27 Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are generally enough staff on duty to meet the needs of the residents during the day and shortfalls at night are being addressed. The provision of staff training is being improved so that all staff have the skills that they need to care for the people who live in the home. Evidence: On the day of the inspection we found that there were enough staff on duty to meet the needs of the people who live in the home. Rotas confirmed this to always be the case during the day time. At our last visit we were concerned about the fact that there was only one trained nurse on duty at night with the three carers. We have been told that there are plans to employ an additional nurse and the post is currently being advertised. A deputy manager will also be starting work in the home when all of the appropriate checks have been completed. We previously raised concerns about the lack of ongoing staff training. This is now being addressed. Staff have attended sessions relating to moving and handling, risk assessment and adult protection. The Care Home Support team are also providing training relating to care planning.We have been told that more than 50 of care staff Care Homes for Older People Page 21 of 27 Evidence: have achieved an NVQ to at least level 2. We have asked the manager to produce a matrix to make it easier for us to see who has attended training sessions. Recruitment procedures appear to be robust. The home has a new administrator who ensures that all of the necessary pre-employment checks are completed before any new staff start working in the home and the eight files that we saw were all complete. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run by a suitable qualified and experienced person and in the best interests of the people that live there. We have acknowledged the measures that are being taken to improve the home, the provision of care and the opportunities for people to influence the services that they receive. Evidence: When we last visited the home the manager had been in post for two days. She is a very experienced and well qualified nurse and we have recognised the improvements that she has made in the short time that she has been at the home. Staff told us that they feel supported and that they consider the overall situation to be much better now. There have been staff meetings and all staff are now having regular supervision sessions to monitor their performance and identify any shortfalls in training. Wound care practices have improved, staff training needs are being addressed and we are being notified of untoward incidents in the home. Care Homes for Older People Page 23 of 27 Evidence: There have been two meetings for residents and their relatives and questionnaires have been distributed to to gain their views of the home. Visits made by the Registered Provider, to satisfy themselves that the home is running well, are now being recorded and kept in the home, in line with Regulation 26. Equipment and services are all appropriately maintained and a recent kitchen inspection by the Environmental Health Officer resulted in a five star rating being awarded. At the last visit there was a concern that some of the hot water temperatures were excessive. This was rectified however, at this inspection some of them were too cold. We have recommended that the temperature monitoring frequency should be increased until this problem has been sorted out. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Medication must be stored,recorded and disposed of in line with Royal Pharmaceutical Society guidelines. In order to ensure the safety of people who live in the home. 15/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 38 We have recommended that hot water temperatures should be tested more frequently to help to identify the reasons for fluctuating temperatures. Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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!