CARE HOMES FOR OLDER PEOPLE
Little Hayes Care Home 29 Hayes Lane Kenley Surrey CR8 5LF Lead Inspector
Alison Ford Key Unannounced Inspection 20th April 2006 11:00 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 Little Hayes Care Home DS0000019033.V289162.R01.S.doc Version 5.1 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. Little Hayes Care Home DS0000019033.V289162.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Little Hayes Care Home Address 29 Hayes Lane Kenley Surrey CR8 5LF 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) 020 8660 6626 020 8668 2449 Diplotec Ltd Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Little Hayes Care Home DS0000019033.V289162.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 15th September 2005 Brief Description of the Service: 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. 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. The stated aim of the home is to provide its service users with a secure, relaxed and homely environment in which their care, well being and comfort is of prime importance. Little Hayes Care Home DS0000019033.V289162.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes first inspection of the year 2006 and was an unannounced visit lasting six hours. During this time a tour of the premises was undertaken, records relating to the health and safety of residents and recruitment of staff were viewed and several of the forty-one current residents, relatives who were visiting and staff members were spoken with. Eight residents care plans were also assessed. Following the inspection, a conversation was also had with one of the GP’s who visits. At the time of the inspection, fees ranged from £524 - £625 per week with extra charges payable for items such as newspapers and hairdressing. These would be discussed with the home prior to admission. The Commission for Social Care Inspection is awaiting an application to consider the manager of the home for registration although she has previously been registered in a similar role. The home is currently applying to the Commission to vary its registration to allow the admission of an unspecified number of residents who have dementia. What the service does well: What has improved since the last inspection?
Previous inspections highlighted a number of areas of concern within the home, which the current manager, who is still awaiting registration, has been working to address. Since the last inspection a deputy manager has been appointed to help her and although there is still a great deal to do, they have obviously been working hard to improve standards within the home. There has been an emphasis on staff training, which is often undertaken in conjunction with staff from the other two homes owned by the same providers.
Little Hayes Care Home DS0000019033.V289162.R01.S.doc Version 5.1 Page 6 Staff were able to confirm that they had been able to access training appropriate to the work that they undertook and that it had helped them to understand the needs of residents. Staffing numbers have been increased since the last inspection and an extra trained nurse is now on duty at night. While acknowledging that this is an improvement, if the home were to be granted the variation of registration to allow residents with dementia to be admitted this may need to be reviewed further. Adaptations are currently being undertaken to aid residents who may be confused. Picture signs are being put up and areas are being ‘colour coded’ in order to help. Additional handrails are being fitted in the corridors and a new shower room is being installed. In order to provide extra interest and stimulation for residents, a new activities coordinator has been appointed and will shortly begin working three afternoons per week. What they could do better:
Although all the residents and relatives that were spoken with expressed their satisfaction with the service, some of the documentation to support the care that is being given is still in need of attention. Care plans are still not always reflective of the care and support needed by residents and there is not always evidence that all identified problems have been considered. If the home is going to admit more people with dementia there will also need to be more thought given to undertaking some life history work which may inform residents current behaviour patterns Some areas of the home would benefit from redecoration to make them more pleasant for residents and there were issues about their safety in the event of a fire. Automatic door closers must be fitted to bedroom doors if residents wish them to be kept open and not all radiators have been covered to ensure that residents do not injure themselves. A window restrictor must be repaired and some residents still do not have the option of locking their doors if they wish to. One area of the home is without sluicing facilities and this will need to be addressed. In order that residents can be confident that staff are supported to carry out their work, staff meetings and supervision must be introduced. Little Hayes Care Home DS0000019033.V289162.R01.S.doc Version 5.1 Page 7 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. Little Hayes Care Home DS0000019033.V289162.R01.S.doc Version 5.1 Page 8 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 Little Hayes Care Home DS0000019033.V289162.R01.S.doc Version 5.1 Page 9 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): 3,6 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. There is information available to allow potential residents to make an informed choice about the suitability of the home and pre-admission assessments generally ensure that residents healthcare needs will be met. This home does not offer intermediate care; this standard does not apply. EVIDENCE: Eight care plans were inspected and they all contained evidence that preadmission assessments had been completed although it was noted that several residents appeared to have some degree of confusion which had apparently developed since the time of their admission. The relatives spoken with confirmed that they had been happy with the information that they had been given prior to admission and the help that they had received. Little Hayes Care Home DS0000019033.V289162.R01.S.doc Version 5.1 Page 10 Little Hayes Care Home DS0000019033.V289162.R01.S.doc Version 5.1 Page 11 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, Quality in this outcome area is poor . This judgement has been made from evidence gathered both during and before the visit to this service. Residents cannot be certain that care plans are sufficiently detailed to acurately reflect the care and support that they currently require or that they are protected by the homes medication procedures. Residents can be sure that they will be treated with dignity and in a manner which reflects their privacy. EVIDENCE: Eight care plans were seen at this visit. Despite obvious improvements there was still a lack of identification of residents social care needs. There was limited evidence of life history work which provides information about residents lives in order to understand their present needs and behaviour.Obtaining this will be especially important if the home begins to admit residents with dementia. Little Hayes Care Home DS0000019033.V289162.R01.S.doc Version 5.1 Page 12 Not all of the care plans included a photograph of the resident and some had no identified key-worker, It is recommended that these should be incorporated. Some residents appeared not to have an action plan plan for all their identified problems and not all of them had evidence of regular review. Care must be taken to ensure that this occures on a regular basis to ensure that residents healthcare needs continue to be met. No care plans were seen for interventions in wound care although it was later found that they were all in a file held centrally.This also contained photographic evidence of the evaluation of the wound healing process. A file was also seen that showed that consultation had been sought regarding the action to be taken should a resident become very unwell or die. It was suggested that this should also mention the policy of the home with regard to resuscitation while acknowledging that these descisions are not the responsibilty of residents relatives. Medication records were seen and were in order although it was noted that there was no indication on eyedrops of the date of opening. Procedures are in place to deal with unwanted medication. Residents confirmed that they were always treated kindly and staff were observed to be acting in a pleasant and caring way. Little Hayes Care Home DS0000019033.V289162.R01.S.doc Version 5.1 Page 13 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 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents in the home can be sure that although current activities are limited there are plans in place to improve this situation to offer them extra interest and stimulation .They can be assured that meals are suitable and varied with choices that will suit their preferences. EVIDENCE: There were photographs of various activities that had taken place and an activities programme was on the board. A new activities coordinator is about to start work three afternoons a week. This will provide extra interest and stimulation for those who wish to join in. Relatives explained that they are always made welcome in the home and are able to visit whenever they wish. Residents confirmed that they are able to exercise choices in their daily lives regarding the clothes that they wear and meals that they eat. It was observed that one resident did not wish to get out of bed until much later in the day and this was respected. Little Hayes Care Home DS0000019033.V289162.R01.S.doc Version 5.1 Page 14 All those spoken with agreed that the food served in the home was very good; and there was always a choice. Picture menus were available for some dishes and this will be developed further if residents with dementia are admitted into the home. Little Hayes Care Home DS0000019033.V289162.R01.S.doc Version 5.1 Page 15 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): Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents can be sure that their concerns will be listened to and acted upon appropriately and that procedures to ensure their protection have improved. EVIDENCE: The complaints book was seen and the one entry showed that the issue had been dealt with appropriately. Relatives and residents that were spoken with were confident that any concerns that they had would be acted upon. Staff that were spoken with displayed knowledge of issues around adult abuse and a training session was being held on the afternoon of the inspection. It was noted that in two cases where concerns had been raised about staff behaviour, in the past, they had been disciplined internally and not referred under the correct procedures. The current Manager displayed an understanding of the actions that should be taken in similar instances and was certain that it would be done correctly in future. Little Hayes Care Home DS0000019033.V289162.R01.S.doc Version 5.1 Page 16 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): 19,26 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service Most of the home offers safe comfortable accommodation for residents however, to improve the environment for all residents, other areas would benefit from redecorating and there are also concerns about resident’s safety in the event of fire. EVIDENCE: A tour of the premises revealed that on the day of the inspection the home was clean and tidy. One corridor was slightly malodourous and this has apparrently been an ongoing problem. Some of these rooms and a bathroom also need redecorating, some radiators are still not covered, some bedroom doors still do not have locks.The window in one room had a restrictor that was broken and must be repaired. A plan must be submitted outlining when this work will be completed.
Little Hayes Care Home DS0000019033.V289162.R01.S.doc Version 5.1 Page 17 It was noted that some bedroom doors were wedged open. These should be kept shut however, if a resident wishes them to be left open an automatic door closer which operates in the event of a fire must be fitted. Extra handrails are currently being fitted, sineage is being improved and areas of the home are colour coordinated to help orientate residents. It was noted that ”the blue section “ does not have a sluicing disinfector.This must be installed if residents wth dementia are to be admitted in future. Wheelchairs were seen stored in a stairwell and could present a fire hazard; a cupboard must be built if this area is to be used for storage. Little Hayes Care Home DS0000019033.V289162.R01.S.doc Version 5.1 Page 18 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 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service Residents can be sure that current staffing levels and staff training will ensure that their needs are met and recruitment procedures are in place to ensure their protection EVIDENCE: Staff rotas were seen. A long standing issue has been adressed and staff numbers have increased. These are currently adequate however may need to be increased if more residents with dementia are admitted.This situation is exacerbated by the sprawling layout of the home which is very confusing. Staff training is ongoing and the manager has lots of ideas about training for the future.Recent training has included first –aid , dealing with challenging behaviour, wound care, COSHH and continence. All the care staff have completed or are undertaking NVQ level2 or above. Recruitment procedures have caused concerns in the past however at this visit five staff file were seen and were all in order. They included evidence of clearance from The Criminal Records Bureau and work permits where required. Little Hayes Care Home DS0000019033.V289162.R01.S.doc Version 5.1 Page 19 Little Hayes Care Home DS0000019033.V289162.R01.S.doc Version 5.1 Page 20 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): 31,33,36,38 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The lack of registration of the person in chargeof the home means that residents cannot be sure that it is managed by a suitably qualified and experienced person. Residents cannot always be certain that all necessary policies and procedures are in place to ensure their safety and wellbeing. EVIDENCE: The current manager is a trained nurse with additional qualifications and previous experience in a similar role and displayed a thorough understanding of all the relevant issues. However, her lack of registration means that she has not undertaken the processes to provide evidence of her suitability and this must be addressed.
Little Hayes Care Home DS0000019033.V289162.R01.S.doc Version 5.1 Page 21 Staff are informed of changes that occurring through a newsletter although opportunities for feedback are limited. Staff meetings must be introduced to give them a forum to air their views. Relatives and residents meetings are held every two months to allow an opportunity for the running of the home to be influenced by those who are using the services. Staff supervision is not occurring on a regular basis and a programme to introduce and manage this must be devised and will be monitored at future visits. Certificates of worthiness and other records providing evidence of the homes commitment to the health and safety of its residents were seen. These were mainly in order although there was some confusion about the 5-year electrical safety check. A valid copy of this must be sent to the Commission for Social Care Inspection office. Little Hayes Care Home DS0000019033.V289162.R01.S.doc Version 5.1 Page 22 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X 1 X 2 Little Hayes Care Home DS0000019033.V289162.R01.S.doc Version 5.1 Page 23 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 OP7 Regulation 15 Requirement The home manager must ensure that care plans are reviewed regularly to ensure that they reflect the care and support that is currently required and that residents healthcare needs remain met. Service user plans must include reference to social care needs. (Previous timescale 30/09/05 not met) The home manager must ensure that a care plan is in place for each of a residents identified problems. The home manager must ensure that eye drops are dated on opening. The Registered Provider must supply an action plan detailing when the redecoration of the home will be completed. The Registered Provider must ensure that all radiators in the home are covered. The Registered Provider must ensure that all bedroom doors are fitted with appropriate locks
DS0000019033.V289162.R01.S.doc Timescale for action 30/07/06 2. OP7 15 30/07/06 3 OP7 15 30/07/06 4 5 OP9 OP19 13(2) 23(2)(d) 20/04/06 30/07/06 6 7 OP19 OP19 13(4)(c) 13(4)(c) 30/07/06 30/07/06 Little Hayes Care Home Version 5.1 Page 24 8 OP19 23(2)(k) 9 OP19 13(4)(c) 10 11 OP19 OP19 13(4)(c) 13(4)(c) 12 OP31 8(1)(a) 13 OP36 18(2) 14 15 OP36 OP38 24 13(4)(c) operable from the outside in the case of an emergency, In the event of a variation in registration being approved to admit an unlimited number of residents with dementia the Registered Provider must provide an additional sluicing disinfector. The Registered Provider must ensure that automatic door closers, working in the event of a fire, are fitted to the bedroom door of any resident wishing their door to be kept open. The Registered Provider must ensure that the window restrictor in room 36 is repaired. The Registered Provider must ensure that if wheelchairs are to be stored in the stairwell a cupboard is built for them. The Registered Provider must ensure that a suitable person is put forward to be registered as manager of the home. The home manager must ensure that there is evidence that all staff have had supervision sessions at least every two months. The home manager must ensure that regular staff meetings are held in the home. The Registered Provider must ensure that a copy of a valid electrical safety certificate is sent to the office of The Commission for Social Care Inspection. 30/12/06 30/07/06 30/07/06 30/07/06 30/07/06 30/07/06 30/07/06 30/07/06 Little Hayes Care Home DS0000019033.V289162.R01.S.doc Version 5.1 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP8 OP8 Good Practice Recommendations It is recommended that all care plans have a photograph of the resident on them and the name of the allocated key worker. It is recommended that relatives and residents are made aware of the homes policies regarding resuscitation Little Hayes Care Home DS0000019033.V289162.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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