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Inspection on 27/06/05 for Little Hayes Care Home

Also see our care home review for Little Hayes Care Home for more information

This inspection was carried out on 27th June 2005.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home employs a number of capable care assistants, and they have been encouraged to play a very active part in service user care, including record keeping. It was clear that their efforts were appreciated by service users, and it is hoped that they will not be discouraged by the number of Standards that were judged to be unmet at this inspection.

What has improved since the last inspection?

Due to ongoing unacceptable recruitment practices, the home was served with an enforcement notice. On this visit, it was clear that considerable effort (largely by the home`s administrator) had gone into rectifying matters, and there was a noticeable improvement.

What the care home could do better:

Clearly, with fourteen new requirements, there are areas in which the home needs to improve. A number of these areas will be improved once staff receive adequate induction, support, and are fully aware of the importance of adequate and accurate recording. It is anticipated that the recruitment of anexperienced manager will enable the majority of the problem areas to be resolved. A more proactive approach is needed, with more attention to detail. This should lead to a reduction in the number of complaints and an improvement in the quality of the service.

CARE HOMES FOR OLDER PEOPLE Little Hayes Care Home 29 Hayes Lane Kenley Surrey CR8 5LF Lead Inspector Margaret Lynes Announced 27 & 28 June 2005, 09:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Little Hayes Care Home G53-G53 S19033 littlehayescarehome V192246 270605 stage 4.doc Version 1.30 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 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 (50) registration, with number of places Little Hayes Care Home G53-G53 S19033 littlehayescarehome V192246 270605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7/2/05 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 which 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 spread over two floors. There are two passenger lifts for ease of access. 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 G53-G53 S19033 littlehayescarehome V192246 270605 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over the course of a day, from 0930 until 2010. During that time a number of records were examined, parts of the premises were inspected and time was spent talking with service users, their relatives and staff. Due to the number of unmet requirements from previous inspections, the home received an additional visit in February of this year, and a further visit in April to investigate a complaint. Of the nine requirements that were still outstanding at the February visit, four have been met, one is no longer applicable while four still remain outstanding. The complaints visit resulted in the majority of the issues of concern being substantiated. This visit has resulted in a further 14 requirements being made. One of the major problems at present is the lack of a registered manager. This should be resolved shortly, with a new incumbent due to commence work at the beginning of July. It is imperative that they are given the time and resources needed to improve the quality of care being provided at Little Hayes. What the service does well: What has improved since the last inspection? What they could do better: Clearly, with fourteen new requirements, there are areas in which the home needs to improve. A number of these areas will be improved once staff receive adequate induction, support, and are fully aware of the importance of adequate and accurate recording. It is anticipated that the recruitment of an Little Hayes Care Home G53-G53 S19033 littlehayescarehome V192246 270605 stage 4.doc Version 1.30 Page 6 experienced manager will enable the majority of the problem areas to be resolved. A more proactive approach is needed, with more attention to detail. This should lead to a reduction in the number of complaints and an improvement in the quality of the service. 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 G53-G53 S19033 littlehayescarehome V192246 270605 stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Little Hayes Care Home G53-G53 S19033 littlehayescarehome V192246 270605 stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 (6 is N/A) Each of the service user files selected for examination contained a satisfactory pre-admission assessment. This means that the service user and their relatives can be reassured that the home has taken into account their individual needs, and feels that it can meet them; and the staff in the home can be as familiar as possible with new service users, and have an understanding of what specific service they will need to provide. EVIDENCE: The files of 7 service users were inspected. All of these contained a preadmission assessment profile. All but two of these were assessments provided by the placing authority. This is acceptable provided that sufficient information is available. In each of the cased mentioned the placing authority had sent the home satisfactory details, indeed these assessments were far more detailed than those carried out in-house. A new pre-admission proforma is about to be introduced for staff to complete, which if correctly used should ensure that any assessment carried out by the home is sufficiently detailed. Little Hayes Care Home G53-G53 S19033 littlehayescarehome V192246 270605 stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 The service user plans adequately covered the health and personal needs of the service users, but did not include reference to their social care needs. This means that the staff team are not aware of the differing needs of their residents, and cannot fully know what specific care should be given. Staff ensure that each resident is able to access community based health facilities as and when required. However greater diligence is required from staff in respect of keeping documentation accurate and up to date to ensure that service users health care needs are fully met. Not all service user are assured that their right to privacy will always upheld. EVIDENCE: Each of the files inspected contained a service user plan and these were supplemented by a variety of other assessments. They did not, however, contain any reference to social care needs. The aforementioned assessments were better completed in some files than in others. This is largely because new Little Hayes Care Home G53-G53 S19033 littlehayescarehome V192246 270605 stage 4.doc Version 1.30 Page 10 recording proformas have been introduced recently, and not all of these documents have been filled out yet. It is important that these forms are completed as soon as possible so that the records can be kept up to date. Comment has been made in previous inspection reports regarding crossreferencing the needs identified in the service user plan to the daily notes. This is still not being done, so it is not always easy to identify what specific action staff have taken to meet individual service user’s needs. A number of service users suffer from pressure sores however the treatment records were not, in all cases, being kept up to date. It was noted that staff were seemingly oblivious to the needs of one service user who had a catheter and it was disappointing to the Inspector that they had to ask staff to attend to the service user, which they promptly did, but with little regard for their privacy. Lack of regard for privacy was also noted when staff did not knock before entering service users’ bedrooms. Two errors were noted on the medication administration records. One related to staff not signing to say medication had been given, while the other concerned staff not giving an explanation as to why medication had not been given. Little Hayes Care Home G53-G53 S19033 littlehayescarehome V192246 270605 stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 The home does have a designated activities co-ordinator, however not all the service users felt assured that their recreational interests and needs were being met. This can have a detrimental affect on their general well being. The home welcomes visitors at any reasonable hour and relatives are being encouraged to be further involved by meetings and newsletters. EVIDENCE: A part-time activities co-ordinator is employed by the home, and various activities are provided. Overall however, there did not seem to be a lot of interaction between the staff team and the service users, outside of providing nursing/personal care. There were exceptions to this and it must be said that a number of the care assistants in particular had a good knowledge of their ‘key’ clients, and did interact with them. Their proactive work needs to be encouraged and encompassed by all of the staff. There was a good response rate to the CSCI’s questionnaires. A little over a quarter of the relatives who replied raised concerns. These related to a lack of activities, property being mislaid, lack of access to the garden/poor Little Hayes Care Home G53-G53 S19033 littlehayescarehome V192246 270605 stage 4.doc Version 1.30 Page 12 maintenance of the garden, lack of attention to detail (particularly to personal care), poor wheelchair access to the home, lack of communication from staff and insufficient staffing levels. In many ways these concerns mirrored the issues that were raised by relatives during the home’s own quality assurance survey. What remains to be seen is what action the home will take to rectify them. Almost half of the residents who took the time to complete a questionnaire also indicated that they were not completely satisfied with their care. They raised issues such as a lack of activities, lack of communication, lack of privacy, lack of involvement in the day-to-day running of the home, and, at times, unsatisfactory food. The manager needs to take these concerns on board, and devise methods of resolving them. It was noted that relatives meetings have been held, and that the home has once again started to produce a newsletter. The Inspector was pleased to be able to join service users for lunch. The food was well presented and service users commented that the meals were usually satisfactory. The dining area was adequate however the meal experience could be easily enhanced by the provision of new cutlery and crockery, and, in many cases, new over-bed tables which can actually be adjusted to suit the individual service user.These were points raised by one relative. Little Hayes Care Home G53-G53 S19033 littlehayescarehome V192246 270605 stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The home has a satisfactory complaints procedure in place, which is accessible to service users. There was also a satisfactory adult protection procedure in place which, if followed by staff, will offer sufficient protection to service users. EVIDENCE: The complaints log was examined and indicated that several complaints had been made since the last inspection visit, but that they had been dealt with, albeit in some cases this had been rather slowly. Since the start of this inspection year (April 1st) CSCI has received six complaints about Little Hayes. These generally regarded the deteriorating level of care being provided. Investigation upheld these complaints. Therefore, while Standard 16 is met in terms of the provision of a complaints procedure and adequate access to it, the manager and the proprietors must, as a matter of urgency, takes steps to improve the quality of care being provided. Little Hayes Care Home G53-G53 S19033 littlehayescarehome V192246 270605 stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 21, 24 and 26 Overall the standard of cleanliness is I need of improvement. This means that the environment for the service user is not as pleasant as it could and should be. EVIDENCE: The two requirements that were outstanding with regard to the premises have been dealt with. The entire building was not assessed on this visit however from observation of parts of the home it was not felt that the standard of cleanliness was acceptable. There was a noticeable odour on walking into the home, which is unacceptable. The home has been without the services of a housekeeper for almost two months, and the standard of cleanliness had notably dropped. A new housekeeper started work on the day of this inspection and it is to be hoped that they can quickly improve matters. One relative commented on the lack of cleanliness of food trays – this is another issue that the incoming housekeeper needs to address. Little Hayes Care Home G53-G53 S19033 littlehayescarehome V192246 270605 stage 4.doc Version 1.30 Page 15 Little Hayes Care Home G53-G53 S19033 littlehayescarehome V192246 270605 stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 Service users needs are at risk of not being met by the current numbers and skill mix of staff. This could have serious implications for their health and well being. Service users can now be more confident that they are protected by the home’s recruitment practices and that they are in safe hands at all times. In order that service users can be confident that the staff are trained and competent to do their jobs greater emphasis should be put in ensuring that new staff receive an appropriate induction programme. EVIDENCE: While the number of care staff on duty met the minimum levels previously set, the same could not be said for the number of qualified staff on duty. This consistently falls below the minimum, and has done for some considerable time. There are ongoing negotiations between the proprietors and the Commission, but it has to be said that until this matter is resolved the lack of qualified staff can only have a detrimental effect on both service users and staff. The rota for one week was assessed. This showed that on each day shift there were usually 2 qualified nurses on duty in the morning, with 6 - 8 care assistants; 2 qualified staff with 5 - 8 care assistants on duty in the afternoon/evening; and 1 qualified staff with 2 - 3 carers on duty overnight. The number of qualified staff falls below the minimum levels previously agreed. Little Hayes Care Home G53-G53 S19033 littlehayescarehome V192246 270605 stage 4.doc Version 1.30 Page 17 For the current number of service users in the home (36 at the time of this inspection), there should be 3 qualified staff on in the morning, two in the afternoon/evening and 2 at night. Following an enforcement notice the recruitment practice in the home has considerably improved. This means that new staff have been properly vetted before being appointed, which in turn means that the service users are not placed at unnecessary risk.The files of twelve new staff were inspected. It was pleasing to note that everyone had obtained at least a POVA (First) before commencing work. There was just one reference outstanding, and the home’s administrator was actively chasing this. It was noted that there were two staff whose student visas were shortly due to expire, while there were a further two staff who did not have a valid work permit. Again, the administrator was actively working to resolve this. While staff have been able to access a number of tutorials and study days, the lack of an appropriate induction for new staff means that both they and the service users are being placed at risk. Without an introduction to the home, its layout and its residents, it is difficult to see how new staff can fully meet the needs of the service users or carry our their roles effectively. Little Hayes Care Home G53-G53 S19033 littlehayescarehome V192246 270605 stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33 and 38 At present, as the home does not have a registered manager who is able to discharge his or her responsibilities fully service users are not able to benefit from a consistent management approach The home now has a comprehensive quality assurance system, which will enable the management to identify any areas where the service is substandard. This system is newly in place and once it is fully operational it should mean that the home is run in the best interests of the service users. Service users and staff cannot be assured that their health, safety and welfare is being promoted as it should be, until the management of the home meets two previously made requirements concerning health and safety. EVIDENCE: Little Hayes Care Home G53-G53 S19033 littlehayescarehome V192246 270605 stage 4.doc Version 1.30 Page 19 The former registered manager left the home over 6 months ago, and until recently the deputy was acting up. She has taken the decision not to pursue the manager’s post on a permanent basis, which means that the home is still without the benefit of having a consistent management approach. The shortage of senior qualified staff is problematic, and indeed has been an issue throughout the deputy’s tenure as acting manager which may have a bearing on the number of complaints being received, and the fall in the quality of the service being provided. Two requirements remained outstanding from previous inspections with regard to the need for a quality assurance system and for an annual development plan for the home. Both of these are now in place and it was good practice to see the results of relative surveys on clear display in the home. It was of concern to find that in spite of a previous requirement, the fire alarms were still not being tested on a weekly basis. This compromises the safety of the service users and the staff, as does the lack of an adequate number of trained first aiders – again this was the subject of previous requirements. Little Hayes Care Home G53-G53 S19033 littlehayescarehome V192246 270605 stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION x x 3 x x 3 x 1 STAFFING Standard No Score 27 1 28 x 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 1 2 3 x x x x 1 Little Hayes Care Home G53-G53 S19033 littlehayescarehome V192246 270605 stage 4.doc Version 1.30 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13 Requirement The proprietors and/or the manager must ensure that medication administration records are completed at all times. The previously set timescale has not been met. The daily notes should indicate how the assessed needs/goals of the service users (as detailed on their service user plans) are being met. The previously set timescale has not been met. Fire alarms must be tested on a weekly bass and a record of these tests kept. The previously set timescale has not been met. Additional first aiders must be trained so that there is one such person on duty at all times. The previously set timescale has not been met. The service user plans must include reference to social care needs. Staff must ensure that the health care needs (including catheter care) of service users are met. Staff must ensure that wound care documentation is up to date at all times Staff must ensure that the right G53-G53 S19033 littlehayescarehome V192246 270605 stage 4.doc Timescale for action 28/6/05 2. 7 15 28/6/05 3. 38 23 28/6/05 4. 38 13 30/7/05 5. 6. 7. 8. 7 8 9 10 15 13 13 12 30/7/05 28/6/05 28/6/05 28/6/05 Page 22 Little Hayes Care Home Version 1.30 9. 12 16 10. 13 16 11. 14 12 12. 13. 26 27 16 18 14. 30 18 to privacy of all service users is respected at all times. The proprietors and/or the manager must ensure that the service users are provided with an adequate number of appropriate activities. The home must ensure that it establishes and maintains good communication with service users and their families. All staff must ensure that service users are enabled to exercise choice and control over their lives. Staff must ensure that the home is odour free at all times. The Proprietors must ensure that there are an adequate number of qualified staff on duty at all times. The proprietors and/or the manager must ensure that all new staff receive an appropriate induction. 30/7/05 28/6/05 28/6/05 28/6/05 28/6/05 28/6/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 15 Good Practice Recommendations It would be good practice to periodically replace crockery and cutlery, and to ensure that all over-bed tables were in working order. Little Hayes Care Home G53-G53 S19033 littlehayescarehome V192246 270605 stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 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 © 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 Little Hayes Care Home G53-G53 S19033 littlehayescarehome V192246 270605 stage 4.doc Version 1.30 Page 24 - 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. 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