CARE HOMES FOR OLDER PEOPLE
Little Hayes Care Home 29 Hayes Lane Kenley Surrey CR8 5LF Lead Inspector
Alison Ford Key Unannounced Inspection 29th June 2007 10:30 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.V342147.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Little Hayes Care Home DS0000019033.V342147.R01.S.doc Version 5.2 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 littlehayes@btconnect.com Diplotec Ltd Julia Barbara Christodoulides Care Home 50 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (40) of places Little Hayes Care Home DS0000019033.V342147.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 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. 7th March 2007 2. Date of last inspection 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 residents with a secure, relaxed and homely environment in 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 £416 - £680 depending on the room occupied and the dependency of the resident. These and any extra charges payable would be discussed prior to admission. Little Hayes Care Home DS0000019033.V342147.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes first key inspection of the year 2007 / 2008 and was an unannounced visit. During this time a partial 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-four residents currently in the home, and staff members were spoken with. Six residents care plans were also assessed. In compiling this report consideration has also been given to other information made available to The Commission throughout the inspection year, which includes complaints and notification of incidents. At the time of the visit there was still one unresolved complaint against the home and enforcement action has begun in an attempt to address the issue. Since that time a response has been sent to the complainant although the outcomes of this are still awaited. No other complaints have been received about the service since the last inspection. What the service does well:
This home provides comfortable and clean accommodation for its residents, all of whom were complimentary about the staff in the home and the care that they received. Several said, ”its nice living here” “staff are very kind “another commented, “it couldn’t be better” All the residents looked well cared for and agreed that they that they were free to exercise choices in their daily lives and were always treated with respect and in a way that respected their individuality. Pre admission assessments ensure that the home is always confident that it will meet the needs of its residents and the way in which support and interventions are given is reviewed regularly to ensure that it continues to meet their needs. Any potential resident would be given copies of the homes Statement of Purpose and Service User Guide to take away to read so that they or their relatives could decide whether the home and the services provided will suit them. Little Hayes Care Home DS0000019033.V342147.R01.S.doc Version 5.2 Page 6 Individual care plans outline all of the care and support that is required by residents and ensure that all staff know exactly how they prefer to be supported. These are reviewed on a regular basis to ensure that any changing needs continue to be met. Daily activities are provided to offer interest and stimulation to residents and a new activities co-ordinator has been employed since the last inspection. Several residents have been on trips out of the home and pictures on the wall illustrate their enjoyment of these. Visitors would always be made welcome into the home and residents are encouraged to retain links with the local community. Residents are protected by the homes recruitment policies however, although there is a complaints procedure in place this has not always been adhered to so they cannot be sure that their concerns will be listened to and acted upon. Policies and procedures are in place to ensure that the health and safety of residents and staff is protected and staff training is given a high priority so that they are able to understand the needs of the people that they are caring for. What has improved since the last inspection?
Since the last inspection all of the requirements that were issued at that time have been complied with. The planned programme of redecoration and refurbishment has been completed and a new sluicing disinfector has been installed. Care plans are now being audited on a regular basis to so that all staff are aware of the support and interventions that residents currently need and more of the plans are beginning to reflect their social needs and preferences as well. This will help those concerned with organising activities for residents provide them with a timetable, which will suit their preferences and remaining abilities. Work is also ongoing to collect information about resident’s previous lives and achievements. This will also help with offering activities which interest residents as well as enabling staff to get to know them better and understand them. For those residents who wished to have more privacy and be able to lock their bedroom doors, locks had been fitted and these have now been modified to ensure that staff are able to open the doors from the outside in the event of an emergency. . To ensure that people are given all of the information that they need when they are choosing a home some amendments have been made to The Statement of Purpose and Service User Guide regarding the fees that are payable and the latest inspection report.
Little Hayes Care Home DS0000019033.V342147.R01.S.doc Version 5.2 Page 7 At the last visit errors were noted in medication administration and an immediate requirement was issued in respect of this. Records are now audited weekly and staff have benefited from further training and assessment. No errors were noted on this occasion. There has been an increased emphasis on staff training over the last year however, and more care staff have been able to start training to gain an NVQ level 2 qualification. Staff are also now being offered formal supervision sessions on a regular basis. These sessions provide an opportunity for their performance to be monitored and for them to identify any future training needs, which will help them to offer care according to current best practice guidelines. Staff that were spoken with agreed how useful they were finding these sessions. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Little Hayes Care Home DS0000019033.V342147.R01.S.doc Version 5.2 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.V342147.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,3,6 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who use this service have access to enough information to help them to make an informed choice about the suitability of the home. Pre-admission assessments are undertaken which judge the homes suitability to meet the healthcare needs of any one considering moving into the home however these would benefit from more detail. This home does not offer intermediate care; this standard does not apply. EVIDENCE: Prior to admission, any potential resident would have an assessment done by a senior member of staff to make sure that the home would be able to provide appropriate care and support for them. A sample of these was seen and it was
Little Hayes Care Home DS0000019033.V342147.R01.S.doc Version 5.2 Page 10 considered that more detailed information was needed to provide evidence of the homes ability to meet resident’s needs. A care manager’s assessment is also provided for residents whose care is funded by the local authority Potential residents and their families are given a copy of the Statement of Purpose and Service User Guide, which has been prepared in format specifically for this purpose. Larger bound copies would be given to them following their admission. This information helps them to judge whether they think that the home will be suitable for them and if they will be happy with the facilities and services that are offered to them. Little Hayes Care Home DS0000019033.V342147.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9,10,11 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. People who use this service can feel confident that care plans reflect the support that they currently require and care will be delivered in the way which they prefer. Appropriate measures are in place to ensure that they are protected by the homes medication procedures. They can be sure that they will be treated with dignity and in a manner which reflects their privacy. EVIDENCE: Six care plans were seen at this visit. These are now being audited regularly and continue to improve. Some of them, especially of those residents admitted more recently, show evidence of life history work which provides information about residents previous lives and helps staff to understand their present needs and behaviour. Residents individual problems and the support that they require have been identified and proposed interventions outlined.These are reviwed regularly to ensure that any changing healthcare needs are identified
Little Hayes Care Home DS0000019033.V342147.R01.S.doc Version 5.2 Page 12 Bodymaps are in place in the care plans which provide evidence of the skin integrity of residents at the time of their admission in to the home. Factors which could identify any deterioration in health or lead to the formation of pressure sores are monitored regularly and nutitional assessments are in place. Risk assessments are undertken to identify those who might be prone to falling and care plans spacific to night time hours are completed. Medication storage and administration was in order at this visit: audits are undertaken on a weekly basis. Resident that were spoken with all confirmed that they are treated with respect and that their healthcare needs are met in a way which suits them. Staff were observed interacting with them in a pleasant and kind manner. Qualified nurses and senior carers in the home have been working with the local hospice, receiving training to help them care for people at the end of their lives in a way, which suits their preferences. Little Hayes Care Home DS0000019033.V342147.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14,15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use this service are encouraged to make choices within their daily live as much as their abilities allow and activities are in place to offer interest and stimulation. Their visitors are always welcome and they can be assured that meals are suitable and varied with choices that will suit their preferences. EVIDENCE: There are photographs of various outings that that had recently taken place and an activities programme was on the board. A new activities coordinator has started work since the last inspection and was pleased to describe the sessions that she had been running. Examples of resident’s artwork were seen around the home. Residents were able to comment on how much they had enjoyed the recent sessions. Little Hayes Care Home DS0000019033.V342147.R01.S.doc Version 5.2 Page 14 Relatives and friends of residents 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. All those spoken with agreed that the food served in the home was very good and there was always a choice. The lunchtime meal was observed and looked very appealing. Menus have recently been revised and they are displayed in the dining room. Records are now kept of the food that is actually eaten by residents to provide evidence of a nutritionally balanced diet and a list of their preferences is now available in the kitchen for reference. Little Hayes Care Home DS0000019033.V342147.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards16, 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The people who use this service know that there are policies and procedures in place to respond to their concerns however they cannot be sure that their complaints will be listened to and acted upon in a timely manner. Procedures are in place to help safeguard them from abuse. EVIDENCE: Staff that were spoken with, displayed knowledge of issues around adult abuse, there is ongoing training within the home and pre-employment checks are in place to ensure residents protection. There is a complaints procedure and copies of this are in the Statement of Purpose and Service User Guide. It is noted that there is still one unresolved complaint, which was first made in November 2006. The Registered Providers have still not replied to this despite requests from both the complainant and The Commission and enforcement action has begun in order to address this. It is acknowledged that a response has been sent to the complainant since this inspection and an outcome is now being awaited. Little Hayes Care Home DS0000019033.V342147.R01.S.doc Version 5.2 Page 16 Little Hayes Care Home DS0000019033.V342147.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards19, 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The people who use this service consider that the home offers them clean and comfortable accommodation, which suits their needs and capabilities and they are quite happy living there. EVIDENCE: A tour of the premises revealed that on the day of the inspection the home was clean and tidy. The planned redcoration is now complete and automatic door closers were seen on doors that residents wished to keep open. Extra handrails have been fitted, sineage has been improved and areas of the home are colour coordinated to help orientate those residents who have dementia.
Little Hayes Care Home DS0000019033.V342147.R01.S.doc Version 5.2 Page 18 A new sluicing disinfector has now been installed. Some concerns were previously raised about the locks on the bedroom doors of the few residents who wished to have a key. These doors would not be openable from the outside if there was an emergency however they have now been replaced. Little Hayes Care Home DS0000019033.V342147.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service can be sure that staff training will ensure that their needs are met, and that recruitment procedures are in place to ensure their protection. Staff are always on duty in sufficient numbers to care for the numbers of residents living in the home. EVIDENCE: Staff rotas were seen. These showed that there are always sufficient numbers of staff on duty to meet the needs of the residents none of whom said that they had to wait a particularly long time if they rang a bell for assistance. Staff training is ongoing and both statuatory training and additional training in dementia awareness has been completed. More staff have begun an NVQ level 2 course which will ensure that more than 50 care staff will have completed this. Additional traing has been given to all of the qulaified nurses and senior care staff in issues concerned with caring for those in the latter stages of their lives. Recruitment procedures have caused concerns in the past however at this visit the records of those staff member that were seen were all in order. Little Hayes Care Home DS0000019033.V342147.R01.S.doc Version 5.2 Page 20 Little Hayes Care Home DS0000019033.V342147.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service can be sure that the home is managed by a suitably qualified and experienced person and in their best interests. Policies and procedures are in place to ensure their safety and wellbeing and current health and safety legislation is complied with. EVIDENCE: The current manager is a trained nurse with additional qualifications and previous experience in a similar role and displayed a thorough understanding of the needs of the client group in the home.
Little Hayes Care Home DS0000019033.V342147.R01.S.doc Version 5.2 Page 22 Staff are informed of changes that are occurring within the home through a newsletter and staff meetings are held regularly so that they have a chance to air their views. Relatives and residents meetings are held every two months to allow them the opportunity to influence the running of the home and The Registered Provider visits the home on a regular basis in accordance with Regulation 26. Staff supervision is now happening on a regular basis and all staff that were spoken with explained how they had found it useful. Some financial transactions are undertaken on behalf of residents although their money is all banked centrally. This money would be used for services such as chiropody and hairdressing and resident’s representatives would be sent an itemised bill for this. A selection of certificates of worthiness and other records providing evidence of the homes commitment to the health and safety of its residents were all seen at the last key inspection and were all in order. Kitchen records are now being kept in line with new legislation. Little Hayes Care Home DS0000019033.V342147.R01.S.doc Version 5.2 Page 23 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 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 3 3 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 3 X 3 X 3 X X 3 Little Hayes Care Home DS0000019033.V342147.R01.S.doc Version 5.2 Page 24 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 OP3 Regulation 14(1) Requirement Pre-admission assessments must be recorded in more detail in order to provide evidence of the homes ability to meet the needs of the resident. All complaints and concerns must always be responded to according to the homes complaints procedures. (Previous timescale 30/03/07 not met) Timescale for action 30/10/07 2 OP16 22 (3)(4) 30/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Little Hayes Care Home DS0000019033.V342147.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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
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