Inspection on 11/09/07 for Yatton Hall

This inspection was carried out on 11th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Yatton Hall 05/05/09

Yatton Hall 09/06/08

Yatton Hall 17/01/08

Yatton Hall 08/02/07

Yatton Hall 08/06/06

Yatton Hall 21/11/04

Yatton Hall 06/05/04

Similar services:

2 Perhaver Park

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Poldhu

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Yatton Hall High Street Yatton North Somerset BS49 4DW Lead Inspector Kathy Marshalsea Key Unannounced Inspection 10:00 11 September 2007 th X10029.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 Yatton Hall DS0000020292.V343629.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 and Care Homes for Adults 18 – 65*. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Yatton Hall Address High Street Yatton North Somerset BS49 4DW 01934 833073 01934 877373 yatton.hall@fshc.co.uk 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) Grandcross Limited(wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Lisa Marie Brain Care Home 48 Category(ies) of Learning disability over 65 years of age (2), Old registration, with number age, not falling within any other category (35), of places Physical disability (13) Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) maximum 48 of either gender Physical Disability (Code PD) - maximum 13 of either gender Learning Disability over 65 years of age (Code LD(E)) - maximum 2 males only. The maximum number of service users to be accommodated is 48. 2. Date of last inspection 8th February 2007 Brief Description of the Service: Yatton Hall provides nursing care for up to 48 people. The accommodation is provided on three floors, served by a lift. The first two floors are for older people, the top floor for younger disabled people. There are 44 single and two double rooms. The accommodation has even, level access throughout, and the surrounding area is level too. Located in Yatton High St, it is close to the village shops and facilities. The weekly fee range stated on 8th January 2007 started with the Local Authority rate of £494.00 plus a top up of £30.00 up to £1050.00 for the Younger Physically Disabled persons. Private fees for the older person start at £608.00 per week. The Registered Nurse Care Contribution paid to the home for privately funded clients is retained by home. An increase was due to be applied to the weekly fees payable on 6th February 2007. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key inspection was unannounced and done by two inspectors. Before the visit took place information was gathered by looking at records held in the local Commission for Social Care Inspection office, and from information provided from the Annual Quality Assurance Assessment, which had been sent to the home for them to complete. Other information was also supplied by people living in the home and their relatives, health care professionals and general practitioners in our survey forms, which have been sent out before the inspection visit. All of this information was used to decide upon which areas of the National Minimum Standards needed to be focused upon during this visit. The manager was not present for this visit as she had been on sick leave for a period of about six weeks before this visit. The deputy manager had been in charge of the home during this period of sick leave and was there for this visit. Inspectors were also assisted by the regional manager who came to the home towards the end of the visit; the inspector’s feedback was given to her. It was evident during this visit is that there had been a deterioration in the running of the home since the last inspection visit. Three immediate requirements were made at the end of this visit which needed to be actioned within 48 hours of the inspection. As the manager wasnt present it was not possible to evidence that other requirements made at the last inspection visit had been done. The deputy manager had been given the freedom to book agency staff so that she could work separately from the other trained nurses and concentrate on managing the home. It was evident that this had not happened frequently enough for the management to be effective. Due to the level of concern about the deterioration of the home a management review took place with the inspector and her line manager after the inspection, and a service of concern meeting will be held with the providers within a short period of this inspection visit. This is to make sure that the manager and provider are clear about the areas of weakness and will take appropriate action to make sure the people living in the home are safe and well cared for. What the service does well: Some positive comments on the survey forms received included: The staff are very considerate and keep us informed They respond quickly to any matter I ask about. Nursing and caring is very good. The night staff are very good. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 6 They have always given me all the assistance I have asked for and overall will do what they can to help with any problems arising. I think that the home takes care of me very well and helps me to like the life that I want in the home. The staff give my relative the attention and patience required. The staff are very considerate about the needs of my relative in keeping us also informed. I spent many hours at my relatives bedside and the staff were always helpful to my family and me. Health care professionals felt that the home dealt well with the administration of medicines, application of dressings, provided well for known spiritual needs, and encouraged interaction from family and friends. The staff are effective at the prevention of pressure sores and the trained staff competent at the application and recording of dressings to wounds. What has improved since the last inspection? What they could do better: Negative comments on the survey forms included: They need higher staffing levels The food could be better Clean water jugs and glasses topped up regularly without having to keep asking “More regular emptying of catheter bags It would be most helpful to put worries and concerns direct to the representatives of Four Seasons. They are faceless but hold the means to changing all the problems More basic food for older folk More staff are needed There are never enough staff to do more than is asked. Theres no time for casual chats or a walk out or anything similar “ The staff listen but dont always act This seems to be an ongoing issue of what my relative wants and what carers feel they can provide. I am aware that I only hear one side of the problem Responses on the general practitioners survey form commented “no” as to whether the home communicated clearly and worked in partnership with them, and also whether staff would demonstrate a clear understanding of the care needs of people living in the home. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 7 Both also said that they were not satisfied overall with the care provided to people living within the home. Both said that many nurses did not seem to understand what is happening with their patients and one said there seemed to very little in the way of entertainment for some people living in the home. Both also expressed concerns about frequent outbreaks of scabies, which was checked by the inspectors during this visit. Other healthcare professionals expressed concern about a recent admission causing problems which was also checked out by the inspector during this visit. Another felt the new care assistants required more training and that agency staff needed more support. The Immediate Requirements made were for the staffing levels to be better organised or increased, for two people living at the home to have better safety checks and more complete and up to date assessments of the risks to their welfare, and for staff to make sure that cold drinks are available wherever people happen to be sitting and for them to be assisted where necessary. The opportunity for elderly people living in the home to have an active, interesting and personal social life is extremely limited and depends upon their ability to amuse themselves. This was brought up as an issue at the last inspection and needs to be a focus for all staff not just the activities organiser. The staff need to make sure that they prove that they are reducing any risk of people falling. This should include a re-assessment after falls particularly when this is a common feature of a persons’ condition. More pro-active measures could have been taken in two instances so that the regular risk of a fall may have been reduced. Assessments and the care plans need to give staff the same information. Care plans do not include social or personal details and are not written in consultation with the people themselves. When the plans are reviewed important information from other records are not used nor are care staff consulted. This means that some of the reviews do not reflect the condition of the person. Any health care assessments need to be up to date and should be used to inform the care plan. Staff should be provided with up to date training in the care of people with dementia, fire safety, the conditions of the people they are caring for and the subject of abuse. This is to make sure that they have the skills to meet the needs of the people living in the home. They also need to have regular and useful supervision sessions where their practice can be discussed and any training needs recognised and then organised. The home should provide level access throughout any area of the home used by the people living there. Thought should be given to finding storage areas, which are not lounges, or dining areas, to make sure that people have a choice of sitting in a homely area uncluttered by equipment. Staff need to respond to call bells promptly to make sure that people are safe and have their dignity preserved. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 8 Staff need to record all complaints particularly when the manager is not present to make sure that complaints are taken seriously and actions taken to remedy the concern. The company needs to make sure that the home is monitored monthly with an unannounced visit from one of their regional managers and that report of the visit then sent to the Commission for Social Care Inspection. 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. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. People wanting to live in the home do have an assessment of their needs before a decision is made about whether their needs can be met. The home is not able to meet the needs of those people whose primary need is dementia, as staff have not been given the training to understand the condition. Staff were not making sure they keep some people safe by not doing enough safety checks. The checks they were doing were irregular and not recorded. Those people who were not sitting in their bedrooms did not have cold drinks. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 11 EVIDENCE: At the last inspection visit the inspector judged that there was a good level of information available to prospective people who wanted to live in the home. They also judged that pre-admission assessments were made and people were only admitted if they are assessed needs could be met. Evidence gathered during this visit confirmed that so these standards were not a focus during the inspection. However one person who had been admitted to the home this year was case tracked, as there had been some concern in survey forms about their behaviour affecting other people living in the home. First of all I spoke with the deputy manager about whether anyone had been causing them any problems. She informed me about a person who was admitted earlier in the year, and at that time the person was being nursed in bed and had not been a problem to manage. As they had got better and were able to walk again there had been some problems. Other people living in the home had been complaining about this person going into their rooms, particularly at night. This person had also been refusing some care and some of their medication. The home recognised that they could no longer meet this person’s needs as their mental health problems had now become their primary need. The appropriate people had been contacted and were trying to support the family in finding a more suitable home for this person. The Deputy Manager said the main problem was that this person often tried to leave the building and therefore they were keeping the front door locked. I went to meet this person and then spent some time observing their behaviour, how staff reacted to them, and how often staff were checking where they were. Over a period of an hour and a half this person often got up and started to walk either into the dining room opposite, where the patio doors were often left open, giving easy access into the garden and close to the main road, or into the corridors. Despite me asking for these doors to be kept shut, they were opened again twice during that morning, posing a high risk of this person leaving the building. There were two care assistants on duty on this floor; they had 11 other people to attend to. It was evident that while they were trying their very best to keep an eye on this person, no regular safety checks were being done, and the checks that were done where not recorded. I looked at the pre-admission assessment which detailed this person’s needs including their mental health problems and mental capacity changes. The assessment was detailed for this persons physical needs and recognised areas of concern such as them trying to walk on their own, having a high risk of developing a pressure sore, and weight loss. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 12 I checked various assessments that had been done after this person was admitted to the home. The falls risk assessment was done the day after admission and identified this person was a high risk of having a fall. I checked the accident records which show that following admission this person had 12 incidents where they were found on the floor. Despite this the falls risk assessment had not been re-evaluated to ensure that any risks would be minimised. Other risk assessments done on admission stated that staff need to regularly observe this person due to the risk of falls but didnt tell staff how often should happen and had not been reviewed following the falls mentioned above. The manual handling risk assessment had been done in June 2007 and contained confusing information about whether one or two staff should assist this person, despite the fact that this had been reviewed since then it was still confusing. A risk assessment for them developing a pressure sore had been done on admission and thereafter monthly. I looked at the care plan to see how staff had been directed to meet this persons needs. Most of the plan had been written on or shortly after the admission of this person. The plan was fairly basic and did not contain the person’s abilities on admission, and did not give staff clear instructions, for example if this person refuses care what techniques they should use. I spoke with two care staff on duty who said that they go away and try again later; success with this technique is variable. The plan for her mobility showed the progress from not being able to walk independently on admission to being able to do that now. There was no information in this plan or its review about the amount of falls this person had despite there being some accident slips in the pocket of this plan. There was also a plan for this person’s reduced appetite, in which staff are instructed to ensure that this person has drinks in between meals. No cold drinks or other drinks were available to this person or others sat in the lounge apart from the routine mid-morning hot drinks round. The plan for this persons ability to use the toilet had been done on admission and staff said was now completely inaccurate. No reference was made within this for indicators of this person needing to use the toilet, nor any reference to the continence assessment. Despite the fact that there was difficulty with this person being very restless at night and in their confusion going into other peoples bedrooms this was not detailed in the first plan I read for sleeping. There was no useful information about preferred retiring or rising times and whether any night sedation was being used. There was then another plan for night-time which stated usual bedtime, the use of bed rails, and an alarm pad, with no rationale as to why those are being used. There was also then another plan for safety in bed. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 13 This instructed staff to offer the person a commode when they were restless so that they did not attempt to get out of bed, and that they would be checked regularly on the night rounds. There was no information in the reviews about whether the strategy had been successful. The plan for this person’s challenging behaviour did not detail any information about any incidents, staff were told to use diversion therapy without any detail of what that should be. The plan for this person trying to leave the home gave vague instructions for this person to be monitored, the front door to be locked, and all attempts at “escaping” documented. The following review of this plan gave no information about whether there had been any attempts to “escape”. And speaking to the staff it was evident that there had been incidents where this person had been found outside the building, but these had not been documented in the review. The care plans for this persons mental health problems and subsequent behaviour as a result of this were very vague and did not give staff clear instructions about how they could meet this persons needs. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,10 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. There was not enough being done to prevent people having falls. Health care needs are assessed and referrals made to other health care professionals for help, these are not always recorded. Care plans need to show personal and social care needs so that the plan is about the whole person and is personal to them. Health care assessments were not always accurate and the information in them not used in the care plan. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 15 Wound records were satisfactory and the prevention of pressure sores is well managed by the staff. EVIDENCE: We case tracked four other people living in the home to try and gauge how people with a variety of needs are looked after. These included two people who did not join in the arranged activities, one person with a wound and one person who experienced a very high number of falls regularly. The accident records for the person who experienced a high number of falls showed that it was not unusual for this person to have three falls in one day and indeed had done so on the day before the inspection visit. One of their care plans stated unable to maintain safety and is at risk of falls there was no information for the auditing of these falls such as what time of day they may have been, and what might trigger this person to get up. The latest monthly review for this care plan stated, falls continue and staff continue to reiterate that this person must wait for staff to come and they are not to try and walk on their own. There was no set times given for staff to check this person, staff told the inspector that they check as they go by but do not write this down. I spoke with this persons named nurse who was on duty during the visit. They have sought advice about how to manage this difficult situation. It was a shame that none of the actions described to me had been mentioned in this persons records. A referral had been made to the falls assessment team who had been in and advised the home to change this person’s walking frame. However this change of frame had caused more problems than the original frame, so the staff reverted back to using the old one. A referral had also been made to a physiotherapist who had also been in and was coming back to advise staff about assisting the person with exercises. Their advice was for staff to assist this person to walk at least four times a day. It was recognised that while this person is able to use the call bell, they then get up straight away without waiting for staff. It was agreed that due to this persons progressive condition the situation was not going to improve, and that due to some cognitive impairments it is not appropriate for staff just to keep reiterating the fact that they must wait for staff before getting up. We advised staff to immediately start recording the safety checks that they do for this person, and also for them to decide how often they need to go into them as a proactive measure to assist them before they actually need assistance. This may help in minimising the amount of falls experienced. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 16 As this person has a rare condition the nurse was advised to get some information about this condition. We later found out that this persons key worker had got some information from the Internet about the condition, however it was not apparent whether this was shared with all of the staff. Two people’s records were looked at due to the fact that they do not to join in the arranged activities, so they could have been at risk of being isolated and bored. Their records gave no information about their social or personal preferences and neither had a social care assessment, which the company uses. I spoke with a care assistant looking after one of these people who had been living at the home for two years. They were able to tell me a lot about the care needs of this person and had also some really useful information about their preferences, such as which music they like, and what time of day they prefer to watch the television or listen to their music. They also told me that one of their relative visits them weekly. None of this information was within their notes. I went to meet this person once in the morning and the television was on as per their preference, and once in the afternoon when the music they preferred was now playing. While this is commended it would be useful for this to be included in records, so that all staff know about this. It was also seen in their key worker diary that virtually no entries were made, nor in the social assessment sheet, which is a record of any social activities that have happened for them. This is disappointing and will be discussed further under the section about daily life and social activities. The other person had been living at the home four years at the time of our visit. The entire care plan was in regard to meeting their physical needs. The information giving staff details of how to meet this persons physical needs were adequate. But it was not person centred and did not give staff details about this persons remaining abilities. Records did show that attention had been given to this persons diet and that their weight was being maintained. New health care problems had been referred to the GP. Some of the health care assessments had not been reviewed recently and in some instances did not seem to tally with this persons current physical condition. This is also the case for the risk of falls, which had been detailed in the care plan and had warranted a referral to the GP, but there was no information in the review of the falls risk assessment about whether there had been any falls. There was no social or personal care plan. There was no social assessment. A social activities plan stated that this person enjoyed communion, bingo and dominoes, TV, and the in-house entertainment. The social activities progress report for 2007 showed five entries for attending communion three refusals to play dominoes and three attendances at the arranged entertainment. There was no information about what television programmes this person preferred, and whether they were able to use the television independently. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 17 Staff informed me that no person living in home had a pressure sore at the time of our visit. I checked the wound care records for one person. The plan had been written in January of this year and had been reviewed regularly since then. The plan did contain information about what dressing products were to be used, but not how often the dressing should be attended to. A wound assessment chart was being kept and done each time the dressing was changed, and a judgement being made about how the wound was progressing. There was a photograph of the wound, which was taken with the persons permission. Due to the fact that this wound had been treated in hospital recently staff were advised to completely rewrite the plan giving this information, and to include how often the dressing should be attended to. A nurse did this immediately. Staff must ensure that when they complete risk assessments in respect of any health care need such as pressure sore formation, nutritional needs and manual handling requirements that these are used to inform the care plan so that all the information is accurate and tallies with the assessments. It was seen that nutritional screening is done upon admission, but was not being checked on a periodic basis. It was evident that people’s weight is being monitored regularly, but it was unclear whether some instructions in the care plan for recording fluid and food intake is actioned by the trained nurses. The home has a manual handling instructor who also works as a carer in the home. They are responsible for training staff, doing safety checks for bed rails and lifting equipment, and ensuring that good practice for moving people is used at all times. There had been concerns raised on the GP survey forms about frequent outbreak of scabies. I spoke to two of the trained nurses about this comment. They stated that for the first “outbreak” a definite diagnosis was not made and that in their opinion it was not scabies. In the second “outbreak” a proper test that would have given a diagnosis of scabies was not done. The Regional Manager also checked this out, and discovered after taking advice from a specialist, that the staff needed to be treated as a preventative measure, as well as everyone living in the home so that there was no risk of cross infection. They stated that the surgery had not given them this advice. She arranged for this to be done and this was being arranged while we were there. This will be checked at the follow up visit. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,15 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Older people living in the home do not have their previous hobbies and interests recorded so that staff can help continue them. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 19 EVIDENCE: One person said on their survey form: I like the home very much and enjoy playing scrabble It was evident during our visit that there been no improvement in the level of activities provided for the older people living in the home. One of the questions in the survey forms asks “are activities arranged by the home that you can take part in”. One person said always, one person said usually, one said sometimes, and one said never. The home does have an activities organiser who was working as a care assistant on the morning of our visit and then doing activities during the afternoon. We saw that they were spending a lot of time with playing a board game with a young adult, which was rewarding for that person, but may not be the best use of their time. Staff did seem to have some spare time during the afternoon of our visit, and it might have been more useful for a carer to play the board game, while the activities person spent time catering to the wider needs of the older people. One person told the inspector There are not enough activities, things that are arranged only suit some people, others are not asked what they would like to do. Another said that they had been living in the home for two years and that no one had asked them what they enjoy doing. Fortunately they were reasonably independent and were able to do some things that they enjoy doing before they came to the home. However they said there was very little social stimulation and while they are aware of some activities such as board games and entertainers that this was not of interest to them. When I asked they stated that there were three things that would make a significant improvement to their quality of life. These included two hobbies which had not been possible to pursue, as they were unaware that they could do. There was no social care assessment in this persons file. With their permission I passed this information to the regional manager. The actions needed to be taken to help this person pursue their interests will be checked at subsequent visits. The manager had stated on her Annual Quality Assessment form that there are plans to widen the activity programme and provide further training for the activity organiser to cascade to staff. It is disappointing for the older people living in the home that the recommendation made at the last visit for the social activities provision for older people to be reviewed, to ensure that there is a range of activities and opportunities for social care needs to be met, has not yet been met. In the files seen there was very little in the key worker diaries about any social activity, trip or social event. It would be impossible for one activities organiser to provide social care and stimulation to all of the people living in the home, therefore all of the staff must engage in this process. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 20 Information given on the survey forms about whether people liked the meals at the home were: two said usually and three said sometimes. One person said, Vegetables are sometimes hard and the meat tough to eat. As I wear dentures this is impossible so sometimes I dont have lunch. I have requested no squirty cream to be put on my desserts but they dont take any notice. Other comments were Not enough quality, more choice needed, “Need more basic food for older folk.” This standard was not assessed in full but information mentioned above was passed on to the regional manager. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Some complaints had not been recorded so were not investigated leading to some people not feeling confident about making a complaint. Some staff were not clear about what actions they should take if there was an allegation of abuse in the home, this could mean that some allegations may have been made and not dealt with properly. EVIDENCE: There have been two complaints in the last 12 months; both were resolved within 28 days, in accordance with their policy. We were given information during our visit about some complaints that have been made while the manager was off sick. Only one of these had been recorded in the complaints file. In the survey forms three people stated they know how to make a complaint and two people said never. As the manager was not present we were not able to talk to her about how she records complaints, and at what stage grumbles are recorded as a formal complaint. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 22 There did not seem to be a clear process for ensuring that those people who have communication difficulties have either staff or an external person advocating on their behalf. As the named nurse and key worker system is also not being used to its optimum level this is of concern. I spoke to some of the trained staff on duty about their understanding of the prevention of abuse for people living in the home. Only one out of three was very clear about the process of involving external agencies, and the best way of making the situation safe while an investigation took place. The two staff who were not clear had been working at the home for some time and had received in-service training about this subject. Neither had attended the local social services training about the subject, which would give them local and upto-date information about either alerting people about a suspected case of abuse or how to investigate an incident. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Some communal areas were cluttered with equipment and were not homely. The passenger lift and smoking area did not have level access increasing the risk of someone having an accident. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 24 EVIDENCE: The home is purpose-built and is set out over three floors; the first two floors are for elderly people and the top floor for younger adults. On each floor there are individual bedrooms plus bathrooms, toilets, and a lounge. On the ground floor there is the manager and administrator’s offices. There is also an outside uncovered smoking area, which is difficult for people in wheelchairs to get to due to a raised area in the doorway. This could pose a risk to the staff who are trying to raise wheelchairs over this raised area. On the ground floor there is a large lounge and separate dining area which has patio doors leading out into the garden. There is a passenger lift to each floor, we saw a note on the lift instructing people how to ensure that the lift access is level as this has not been functioning properly. When I spoke to staff they said this had been like this for a few weeks and was causing problems for some people living in the home. We saw one person trying to manoeuvre in and out of the lift with some difficulty. We saw some cupboards which were labelled “wheelchair store”, when we checked it was seen that these were used to store incontinence products. As there is limited storage space in this building it may be advisable for these wheelchair stores to be used for that purpose. We saw some bathrooms which were cluttered with various pieces of equipment such as commodes, walking frames and wheelchairs. The toilets we saw were spacious and had aids to assist people to be independent when using the toilet. We saw that there were no names on bedroom doors, or anything to personalise the door, which might help some people, recognise their bedroom. At the last inspection it was noted that in the middle floor lounge was an excess of equipment, and was being used as a storage area. Staff corrected this at the time but one end of this room is still being used for storage for wheelchairs and lifting equipment. During our visit only one person living in the home was seen in this room. Consideration must be given to storing equipment elsewhere so that this room is welcoming and looks homely. On the top floor it was noted that some of the carpets were frayed in the doorways to the bedrooms and also paint on the skirting and door frames was quite chipped. The lounge was bright and airy and was being used during our visit. The dining area is combined with the kitchen area and though quite small was being well used at lunchtime. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 25 There was a fairly strong smell of urine in a particular area on the ground floor near the back stairs and by bathroom two. Otherwise there were no malodours on the day of our visit. The manager stated on her Annual quality Assessment form that deep cleaning was to be more robust, and that they planned to refurbish the communal lounges. It was also stated that all maintenance checks are robustly done and a list was provided of all the checks such as fiveyear electrical testing. These checks were not looked at during this visit. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There was poor organisation of the staff so that areas of greater need did not have enough staff. There was also a shortage of permanent staff so the home were relying on agency staff or their staff doing overtime. Both factors have had a poor affect on the people living in the home, as call bells are not answered promptly. Staff are not receiving enough training in the conditions of the people they are caring for. EVIDENCE: Comments on survey forms about the staff included: The home could be better run -- lots of changes of staff. Dont answer call bells very quickly. As I need two carers to help me I often have to wait Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 27 Staff are very kind to my relative “There are never enough staff to do more than is asked. There is no time for a casual chat or a walkout or anything similar.” Some staff are better than others. There seems to be a conflict between what my relative wants and what they can provide. They have good night staff The staff are very considerate and keep us informed They respond quickly to anything I ask. The nursing and caring is very good. Three survey forms stated that they felt the home should have higher staffing levels. On the day of our visit there were 34 people living in the home. We were told that staff work on set floors and that there was a registered nurse on each floor. The registered nurse on the ground floor was the deputy manager who was also managing the whole home. We were given information during our visit that there had been a shortage of care assistants over the past two months. Rotas that we saw confirmed this. We talked with staff about the situation and they talked about the frustration of not always being able to meet peoples needs in a timely way. It was evident that although the home was not full the dependency levels of the people living there was quite high. For example 26 out of the 34 people living there needed two staff to assist them to wash and to move about. On our visit there were eight assistants on duty, three on the top floor, three on the middle floor and two on the ground floor. Despite the fact that there were only nine people on the top floor the activities co-ordinator was also working as a carer on this floor during the morning. It was of concern that the deployment of staff did not meet the needs of the people living there. On the ground floor two care staff were being expected to care for 12 people, nine of whom needed two to help them, and try to observe one person who was at high risk of leaving the building. The staff were working very hard to try and achieve this but this was not realistic. An Immediate Requirement notice was left at the end of the visit for the home to ensure that the numbers of staff on duty must meet the dependency levels of the people in the home, and must include minimising any risks to them. This needed to be achieved by the 12th of September 2007. Five recruitment records were checked to make sure that this process was still being done properly, and protecting the people living in the home. The checks confirmed that this process is fine generally, although we were not able to view all the criminal records bureau (CRB) checks as they were locked in the managers office. We were only able to view the overall matrix of these checks which looked okay. CRB records must be available for inspections. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 28 One person who had started working at home this year did not have a reference from their past employer. Their application form stated under the reason for leaving their last employment that they wish to discuss this at their interview. This discussion was not recorded so it was not possible to verify why they had left, and why they were not able to offer their last employer as a referee. This should be recorded. Records showed that staff undergo a period of induction when they start working at the home. We did not talk to staff about this induction process. It was not possible to look at an overall plan of training that had happened and was being planned. We spoke with staff who confirmed that they do receive training in topics such as moving and handling, fire safety, control of substances hazardous to health and medication. None of the staff that we spoke with had any training in the care of people with dementia. This had been a recommendation in the last inspection visit, due to the number of people living in the home with this condition. One person had been working at the home for five months and only had training in moving and handling people. It was not possible to verify that staff were having regular training in fire safety, this will be discussed further in the next set of standards. Some of the staff records we checked showed that some staff had attended some training last year in subjects such as infection control, catheter management and diabetes training. The person who is the manual handling trainer in the home had attended training this year in the prevention of pressure sores and wound care. They have then been able to incorporate this in the manual handling training. The Annual Quality Assessment form stated that the home needed a better ratio of staff who had completed their National Vocational Qualification in care. The home has 24 care assistants of whom eight have completed this and five were currently doing it. One person that I spoke with during the visit stated that when they rang their call bell it took a long time before anybody came to answer it. They said that on one occasion it had taken 45 minutes for it to be answered. They also said that some staff were rude to them when they came to answer the bell. The staff member had said that they couldnt be expected to answer the bell quickly as they were short staffed. This person said that this poor response to call bells had particularly been worse over the last few weeks. They said that some carers were very good but there was a lot of difference in the standard of care delivered depending on the people on duty. They said that the night staff and the trained nurses were very good. This information was passed on to the regional manager. Other people during the visit confirmed that call bells aren’t answered very quickly. One person said, they dont answer the call bell very quickly, as I need two people to help me I often have to wait. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 29 Another person said that they felt sure that their relative wasnt usually asked about what they wanted to eat because communication with them was quite difficult. They felt that staff did not make enough effort to try and understand their relative so just made choices for them, e.g. meals. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 30 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,36,38 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 31 The home was not being properly managed in the registered manager’s absence nor adequately monitored by Four Seasons. Staff are not being fully supported, as they were not having enough individual supervision sessions. There was no evidence to easily show that staff have enough fire safety training. EVIDENCE: As previously mentioned in this report Mrs Brain, the registered manager, was off sick during this inspection visit. During this period of sickness the deputy manager had been acting up as the manager. As mentioned in the summary the Deputy had been working on the floor as a registered nurse as well as trying to run the home. Unfortunately the regional manager for this area had been suspended therefore there had not been regular checks from the organisation for the same period. At the time of our visit an acting Regional Manager had been appointed for the home, and was able to take the feedback from our visit. People living in the home who spoke about Mrs Brain were positive about her management style and her responsiveness to any concerns that they had. It was difficult for us to see what monitoring was being done in regards to the care, for example, auditing of accidents and care plans. This could have been due to Mrs Brains absence, but ought to be available for other people to look at. Staff spoken with during our visit said that it had been difficult not having a full-time manager. It was apparent that there was a complete lack of leadership in the home and that things had deteriorated in her absence. Apart from the auditing of care there had been no staff meetings, and staff supervisions had not been taking place, some not since January 2007. The organisation must take responsibility for not checking up on the standards of care during this time, and offering one-to-one support for the Deputy manager. It is accepted that there is always a manager at the end of a phone call, but this is no compensation for being present in the home. One healthcare professional stated on their form “the manager needs to have her presence felt in the home to boost staff morale, for example by having morning rounds every day and monitoring the standard of cleanliness in the home.” The fire log was checked to ensure that safety checks are being done to minimise any risk of a fire and ensure that staff have the correct equipment and skills to deal with a fire. The safety checks of the fire alarms were done weekly, there had not been a fire drill since January 2007 which 14 staff are involved with, it was not clear what time of day this was. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 32 Emergency lights are checked weekly but had not had the six monthly prolonged test so far this year, fire fighting equipment was checked weekly and there is a log of the equipment to be checked. The emergency lights and fire fighting equipment had both been checked by the contractor this year. There were no records in the fire log of any staff fire safety training, and no matrix of when staff had attended training to ensure that the night staff are updated three monthly and the day staff six monthly. The regional manager was asked to send this information to me as soon as possible. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 33 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 X 2 X 3 1 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 X 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 ENVIRONMENT Standard No Score 19 2 20 2 21 3 22 2 23 X 24 X 25 X 26 2 STAFFING Standard No Score 27 1 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 X 32 1 33 X 34 X 35 X 36 1 37 X 38 2 Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? NOT VERIFIED 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 OP27 Regulation 18(1)(a) Requirement The registered person shall ensure that at all times suitably competent person are working at the home in sufficient numbers as are appropriate for the dependency needs of the service users. The registered person shall ensure that measures are taken to reduce any risks to two service users identified during the inspection visit. These should include safety checks which need to be recorded. A full assessment of the risk to them needs to be done and reviewed as necessary. The registered person shall ensure that all service users must have access to and/or help to have a fresh drink at all times. The registered person shall ensure that the social activities provision for older persons at the home is reviewed to ensure that there is a range of activities and opportunities for individual social care needs to be met. Timescale for action 12/09/07 2. OP8 13(4)© 11/09/07 3. OP8 12(1)(a) 11/09/07 4. OP12 16(m)(n) 01/10/07 Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 35 5 OP7 15(1)(2) 6 OP8 13(4)© 7 OP15 16(i) 8 OP30 18(1)©(i) 9 OP22 23(1)(b) 10 OP30 18(1)©(i) 11 OP36 18(2)(a) 12 OP16 22(3) The registered person shall ensure that the care plans are drawn up with the service user and set out in detail the actions to be taken by staff to ensure that the health, personal and social care needs of each person are met. When reviewed all available information must be used to inform the review so that changes can be made which reflect the current condition of each service user. The registered person shall ensure that all accidents/falls are audited, and any new or increased risk of falling is reviewed and reduced as much as possible. The registered person shall ensure that each service user is offered a choice of meal by using visual choices where necessary. The registered person shall ensure that all staff have suitable local training in the subject of abuse so that they know how to respond to an allegation of abuse. The registered person shall ensure that the passenger lift is safe and provides level access. This must also be provided for access to the smoking area. The registered person shall ensure that all staff have training in the conditions of the service users such as Dementia. The registered person shall ensure that all staff have regular and suitable supervisions sessions. The registered person shall ensure that all complaints are fully investigated. 31/10/07 30/09/07 30/09/07 30/11/07 30/09/07 30/12/07 31/10/07 30/09/07 Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 36 13 14 OP38 23(4)(d) 12(4)(a) OP10 The registered person shall ensure that all staff receive suitable fire safety training. The registered person shall ensure that call bells are answered promptly. 30/10/07 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6 7 Refer to Standard OP8 OP28 OP22 OP15 OP19 OP30 OP19 Good Practice Recommendations Sufficient lifting equipment should be available for staff to use. Another stand-aide is needed. Care staff should be encouraged to undertake training and achieve NVQ Level 2. The storage of equipment should be safe and should not clutter the service users or communal areas. Staff should encourage service users to sit together at meal times to make the meals a more sociable occasion. The smoking area should be covered for the service users comfort. A training matrix should be compiled to ensure that there is a sufficient plan for staff development. A programme of maintenance and renewal of the fabric and decoration of the premises is produced and implemented with records kept. Yatton Hall DS0000020292.V343629.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33, 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. 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