Inspection on 17/01/08 for Yatton Hall

This inspection was carried out on 17th January 2008.

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

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

Other inspections for this house

Yatton Hall 05/05/09

Yatton Hall 09/06/08

Yatton Hall 11/09/07

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 Unannounced Inspection 10:00 17 January 2008 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.V354987.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.V354987.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.V354987.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 8/01/07 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.V354987.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means that the people who use this service experience poor quality outcomes. This key (main) inspection visit 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 survey forms, which had been sent to the home. These forms were completed by people living in the home, their relatives and staff. All of this information was used to make a decision about the outcomes for people living in the home. The manager was not present for this visit. The regional manager came to the home during our visit and was given all of the information from our findings to finish the inspection. We issued three major requirement notices; these are used when we need a home to take swift action to make situations safer for the people living in the home. The first was that following an accident/fall/incident staff did not reassess whether there is any additional risk to the person, and show these reassessments in the records. The second was to ensure the safety of people who live and work in the home, and making sure that fire equipment is tested at the recommended intervals, and the staff receive fire training at the recommended intervals. The third was for the home’s repeated failure to meet the environmental health regulations in the kitchen. As the home has continued to be a service of concern a meeting will be held with Four Season’s representatives and ourselves to discuss this. What the service does well: Some positive comments on survey forms included: Most of the trained nurses are excellent. The new manager cares about the residents and relatives. One thing the home does well is care for people who live in the home. We each know what is happening with each resident, senior staff support is very good. The home manager is always willing to discuss any issues. They provide a warm comfortable and happy environment. Its a friendly place to work and Im glad to be part of the team. Yatton Hall DS0000020292.V354987.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: To make the home a safe place to live and work in the home needs to meet the actions given in the three Immediate requirement notices that were left. The homes failure to meet hygiene standards in the kitchen is of grave concern. Despite two environmental health inspection reports and a warning letter to the Operations Director of Four Seasons, standards were unacceptable at our visit. The staff need to show that they have looked at risks following an incident where someone living in the home may be put at a new or increased risk. This could be following a fall, an accident, or incidents like someone leaving the building unaccompanied. In some instances there may be nothing more that can be done to minimise any risks, but this needs to be proved in the records. In order to make sure that people have enough time to consider whether they want to live in the home trial visits should take place, particualry for those people who have a Learning Disability. In order for staff to be fully informed about each person care plans need to include personal information and how the person prefers to spend their time and what staff can do to support them to do that. Care plans should be reviewed using all of the information available, particualry when it is the monthly review to make sure that they are a realistic reflection of what is happening for that person. In order for staff to provide consistent and therapeutic care the care plans for mental health need to improve. These should give staff the strategies, which have been found to be useful and effective in order to meet that need. The home must develop much clearer care plans and Risk Assessments for each individual who presents behaviour, which may be perceived as Yatton Hall DS0000020292.V354987.R01.S.doc Version 5.2 Page 7 challenging the service being provided. This would enable staff to offer support in a safe and consistent way and promote each person’s welfare and safety. The younger adults who live in the home must be supported to access a wider range of social activities both within and outside of the home and to determine their own lifestyle. The care planning process and support offered by staff must be developed to ensure this improves. Each person who lives in the home must always be treated with dignity and respect. This must also reflect each person’s care plan and be in accordance with any relevant policies and procedures, such as protecting people form abuse. In order for staff to promote a person’s dignity and make it a more sociable experience staff should sit down with each person when they are assisting them with their meal. In the files we read there were no life histories of the person before they moved into the home and no records of any one to one (key worker) quality time with staff. This may mean that staff are not fully engaged with the idea that they should be providing social care. This needs to begin with an assessment of the person as a whole, and should include their previous interest and hobbies. In order for people to be assured that their complaints are taken seriously and actions taken to remedy their dis-satisfaction any complaints need to be recorded. Then the process of investigating and actions taken should be clearly written, and whether the complainant was satisfied with the response. In order for staff, including senior staff, to be confident about what constitutes abuse and to take the right actions if they are told about an allegation of abuse, there needs to be better training in this subject, supported by supervisions to make sure that the training has been effective. There needs to be an improvement to the home to make it more homely and reduce the amount of walking equipment stored in communal lounges. To give the staff the skills to provide up to date care practices the training plan should include individual staff members training needs and requests. These requests should be checked from the supervision sessions and followed up to make sure that this training is provided or funded. It is recommended that supervision sessions are held 3 monthly,and be a one to one session where care practices, career development and the home’s philosophy of care are discussed. Any areas of weakness or poor practice need to be shown in supervision records and clear goals set with timescales for making sure that there is an improvement. Yatton Hall DS0000020292.V354987.R01.S.doc Version 5.2 Page 8 It is important to follow up any disciplinary action taken in staff files, so that again there is evidence of the investigation, action taken, and then if there is an improvement or recurrence of the problem. In order for the home to be protected against the risk of fire all staff should be aware of where the fire log is kept, be trained regularly and safety checks should be done as often as is recommended by the local fire brigade. 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.V354987.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.V354987.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): 3.4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff still do not have the skills and training to be able to care for people with dementia. EVIDENCE: The admission process for two people who have a learning disability were checked during this visit. This is to make sure that the home did a complete and thorough assessment of the persons needs before a decision was made about whether the home could meet their needs. Yatton Hall DS0000020292.V354987.R01.S.doc Version 5.2 Page 11 This process should have included some introductory visits to the home, increasing in length over time. This was not done in both these cases. After the inspection the manager stated that this didn’t happen as the home the people came from closed at short notice. At the last visit there was some concern about the care of a person who had dementia and was then living at the home. This person no longer lives at the home. We did look at the records, talked with the staff and met one person living in the home who has a cognitive impairment. This persons care plan did contain information about how the staff should help them to meet their physical care needs. However there was extremely limited information about how staff can help this person overcome the difficulties they experience due to their cognitive condition, these problems includes communication difficulties. It was also of concern that this person had left the building unaccompanied on the 16th of January 2008. There was no re-evaluation of this risk neither in any risk assessment nor in their care plan. This person was noticed to be walking around the home for much of the day during our visit, on their own and with little stimulation. Yatton Hall DS0000020292.V354987.R01.S.doc Version 5.2 Page 12 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): 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There was no evidence to show that any risk, following falls/accidents/incidents is re-assessed to reduce the risk as much as possible. People living in the home are not always treated with respect as we witnessed one member of staff shouting at someone living in the home when they were needing help. Yatton Hall DS0000020292.V354987.R01.S.doc Version 5.2 Page 13 Care plans for younger people do not show the support needed for them to live their chosen lifestyle or how staff should react to any challenging behaviour. Care plans for older people do not consider the whole person or reflect important events. EVIDENCE: We looked at the care records of eight people living in the home with a variety of needs. In order to get as much information about them as possible we also met with them, talked with staff about their needs, and checked other records such as accident books to see what had been happening to them. One person been living in the home for a number of years and was the person who had gone out of the home unaccompanied. Their care plan had been rewritten fairly recently. It did have a communication plan but there was no social care plan for this person, despite the fact they would be quite dependent upon staff to provide them with some sort of meaningful occupation. There was no recent evidence that the care plan had been written in consultation with the persons family. The daily progress sheets showed some recent events, which should have been converted into a care plan. For example an incident of aggression towards a member of staff, and an adverse response to the emergency call bell ringing, and then the incident mentioned where they actually walked out of the building. There were no notes in the key worker diary about any social events or meaningful time spent with the person. There was no evidence that their preferred meals were recorded, which would be important due to this persons communication difficulties. The next plan had a good pre-admission assessment, which gave useful information about this persons care needs. The care plan was more personal as it included statements such as the person likes/prefers rather than just statements of fact. There was some good information in the plan for communication and recent developments to help this person communicate effectively. There was also a plan for a new health-care problem, and this had been re-assessed. There was evidence in this persons notes about referrals to other healthcare professionals to support the person. These included the GP, a physiotherapist and the Stroke Team. There was slightly confusing information in the two risk assessments for the risk of falls as one indicated a low risk and the other indicated a high risk. There was no information in the review of the falls risk assessment to indicate why this should now be a high risk. Yatton Hall DS0000020292.V354987.R01.S.doc Version 5.2 Page 14 There were entries of this person being invited to participate in entertainment organised by the home, for example the Christmas party. There were very few entries of any other meaningful occupation, and was no information in the key worker diary about any one-to-one time spent. The accident records were checked to make sure that any risk to people living in the home was reduced after a fall/accident/incident. The record showed that two people had had falls; one person had had more than 14 in January 2008. The first person had hit their head against a wall. Despite this no observations of their well-being was done which would be usual after a head injury. The GP was contacted and visited. This incident was not investigated so that staff could possibly put in measures to prevent it happening again. The second person was someone we had noticed at the last inspection visit as suffering numerous falls. As a result of that measures had been put in place to reduce the risk of them falling. Despite those measures several falls were recorded in various records since the end of December 2007. In the care plan for safety there was no review of the three falls recorded in the daily progress sheets. In the care plan for falls the most recent fall had been mentioned but the others werent.There was no evidence that there was a reduction of risk. We also examined three care plans for the younger adults who live on the top floor of the home. These plans remain in a ‘needs led’ format and each varied in the quality and clarity of the information they contained. The index of one care plan explained there were five key areas which staff are expected to support. This care plan did however contain eight areas of support, although this is not clear from the index. While some sections are clearly written and should be easy for staff to follow other sections need to be improved, for example to better explain to staff how they are to support this person to become more aware of their environment or to help them improve their mood. In another plan nine areas of support are noted and reflected in the index. However, this individual’s social life and providing ‘stimulation’ appear to be key areas in their plan although the ‘Social Activities Plan’ had not been completed nor had any ‘Social Activity Progress Reports’ so it is difficult to see if this individual is being provided with any form of social and stimulatory support, and if they are, what is the outcome. There are general Risk Assessments completed for each individual covering areas such as their risk of falling, moving and handling, eating and drinking and epilepsy. There appears to be a lack of person centred Risk Assessments, to support people to take risks as part of their lifestyle, for example one individual who does go out of the home without staff support has no risk assessment in place to help ensure their safety. Yatton Hall DS0000020292.V354987.R01.S.doc Version 5.2 Page 15 It is also not clear how Risk Assessments are reviewed. The care records show that staff sign a review sheet to confirm that each assessment is reviewed monthly. One review which we examined had not taken into account the increased risk following one individual having a fall despite the records clearly explaining to staff that this fall would affect the assessment of this risk. The medication systems were checked by the Commission for Social Care Inspections pharmacy inspector. During our visit we witnessed an incident on the top floor of the home, which involved a care assistant shouting at someone living in the home. The care assistant had been left on their own while all the other staff on that floor were taking a break together. The care assistant had been trying to assist somebody but was unable to do that on their own. We overheard the care assistant shouting at the person, which obviously was completely unacceptable. The care assistant, when questioned by us, apologised for their actions and went to apologise to the person themselves. We went to speak with a nurse in charge to ask why all of the staff were taking a break together, we were not given a satisfactory answer. This matter was passed to the regional manager who is arranging for this to be investigated. We noticed during the serving of meals that some staff were standing up while trying to assist people with their meal. This was quite an undignified process and made it difficult for this to be a sociable time as conversation then became difficult. Yatton Hall DS0000020292.V354987.R01.S.doc Version 5.2 Page 16 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. Social activities still need to improve for both older and younger people by involving all staff and assessing people’s previous lifestyles. Some people living in the home have made complaints about the food but these were not recorded. The standards of hygiene in the kitchen in December 2007 till our visit were appalling. Yatton Hall DS0000020292.V354987.R01.S.doc Version 5.2 Page 17 EVIDENCE: In relation to the younger adults, we spoke with three individuals who live in the home and one relative who was visiting on the day of our inspection. Each person spoken with told us they liked living in the home and find staff helpful and caring. If they have any problems or are unhappy they can talk to staff who they are sure will help them. They each like their own room and feel they have everything they need. Their rooms are treated as private and staff do knock before entering their rooms. They each have many personal items and their own TV or stereo should they wish to spend time on their own. One person told me they particularly liked the view from the bedroom window as this looked out over the surrounding countryside. Each person we spoke with said they like the food in the home and always had a choice of meals. Staff normally give them three choices of main meal each day and we did see staff asking individuals what they would like for their meal the following day. There were the following comments in survey forms: “There are not many activities and I sometimes don’t like the meals”. “ The meals could be cooked in a safer way. My relative can’t chew meats but as they haven’t got a mincer they blend it so it looks like baby food and then they can’t eat it as it looks like baby food”. “There does not seem to be a lot of emphasis on activities and stimulation in the home”. “More activities are needed to provide a more stimulating home”. For the older people we read about there were some events they joined in like the seasonal events, but not any related to their previous interests and hobbies. It is of great concern that people working and living in the home were being put at considerable risk due to the “numerous serious contraventions of food safety legislation and non-management of food operation at the premises. This allowed the business to be conducted in an unhygienic manner. “ This information was given to us by a food safety officer from North Somerset Council. They visited the premises on the 19th of December 2007 and describe their findings as “appalling.” The same officer conducted a follow-up visit early in 2008, while there were some improvements the standards were still not satisfactory. Yatton Hall DS0000020292.V354987.R01.S.doc Version 5.2 Page 18 During our visit we checked the kitchen and was surprised to find dirty equipment being used such as fat saturated, dirty oven glove, a stained measuring jug, a cracked and dirty casserole dish, frying pans full of old fat, dirty storage cases in the food store, fridge shelves cracked with very dirty seals and both freezers needing defrosting. Two members of staff had cleaned the food store the evening before and despite it only being a small space took them two hours to do. Plastic food containers had been removed during this cleaning session and was still in the kitchen and very dirty although they werent being used. The head cook was on holiday for our visit and the relief cook had worked hard to try and make the kitchen cleaner. On the day of our visit they had no one to help them in the kitchen. The food safety officer joined the feedback of this inspection, and was given the dirty items we found, and went to do their own inspection of the kitchen. They still found many areas that needed to be improved. We were informed that the manager had done an inspection of the kitchen on the ninth of January 2008 and produced a list of areas that needed to be improved. Some of these had been checked and ticked off as being met, but that did not contain all of our findings. As mentioned in the summary we issued an immediate requirement notice to make sure that the home has a satisfactory standard of hygiene in the kitchen. Yatton Hall DS0000020292.V354987.R01.S.doc Version 5.2 Page 19 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 poor. This judgement has been made using available evidence including a visit to this service. Complaints are still not being recorded and some people living in the home and relatives do not feel confident that their concerns will be investigated. Senior staff’s knowledge of how to respond to an allegation of abuse is still inadequate. Information about some people’s behaviour which may be seen as challenging the staff are limited in their scope, do not provide clear guidance for staff and do not always reflect information contained in daily records. EVIDENCE: We had been made aware of a complaint made by a relative about a health care matter. This was not recorded in the complaints book, in fact there were no complaints recorded since August 2007. We had been made aware of another complaint made by someone who was at home for respite (short term) Yatton Hall DS0000020292.V354987.R01.S.doc Version 5.2 Page 20 care. The regional manager was aware of this complaint and was responding to it. Information in the staff survey forms told us that a lot of people had been complaining about the food on the menus in the past six months, this was not recorded anywhere. One comment from someone living in the home stated: “I feel strongly that most things go over their heads and there are a lot of empty promises. I do not feel that many of my valid complaints are dealt with”. “ I had a complaint about one of the night staff as they did not administer my relative’s medication properly and hurt my relative”. “Sometimes it takes a long time for staff and service users to get an answer to problems that have been reported.” At the last visit we spoke with three trained nurses about their knowledge of abuse and what they would do if an allegation of abuse was made while they were in charge. At this visit we spoke with a more senior member of the team about the same scenario. While they were aware of possible areas of abuse they were not familiar with the home’s protection of vulnerable adults policy, which meant that they did not know about contacting Social Services. They were also unclear about whether they should suspend a member of staff if a serious allegation had been made against them. It was a requirement at the last inspection that all staff have suitable local training on the subject of abuse so that they would know how to respond to an allegation. The timescale for this to have been achieved should have been the end of November 2007. Some people who live in the home may present behaviours, which can be perceived as challenging the service being provided. Some of these behaviours involve self-harm, verbal and occasionally physical aggression towards staff. Each person who can present such behaviours has one section in their care plan completed which should describe all known behaviours, key things for staff to consider and de-escalation techniques which are to be used. These are limited in their scope, do not provide clear guidance for staff and do not always reflect information contained in daily records, which should have led to the existing guidelines being reviewed. One individual’s plan states they shout, where the notes completed by staff explain this individual has also recently hit a member of staff. Another individual’s plan states they can be verbally aggressive where their daily notes record many instances of them declining their medication or any food and also attempting property damage. Yatton Hall DS0000020292.V354987.R01.S.doc Version 5.2 Page 21 There are no Risk Assessments in place in relation to any of the behaviours individuals may present or staff responses to them. Staff are not provided with any formal training in either understanding why people may present such behaviours or how to respond to them in a planned or effective way. Staff members we spoke with said they would welcome this type pf training and are sure this would help them provide better care and support for people who do become anxious and at times present some behaviours which are difficult to manage. Yatton Hall DS0000020292.V354987.R01.S.doc Version 5.2 Page 22 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Work needs to be done to make the home more comfortable. There needs to be level access to the outside smoking area. This was found at the last visit in September 2007. Yatton Hall DS0000020292.V354987.R01.S.doc Version 5.2 Page 23 EVIDENCE: It had been a requirement of the last inspection that the passenger lift should be mended so that it was level when it stopped on each floor. The timescale for this to be achieved had been agreed with the company’s Estates manager at the time of our visit. This should have been done by the end of September 2007; we were informed that this was only done in December 2007. It was also required that level access was provided to the external smoking area. This had not been done. Some comments about the environment in the survey forms included the home needs a brighter and more cosy feel peoples rooms, the décor, and furniture all very old. The whole place needs a makeover. The lift floor has not been levelling properly, its been like it for approximately four to five months making it difficult for staff to push chairs in and out. The home is being redecorated throughout, the home requires a lot of cosmetic work. The home provides a warm comfortable and happy environment for all service users. We were informed that there is to be some redecoration and reorganisation of the middle floor lounge which will include having storage space, a new carpets and television. The ground floor lounge was checked at this and our last visit and still has wheelchairs stored in the corner. Yatton Hall DS0000020292.V354987.R01.S.doc Version 5.2 Page 24 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. The home is still relying on frequent use of agency staff which impacts negatively on the continuity of care. Recruitment practices were not being fully followed to make sure that each person is suitable. Staff training is not given in the conditions of the people in their care. EVIDENCE: The home has continued to struggle to recruit enough staff so that they do not usually have to use agency staff. The survey forms we received from staff suggest that this has been a problem: Yatton Hall DS0000020292.V354987.R01.S.doc Version 5.2 Page 25 “Sometimes the handover is not given due to being short staffed and using lots of agency. This also affects us being able to attend training.” “Trained staff should monitor staff behaviour more, deal with problems efficiently and on time.” “There is never enough staff”. We met a new care assistant who was happy to talk with us about their experience of working in the home. They had worked in other care homes and found themselves able to spend time just talking with the people in their care. They had found their induction sufficient to help them settle in but recognised that as an experienced carer they needed little help to find their feet. They had not yet had any fire training despite being at the home for a short while. This should be covered during the initial induction. Staff confirmed that the dependency levels had lessened since our last visit particularly on the ground floor. This has meant that they are able to better meet the needs of the people living in the home. However, we noticed that call bells rang for long periods without being answered. Care staff confirmed that they are not formally consulted about the care plans even when they are being reviewed. A health care professional commented that the quality of the staff was variable and that relatives had made comment to them about there not being enough staff on duty. Rotas show that the home does still use agency staff quite regulary. Some shifts have been covered by the trained nurses working as care assistants. The period of 31st December 2007-27th January 2008 shows that for at least two weeks they rely on at least one 6-hour shift each day being covered by agency staff. One person living in the home said, “ staff are only available sometimes when needed”, staff themselves said that there were usually enough staff to meet people’s needs. Another staff member said” we do not have time to read information. The induction mostly covered what I needed to know. We are not given training to meet individual needs and we don’t have enough staff.” Another “ the information is not passed onto care assistants. My induction could have been better.” “Not enough time is given to National Training Vocational training.” “ We have been working short staffed for a while and a lot of good staff have left. We only get an hour’s break on a 12-hour shift. We are not always supported to be able to give proper care.” The training programme being developed for 2008 includes mostly Health & Safety topics such as moving and handling, food hygiene, infection control, fire and first aid. Two topics relating to the care needs of the people living in the Yatton Hall DS0000020292.V354987.R01.S.doc Version 5.2 Page 26 home were included such as Epilepsy and End of Life training. It is disappointing that more emphasis has not been given to staff training in areas such as mental health,learning disability and physical disabilities. Staff we spoke with said that they would appreciate this type of training. Recruitment records were checked to make sure that they followed safe procedures to protect the people living in the home. Three records were checked. The first contained some worrying information in a reference about the way the person left their employment and how they coped with difficult situations. There was no record of this being discussed at their interview so it was not possible to see the decision-making that led the manager to take this person on. There were also no supervision notes for this person. It was not possible to verify if they were still on their probationary period. The second person’s application form was incomplete. It was difficult to tell if the references were from previous employers and seemed to be from care assistants. The third file was checked for supervision records and the two sessions for 2007 did not have any text, just a scoring system to gauge whether the person was satisfactory or excellent. This was surprising considering that disciplinary action had to be taken against the person in between the supervision sessions. It was not possible to tell what had caused the problem and how it was resolved. Yatton Hall DS0000020292.V354987.R01.S.doc Version 5.2 Page 27 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Yatton Hall DS0000020292.V354987.R01.S.doc Version 5.2 Page 28 There are mixed views about the management style of the registered manager. The manager has not been overseeing all departments to make sure that standards are satisfactory. Some staff are still not feeling adequately supported and supervision sessions are infrequent with poor content. There is no follow up of areas of concern like disciplinary matters or training needs/requests. Fire safety is being compromised by the safety checks not being done as necessary, and staff training could not be verified. EVIDENCE: Unfortunately the registered manager Lisa Brain was not present for this visit. At her request she came to the local Commission for Social Care Inspection office for the feedback after the visit. It has been difficult for us to from our own judgement of her management skills as she has not been present at either inspection visit-there were mixed views about her management style on the survey forms; “ The management should treat everyone as an equal.” “ Reported problems get taken no notice of. The manager does not sort out staff problems.” “ The manager is always available and willing to talk about any issues.” “ I never meet with my manager.” “ The manager doesn’t bother to find out about problems between the different staff groups.” “Since the new manager came the home is really improving, she cares about the residents and relatives.” It is disappointing that many of the Requirements made at the last inspection visit have not been met. In particular the risk of people experiencing repeated falls due to staff not auditing this properly. There is also the failure of the manager to oversee the kitchen so that there was a more marked improvement after the initial inspection by the Food Safety Officer. It is the manager’s responsibility to oversee all departments in the home. Staff were unclear about how often they had staff meetings and supervision sessions are not happening as often they should be, and the content is poor. This was the same at the last visit. The Deputy manager recognised that they were all behind with their supervision sessions and put this down to being too busy. She is responsible for doing the trained nurses and the manager the other staff. She thought Yatton Hall DS0000020292.V354987.R01.S.doc Version 5.2 Page 29 there might have been a staff meeting in November 2007, and thought that staff morale was OK but not good. We checked the fire safety records which were incomplete at the last visit. The fire log showed that the safety tests of fire fighting equipment had not been done since November 2007 and should be done monthly. The last recorded fire drill was not since January 2007 and should be done at least twice a year. Once again it was not possible to check that staff were receiving regular fire safety training-this had been the same at the last visit. The only way this could have been checked would have been to check each person’s individual file. An Immediate requirement notice was left for the home to make sure that the safety tests are done as often as they should be and staff are trained regularly. Yatton Hall DS0000020292.V354987.R01.S.doc Version 5.2 Page 30 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 2 4 1 5 X 6 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 X 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 ENVIRONMENT Standard No Score 19 2 20 2 21 X 22 X 23 X 24 X 25 X 26 X STAFFING Standard No Score 27 2 28 X 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 1 33 X 34 X 35 X 36 1 37 X 38 1 Yatton Hall DS0000020292.V354987.R01.S.doc Version 5.2 Page 31 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 OP15 Regulation 16(2)(j) Requirement Timescale for action 18/01/08 2. OP38 3. OP8 4. OP12 The registered person shall ensure that suitable arrangements are made to maintain standards of hygiene in the kitchen. Immediate requirement 23(4)©(i)(iv)(v) The registered person shall (d)(e) ensure that all fire detection equipment must be tested in accordance with fire safety regulations, and all staff to have appropriate fire instruction. Immediate requirement 13(4) 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. Immediate and repeated requirement 16(m)(n) The registered person shall ensure that the social activities and preferred lifestyle for everyone in the home are known to make sure that it meets individual needs. DS0000020292.V354987.R01.S.doc 18/01/08 17/01/08 28/03/08 Yatton Hall Version 5.2 Page 32 Repeated requirement 5. OP30 18(1)(i) 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. Repeated requirement The registered person shall ensure that the level access is provided for access to the smoking area. Repeated requirement The registered person shall ensure that all staff have training in the conditions of the service users such as Dementia. Repeated requirement The registered person shall ensure that all staff have regular and suitable supervision sessions. Repeated requirement The registered person shall ensure that all complaints are fully investigated. Repeated requirement The registered person shall ensure that care plans set out in detail the care needs for each person and supporting them with their preferred lifestyle. Repeated requirement The registered person shall ensure that care plans for younger adults should include any strategies for staff to use for behaviour, which may challenge them, The registered person shall ensure that there is a risk assessment for any behaviour which challenges the service. 31/03/08 6. OP22 23(1)(b) 28/02/08 7. OP30 18(1)(i) 30/04/08 8. OP36 18(2)(a) 30/03/08 9. OP16 22(3) 30/01/08 10. OP7 15(1)(2) 28/03/08 11 YA23 13 (7) (8) 28/02/08 12 YA23 13 (7) 28/02/08 Yatton Hall DS0000020292.V354987.R01.S.doc Version 5.2 Page 33 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. Refer to Standard OP28 OP22 OP19 Good Practice Recommendations 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. A programme of maintenance and renewal of the fabric and decoration of the premises is produced and implemented with records kept. Yatton Hall DS0000020292.V354987.R01.S.doc Version 5.2 Page 34 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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