Inspection on 05/05/09 for Yatton Hall

This inspection was carried out on 5th May 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Yatton Hall 09/06/08

Yatton Hall 17/01/08

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

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St George`s

5 Seafield Road

Credence House

Poldhu

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Yatton Hall High Street Yatton North Somerset BS49 4DW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Paula Cordell     Date: 0 6 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Yatton Hall High Street Yatton North Somerset BS49 4DW 01934833073 01934877373 yatton.hall@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Grandcross Limited(wholly owned subsidiary of Four Seasons Health Care Ltd) care home 48 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 2 35 0 learning disability old age, not falling within any other category physical disability Additional conditions: 0 0 13 The maximum number of service users to be accommodated is 48. 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. Date of last inspection Brief description of the care home The home is owned by Grandcross Limited (wholly owned subsidiary of Four Seasons Health Care Ltd). Four Seasons Health Care is a large organisation with approximately 450 homes situated throughout Great Britain. Mrs Lisa Brain manages the home. Yatton Hall provides nursing care for up to 48 people. The accommodation is provided Care Homes for Older People Page 4 of 34 Brief description of the care home on three floors, served by a lift. The first two floors are for older people, the top floor for younger disabled people. There are 48 single bedrooms, not all the bedrooms have ensuites. 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 home is staffed with a registered nurse at all times. At the time of publishing this report, the weekly fee range started with the Local Authority rate of 586.42 up to 1050.00 pounds for the Younger Physically Disabled persons. The Registered Nurse Care Contribution paid to the home for privately funded clients is retained by home. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit as part of a key inspection process. The purpose of the visit was to review the requirements and recommendations from the visit in June 2008 and monitor the quality of the care provided to the individuals living at Yatton Hall. There has been one complaint forwarded to the Care Quality Commission and this was forwarded to the home to investigate. The home kept the Commission informed during the investigation and the outcome. There have been no additional visits to the home between June 2008 and May 2009. An expert by experience a lay person who has had experience of using care services Care Homes for Older People Page 6 of 34 assisted with the the process of inspection on the first day. Their comments and observations are included in this report. The visit was conducted over two days for a period of nine hours and ended with structured feedback being given to the manager and the operations director. The inspection methods used included a review of records that are required in respect of the legislation and the National Minimum Standards, a tour of the building which allowed for staff to be observed in their day to day roles and to engage with both staff, people who use the service and their relatives including the registered manager and the operations director. Systems were looked at relating to quality monitoring and health and safety. The home has been sending information in respect of regulation 37 notifications of events that effect the wellbeing of the individuals living in the home. These were used as a focus to plan the visit along with the annual quality assurance assessment completed by the registered manager. In addition surveys were sent to people who use the service of which three were returned, relatives in which four were returned and visiting professionals of which two were returned. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 34 Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals to move to Individuals Yatton Hall have sufficient information to enable them to make a decision on whether the home, this would be enhanced if different formats were available. can be confident that a comprehensive assessment is completed ensuring is suitable and can meet their care needs. Evidence: The home has a statement of purpose and a service user guide. This was placed in the lobby of the home for all to access should they wish. This was not viewed on this occasion as there has not been any changes to the service provided. The manager in the completed annual quality assurance assessment stated that this information would be made more more accessible and available in different formats. This will be followed up at the next visit to the home. Individuals spoken with during this visit said that they had sufficient information to Care Homes for Older People Page 11 of 34 Evidence: enable them to make a choice to move to Yatton Hall. One person said that they had visited the home prior to making a decision another said that when they had visited the staff were friendly and this was the best home they had lived in. The home at the time of writing this report had an occupancy of 33 people. The home provides support to Younger Adults on the top floor and the ground and first floor support individuals over the age of 65 years of age. Nursing Care is provided 24 hours a day. The home has a clear admission process, which includes encouraging individuals to visit the home and/or be visited in their previous placement, home setting or in hospital to gather important information to establish whether the home would be suitable. A full assessment is completed which covers all areas of daily living as described in the National Minimum Standards. This then informs the homes care planning processes. The home has recently introduced a new assessment which covers all daily living, manual handling, social and cultural needs. This had been implemented for approximately half of the individuals living in the home. This was much clearer than the previous system. As part of the homes assessment views were sought from the individual and where relevant relatives and other professionals involved. The home has recently built on the information gathering by asking individuals about their life histories and important events. This is good practice. Some of the bedrooms are designated respite care beds. It was evident that a full assessment of need had been completed and a care plan was in place to guide staff on how to support the individual. Contracts were not viewed on this occasion but have been seen on previous visits. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals can be confident that their personal and health care needs are being met. Good systems are in place to safeguard individuals in respect of the administration of medication. Good systems are in place to ensure people are treated sensitively and with respect taking into account the wishes of the individual at the last stages of life. Evidence: Five persons care was looked at during this visit to determine the outcomes for individuals living at Yatton Hall. Two of these were individuals that lived on the Younger Persons Unit. An opportunity was taken to look at care documentation, speak with some of the individuals, carers and the manager about the care that is provided. The home has introduced not only a new assessment format but a new care planning tool. This better evidenced the care that was being provided and linked to the assessment of need and the review process. Care plans were being reviewed on a monthly basis and updated as appropriate. Daily records were maintained of the care that was provided. Care Homes for Older People Page 13 of 34 Evidence: Care plans clearly detailed the support needs of the individuals in a person centred way. The home has addressed the requirements from the last visit. There was clear information relating to both personal and health care needs. Individuals had evidently been consulted about the plans of care and where possible the individual or their representative had signed the care documentation. Many of the care plans had been rewritten and transferred into the new system. Some lacked a date and just stated rewritten. During the last visit it was noted that there was a lack of guidance for staff to follow if a person was agitated this had improved. However, whilst it was documented in the assessment there was no plan of care for one of the individuals ensuring a consistent approach. It would appear that the person is not tolerate of being kept waiting and will hit out at staff. The guidelines from the assessment should be transferred to a plan of care detailing the triggers and how staff should support the individual. This will enable staff to clearly monitor the individual and montir the reasons so that these can be reduced. In a completed survey one relative commended the home on the way the the staff support their relative in light of some of the challenges. Both of the completed surveys from relatives said that the home keeps them informed of any important issues affecting their relative. Clear records were maintained of health care appointments with the GP, dentist, optician and chiropodist. Other health professionals are involved depending on the needs of the individuals including dieticians, continence adviser, diabetic nurse, Parkinsons specialist, epilepsy specialist to name a few. The manager said that they were planning to develop a diabetic lead in the home who would attend training and cascade this to the staff and work closely with the diabetic specialist in supporting individuals in the home. The home completes periodic audits on the care planning processes on a six monthly basis. Individuals views are sought annually through a questionnaire on the delivery of care and informally by the care staff on a monthly basis. Individuals have a named worker called a key worker who assists in the planning and the reviewing of the care. Risk assessments covered a wide range of activities including manual handling, nutritional assessments, falls and other daily activities. These had been reviewed and updated accordingly to changing needs. The manager completes a weekly audit on all falls, pressure wounds and other Care Homes for Older People Page 14 of 34 Evidence: incidents that occur in the home and this is forwarded to the regional manager for analysis. It is evident that the manager is knowledgeable about the people living in the home and their changing needs. Good records were maintained in relation to accidents and incidents and the actions that were taken to minimise any further risk. The medication systems were checked. Records were well maintained. Storage was well organised and in accordance with the Royal Pharmaceutical Guidelines. The controlled medication record was checked and corresponded with the medication held in the home. The home uses a blister system which is delivered on a monthly basis. There were clear records of medication entering and leaving the building. The home is staffed with two registered nurses throughout the day and night and they have the sole responsibility to administer the medication. A policy and procedure on the safe administration of medication was seen at a previous visit and met with the National Minimum Standards and Care Home Regulations. Stock held in the treatment room was well organised and clearly labeled including that needed for pressure wounds. Staff have attended training in pressure wound training and knew what to look out for. Good monitoring was in place in relation to wound care including seeking advice of the tissue viability specialist. The home has a stock of oxygen and this was stored in accordance with the guidelines. The manager has sought the advice of the GP in relation to when oxygen can be administered in respect of epilepsy and this is clearly recorded in the plan of care. Individuals spoken with during the visit said they were treated well and staff responded to their needs. Two individuals said that there are times that staff do not respond to the call bell as quick as they would like and another said they felt uncomfortable ringing the bell when one member of staff is on duty and a complaint has been made about this. This was discussed with the manager who was aware of the complaint and this was being addressed with safeguards for the individuals being put in place. The manager said that she closely monitors the call bells and after 6 minutes if there has been no response this then goes into emergency with a different sound to alert staff. Staff were seen responding to call bells promptly during the visit. It was evident that staff were busy as observed by the expert by experience and the inspector however there were times when staff were observed sitting and talking with individuals or playing board games. Staff said that the shifts are busy but manageable. Individuals confirmed that personal care was delivered in the privacy of their bedroom and staff usually knock prior to entering. Training records demonstrated that staff have attended dignity at work courses. The home has two staff that are Dignity at Care Homes for Older People Page 15 of 34 Evidence: Work Champions. In addition further courses are available on Customer Care and evidence was provided that some of the staff have attended this course. The home has a policy on End of Life and it is evident that this is being put into practice with the views of people using the service and their relatives being sought. Care records included information about how the person wants to be supported if they become ill and require terminal care and what should happen in the event of their death. The manager said that once it is recognised that a person is dying an end of life care plan is put in place detailing the support that is required, which supersedes previous care plans. The home has experience a number of deaths recently and staff described how their sensitively supported the individuals involving family. From talking with staff it was evident that the team had been supportive including the management. The manager said that some staff have attended bereavement training and one member of staff said that there was further training planned. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals have available to them structured activities both in the home and in the community. Visitors are welcomed and encouraged to visit. Mixed views on the food by individuals living in the home were given, however, reassurances were given that this would be reviewed and improvements made. Evidence: The home employs an activity co-ordinator to assist with the planning and the organisation of activities in the home. It was evident from talking with the manager, the operations director, staff and a visiting relative that Yatton Hall wanted to become part of the wider community. Social functions were being opened up to the local community including a barbecue, table top sale, coffee mornings and a stall being set up by the Friends of Yatton Hall at the local carnival. The manager said this has a dual purpose to fund raise and to raise the profile of Yatton Hall in the local community. The activity co-ordinator has attended training relevant to the role including gentle exercise, massage and reminisce therapy. There is a structured activity plan which includes bread making, arts and crafts, visiting pets, theme afternoons, films, visiting entertainers, light exercise and trips out Care Homes for Older People Page 17 of 34 Evidence: to the shops or the local garden centre. One member of staff said they would like more opportunities to take people out but was not sure if this was permitted even if it was to the local shops. A hairdresser visits the home on a weekly basis. Individuals confirmed that along with the structured activities informal activities take place including hand massage, nail care, reading books, puzzles and games on a one to one basis. One person said that the local church visits on a weekly basis and another said that someone visits to give holy communion on a weekly basis. During the visit a volunteer visited the home to support individuals with a games afternoon. From talking with individuals it was evident that their cultural and spiritual needs were being addressed. This is clearly documented in the statement of purpose and discussed during the assessment process before the individual moves to the home. One person said the staff had supported them to go to church on Christmas day it was evident that this had been a positive experience for them. It is evident that there has been improvements in the activities that are delivered in the home with better recording to capture what has been undertaken. One person said that they know that the activities take place but they prefer their own company and they are happy sitting watching television, receiving visitors and listening to their own music. The cook said that in addition to their role of cooking the meals they have developed a small garden to grow vegetables for the home and individuals are encouraged to assist as part of the structured activities. One person said that they make their own bread on a weekly basis. Care staff were observed playing board games and interacting with individuals in the lounge areas. One member of staff said that they liked working in Yatton Hall as staff are encouraged to sit and talk with individuals where this has not been the case in previous employment. Care documentation included how the person likes to spend their time and important people in their life. It was evident from talking with individuals and a visiting relative that people are made welcome. The home maintains a record of all visitors to the home. Individuals can meet with their visitors in the privacy of their bedrooms or in the communal areas. The home has a four week menu that is clearly displayed in prominent places throughout the home. The menu was varied, nutritious and healthy. Alternative dishes are available. Views on the menu were mixed one person said it was terrible, another said the vegetables are overcooked and another said not cooked enough. One person said that their prefer more spicy continental food. It was evident that the newly Care Homes for Older People Page 18 of 34 Evidence: appointed cook was aware of the issues and was regularly talking with individuals, the manager and the staff to improve what was being offered. The manager has agreed to complete a survey specific to the food that is available as a means to improve the service provided. The home has completed an audit in December 2008 which indicated that 14 thought the food was very good, 43 said it was good, 29 fair and 11 poor. It is evident that there is some work to be done in this area. However, from talking with the cook it was evident that he was bringing in new ideas to improve the service provided. The expert by experience viewed staff in upper lounge/diner feeding individuals, whilst discussing what they were going to cook for tea at home, this constituted in the one person not being given time to chew and swallow before another fork/spoon of food was put to their mouth. This was discussed with the manager during the visit. On the second day observations of staff supporting individuals with their meals was that this was done sensitively and appropriately. The expert by experience highlighted concerns about the breakfast six out of the seven days the breakfast consists of cereal and toast with a full cooked breakfast being prepared on a Saturday. The expert highlighted that toast may be difficult for some people to swallow and chew. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good systems are in place to safeguard the individuals living at Yatton Hall including listening and acting upon concerns. Evidence: The home has a complaint procedure which clearly details how the home and organisation will respond to a complaint. This has recently been reviewed and updated to include the change in respect of the Commission for Social Care Inspection to Care Quality Commission. Individuals spoken to were aware of the procedure to follow in the event they are unhappy with the care being provided. Individuals said that they would either report to a member of staff or the manager. It was evident that the manager met with individuals in the home on a regular basis. She was very informed about the needs of the individuals and had a good awareness of what was going on. The home maintains a record of complaints. There have been nine complaints in the last twelve months. Good records were maintained of the complaint, the investigation and the outcome. One relative raised a concern during the visit in respect of a member of staff and the reluctance of the person using the service to use their call bell when this member of staff was on duty. The manager was very aware of the situation and had put safeguards in place and was monitoring the situation closely. Another concern Care Homes for Older People Page 20 of 34 Evidence: raised by two individuals was the quality of the food provided. The manager and the director of operations have agreed that a full audit of the food would be completed seeking the views of all the individuals living in the home. One of the concerns related to the cooking of the vegetables and one person wanting them softer and the other less cooked. It is acknowledged that you cannot please everyone but the manager has agreed to look at how both can be accommodated. Staff spoken with during this visit confirmed that they had attended training in safeguarding as part of their induction and with the local authority. This was confirmed in training records. There are some staff to attend this training but a progrmamme was in place to ensure that this addressed. Further training sessions are planned in May and June 2009. The manager is planning to enrol on a train the trainer in respect of safeguarding to enable her to cascade this training to her staff team. Presently this training is delivered by an a trainer within the organisation. Procedures are in place in respect of safeguarding including a copy of North Somerset County Councils policy on No Secrets as seen at the last visit. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. As noted at the last visit there are still areas that would benefit from a programme of decoration and modernisation. An action plan is in place with much work already having been completed to the benefit and the comfort of the people living in Yatton Hall. However, Yatton Hall does provide a comfortable, safe and clean environment. Evidence: Yatton Hall is situated in the centre of Yatton Village, close to local amenities. The building is situated over three floors. The top floor provides a home for Younger Adults with a physical disability and the two lower floors provide nursing care to people over the age of 65 years of age. The home is suitable to individuals with a physical disability. There is level access to the front of the building and a lift. Handrails are situated throughout with suitable bathing aids in place. All doors and corridors are wheelchair accessible. At the last visit it was noted that some areas of the home required painting. Whilst much work has been completed since the last visit including communal areas and some of the bedrooms. There are some outstanding areas to be addressed which include the remainder of the bedrooms that are presently occupied and the hallways. Care Homes for Older People Page 22 of 34 Evidence: Work is underway with the bedrooms with individuals being temporarily moved to enable their room to be decorated. The expert by experience said that there was a general feeling of the home being cluttered with dark hallways, bathrooms containing hoists and laundry baskets and mismatch of curtains and bedding. The manager responded by saying that there is a decoration programme in place which includes replacement curtains and the remainder of the bedrooms being decorated. A budget has been agreed for the redecoration of the hallway and the home is waiting for contractors to be confirmed. This was confirmed by the operations director and the manager during this visit. Whilst there are no requirements from this visit the overall rating of this standard is adequate in light that there are areas that need decoration, but evidence was provided that was going to be addressed. It was noted that the plastic coating on a handrail on one of the stairs reaching the first floor was in a poor state of repair and had been stuck down and in one area was loose. The latter was rectified by the second day of the visit and the maintenance person was looking to replace or resolve the areas that had been stuck with masking tape. No requirements was made as reassurances were given that appropriate action would be taken to address the concern. Staff, the manager and the administrator said that in the main only staff use the stairs and people who live in the service use the lift. However this could pose a risk to visiting relatives and staff and should be addressed. Individual rooms were comfortably furnished. Individuals were supported to personalise their bedrooms. Lockable storage is provided for valuables. Presently all the rooms are single occupancy although there are two double bedrooms. Not all of the bedrooms have an ensuite. It was evident from visiting the bedrooms on the top floor that they had been supported to make a choice on the colour scheme of their rooms rather than magnolia. This is good practice. Individuals have access to a call bell. These are checked on a regular basis. The manager said that she closely monitors response times. However, some individuals said to both the expert by experience and the inspector that sometimes staff can take a while to respond. The manager gave reassurances that the call bell will go into an emergency tone after 6 minutes. On the day of the visit staff were seen to responding to call bells calmly and promptly. The manager said that there were three hoists throughout the building on each floor, but on the day of the visit one of these were out of action so one was being shared between two floors which meant that four individuals were still in bed at midday. The registered nurse said that normally this was not the case and all individuals were Care Homes for Older People Page 23 of 34 Evidence: aware of the problem. From conversations with staff it was evident that this had been managed well since the hoist was no longer working but this particular day someone needed the use of the hoist for a particularly longer time than normal. The manager and the operations director have agreed that a further hoist would be purchased. This would be good practice especially in the event of an emergency. Records were maintained of ongoing maintenance checks of all equipment held in the home including hoists and the lifts. Bathrooms and toilets are situated throughout the home and can be locked but overridden by staff in the event of an emergency. There was adequate hand washing facilities throughout the home including hand gel wash stations. One of these was situated in the lobby of the home for visitors. This is good practice. Staff attend infection control training as part of their induction and updated periodically. As evidenced in conversations with staff, the manager and staff training records. Window restrictors are in place for all bedrooms and communal spaces on the first and second floor. However it was noted that this is not the case for windows on the ground floor. Whilst this is not a health and safety issue it could enable an intruder to enter the home. Action should be taken to risk assess and take appropriate action to minimise risks to individuals. An opportunity was taken to view the kitchen and speak with the cook. Good records were maintained in respect of food hygiene practices including cleaning schedules, fridge/freezer and food probe temperatures. The home has a food hygiene risk assessment as seen at the last visit. Both cooks had attended food hygiene courses at a basic and intermediate level. It was noted that the kitchen chopping boards were in need of replacement. The cook said that the fridge seal was broken and one of the fat fryers did not work. All these had been reported to the manager who was in the process of resolving the issues. New crockery was being purchased for the younger adult unit. From talking with the cook it was evident that where new equipment was needed the manager would try and ensure that this was purchased and in place promptly. Evidence was provided that the home employs an external cleaning company to deep clean the kitchen every six months. Good records were maintained by the kitchen staff in respect of day to day cleaning that is undertaken. The home has been visited by an Environmental Health Officer and the home has been awarded a four star rating in relation to Food hygiene. The home was clean and free from odour, situated throughout the home is air purifies helping combat some of the odours. The expert by experience commented that some areas of the home there was a vague smell however this was not noted on the second Care Homes for Older People Page 24 of 34 Evidence: day. The manager said that care staff and domestic staff are vigilant in ensuring that the home is fresh and clean. Domestic staff are employed enabling the care staff to concentrate on supporting the people who live in the home. The home has a separate laundry facility with appropriate equipment. The laundry assistant said that it met the needs of the home. There was a concern about laundry not being marked which means sometimes it can go astray but staff endeavor to locate the owner and relatives are encouraged to label clothing. Care Homes for Older People Page 25 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Adequate and competent staff support the individuals living at Yatton Hall this is being further enhanced by the training that is planned over the forthcoming months. Staff morale in the home has improved due to the recruitment of staff which is benefiting the individuals living in Yatton Hall as they have familiar staff supporting them ensuring a consistent approach. Evidence: Improvements have made in relation to the recruitment of staff and the manager said that they are close to having a full staffing accomplishment. This has meant that the home has not had to heavily rely on agency staff. From talking with staff this has evidently improved the morale of the staff team who described good working conditions and a cohesive team now being in place. The Annual Quality Assessment Audit stated that nineteen staff have left in the last twelve months. This was discussed with the manager and the operations director both said that staff have left for personal reasons or for better renumeration, however, due to the present economic climate this retention has improved and more people are applying for posts. The manager completes exit interviews with all staff that have left. The home is adequately staffed taking into account the number of people living in Care Homes for Older People Page 26 of 34 Evidence: Yatton Hall and their care needs. The home is always staffed with two registered nurses both day and night with 8 care staff in the morning, 7 in the evening and 4 care staff at night. Staff said that whilst shifts are busy this is manageable. The manager gave reassurances that this would be reviewed as needs change and occupancy increases. An opportunity was taken to review four members of staffs files in relation to recruitment processes, training and ongoing support. It was evident that a thorough recruitment process takes place including obtaining information about the applicant, two references being sought and completing a criminal record bureau check. Where staff have any gaps in employment or a criminal record this is fully explored at interview and recorded. It was evident that the manager judges the level of risk prior to employing a member of staff. The manager was not aware that staff employed on a POVA first check had to be supervised whilst undertaken any personal care tasks, however the operations director was well aware of the guidance and the company policy. The staff who was employed on a POVA first said that they had been fully supervised for a period of five days and that the majority of the work was working alongside colleagues due to the level of manual handling tasks. Where staff are employed prior to a full satisfactory criminal record bureau check being completed but with a POVA first this must be clearly risk assessed and the member of staff supervised whilst completing all personal care tasks. It is recommended that this is clearly documented and all parties made aware of the need for the newly appointed member of staff to be supervised. Once staff are appointed a comprehensive induction is completed. Newly appointed staff are mentored by more experienced staff. Two newly appointed staff were spoken with during course of the visit. It was evident that they felt supported and were receiving appropriate guidance and training. Both staff said they had completed manual handling training, safeguarding and health and safety training including fire. Both staff were aware that further training was being planned during their induction period. The home presently has a team of 40 staff, 11 of the staff have a nursing qualification and 10 care staff have an National Vocational Qualification in care. The manager said that due to retention of staff and the lack of assessors the home has not managed to achieve the governments target to ensure that 50 of the workforce have an NVQ in care. However, the home has recently gained an assessor and six staff are now in the process of enrolling to complete their NVQ in care. This will be followed up at the next visit to the home. Training files were viewed for a number of staff. The manager stated that she is aware Care Homes for Older People Page 27 of 34 Evidence: that this is an area that could be improved. Whilst it was evident there was a rolling programme of statutory training less apparent was all staff attending training in safeguarding however this was being planned. Every Wednesday there are training sessions for care staff to attend which includes safeguarding, health and safety, Parkinsons, infection control, dignity at work, customer care in addition the manager invites specialists into the home to complete training on wound care, continence, multiple sclerosis to name a few. It is evident that staff retention has had on the impact on the level of training that staff have in that at least half of the staff team are new. The manager said that all the staff are keen to attend courses to increase their knowledge to the benefit of the people living at Yatton Hall. Advertisement for staff training was clearly displayed throughout the home including a record of staff that were interested in attending. Staff were knowledgeable about the care needs of the individuals living in the home. It was evident from the conversations that the recruitment of the additional staff has had a positive effect on the morale of the staff team. Regular staff meetings take place and it is evident that staff had a good awareness of what was happening in the home and this was being relaid to the manager. Care Homes for Older People Page 28 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals benefit from a service that is well managed which seeks and acts upon the views of the people living in Yatton Hall. Good measures are in place to ensure that the service is regularly reviewed with action taken to improve the experience for the individuals and the staff. Health and safety is paramount providing a safe environment for both people living in the home and the staff team. Evidence: Mrs Lisa Brain is the registered manager. She has been in post for approximately three years. She is a registered general nurse and has achieved her Registered Managers Award which has now been superseded by the Leadership and Management Qualification. It is evident from speaking with Mrs Brain and viewing her training records that there is a commitment to ensuring that she is keeping up to date with changing practices and attending training relevant to her role. Care Homes for Older People Page 29 of 34 Evidence: Mrs Brain and the operations director were present during the visit and assisted in the process. Mrs Brain was knowledgeable about the needs of the people living in the home and some of the issues that have been raised during the visit as discussed with some of the individuals living in the home. Comments from the staff and the individuals living in the home evidenced an open approach from the manager and proactive in resolving issues when they arise. One person in conversation said the manager does her best and trys to put things right. A relative said that the manager is excellent, a good listener, caring and professional in all things. The provider is completing the monthly visits in respect of regulation 26 and copies are being sent to the Care Quality Commission. Other quality initiatives include annual surveys being sent to relatives and people who use the service. The manager draws up an action plan on the findings once this has been collated by Four Seasons Healthcare head office. Other audits are completed on all aspects of care and the running of the home on a six and twelve monthly basis. Some of these are completed by the manager and her staff team and then verified by the area manager. A weekly audit is completed on falls, pressure wounds, accidents and incidents, safeguarding, staff sickness and absence monitoring to name a few. The manager was in the process of auditing the staff training and developing an action plan. Regular staff meetings occur and it was evident from talking with the manger that she was exploring how attendance could be improved. People who use the service and their relatives now have a forum to meet up on a quarterly basis and from the last meeting a group has been set up called the Friends of Yatton Hall to organise social and fund raising events. Individual finances were looked at during the last visit. Good systems were in place to protect the money of individuals. The administrator along with the manager have access to personal money belonging to the individuals. During the last visit money belonging to one person was being kept in the medication cabinet. This practice has since stopped affording the individual better protection. Individuals have lockable storage in their bedrooms to keep valuables safe. The focus of the health and safety was fire. From looking at the fire log book it was evident that staff attend regular fire training and appropriate checks were completed on the fire equipment. Staff attend regular fire drills however it was noted that many of the day staff were slightly overdue by two weeks. The manager was aware and said Care Homes for Older People Page 30 of 34 Evidence: that this was being addressed. No requirement was made as it was evident that this was going to be addressed. It was difficult to fully audit the frequency of fire drills for staff as it was a list of names. It is recommended that the home develops a better recording system to enable the manager to better audit the frequency of the drills ensuring she captures all her staff team. It was evident that the home completes routine checks on the environment ensuring it is a safe place to live and work. External contractors complete routine maintenance checks on the lift, gas and electrical appliances and the manual handling aids situated throughout the home. This was evidenced in service contracts and in the annual quality assurance assessment. The expert by experience pointed out that when using the lift it was not clear what floor they were on and the numbers were very faint. The manager has agreed to explore how this can be improved. Care Homes for Older People Page 31 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 22 23 Ensure that adequate hoists and manual handling equipment is available to staff. This will ensure that individuals can be responded to safely and prompt. 05/06/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 7 19 For the care staff to date care plans which would demonstrate that they are current. Risk assess and consider whether window restrictors on the ground floor will assist in making the building more secure from intruders. To review the present system of documentation of fire drills and training so that a clear picture is captured for all staff employed. 3 38 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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