Inspection on 08/02/07 for Yatton Hall

This inspection was carried out on 8th February 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Yatton Hall 05/05/09

Yatton Hall 09/06/08

Yatton Hall 17/01/08

Yatton Hall 11/09/07

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 Barbara Ludlow Unannounced Inspection 8th February 2007 10:30 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.V321668.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.V321668.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 yattonhall@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) Vacant 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.V321668.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 8. May accommodate up to 35 persons aged 65 and over, requiring nursing care. Staffing levels laid out in the letter to Louis Smith dated 6th September 2004 are applicable. Manager must be a RN on part 1 or 12 of the NMC register. May accommodate up to 13 persons with Physical disabilities aged 1864. The home may provide nursing care for two named persons with learning disability; until such time that the named persons cease to use the home. One named resident to reside in room 16, this condition will lapse when this resident leaves Yatton Hall. One named resident to reside in room 28, this condition will lapse when this resident leaves Yatton Hall. One named service user, YP category, to be accommodated as named in the minor variation dated 17/08/06. 5th October 2006 Date of last inspection 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.V321668.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. This unannounced Key Inspection was conducted over three visits made by CSCI inspectors Kathy McCluskey and Barbara Ludlow and overall this was a positive inspection. The first day was unannounced and the two inspectors spent four and a half hours at the home. The following two visits were made by one inspector and by appointment with the manager. Mrs Lisa Brain the home manager was present on each day. The Company Operations Director was present on day two and the homes administrator was available to access records on days one and three. The visits were well received and the inspectors met with service users, staff and six visiting relatives. A tour of the premises was made on day one. Daily life at the home was observed during the inspection days. A number of service users were spoken with in the communal areas and in private in their rooms. The activities on offer were observed and participants and others were asked about the events. Lunchtime was observed on each floor on the first visit and on the middle floor at the second visit. Records were inspected; these included the care plans for the service users whose care was case tracked. Staff recruitment records and contracts were seen. Maintenance records were sampled. Relatives kindly gave their time to speak with the inspectors about their experiences of coming to the home. Written feedback from service users and visiting health care professionals was requested and seven completed forms were returned to CSCI. The comments received and analyses of the feedback are included in the body of the report. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: Yatton Hall DS0000020292.V321668.R01.S.doc Version 5.2 Page 6 The following observation was made in June 2006 and remains valid at this inspection. The Younger persons unit has developed its facilities for the residents and taken account of their wishes and preferences where able. Examples of these include a pool table in the lounge area and a play station/computer area and regular social trips out are made. The younger persons unit offers pleasant accommodation; good social activities and staff commented that they enjoy their work. This unit has a registered nurse and a separate care staff group to care for the younger people in residence. A quiz was planned for the afternoon of day one and service users spoken with were looking forward to it. Activities are open to the homes other residents. Positive feedback was heard from service users and relatives about the care staff. Comment included that ‘ the care staff are excellent’, ‘very caring’, ‘and supportive’. Two people made particular comment that the Polish care staff are ‘very good’ and ‘exemplary’. What has improved since the last inspection? What they could do better: The home does not have separate activities co coordinators for the younger persons and the older persons units. The access to social stimulation for the older persons in residence at Yatton Hall is limited and could be improved. Written feedback supported this observation, three said there are usually activities to join in with, two said there are sometimes and one relative said ‘never’ enough, quoting in particular the access by older persons to social activity. A visiting professional also commented that there is little social stimulation for the older people at the home. Yatton Hall DS0000020292.V321668.R01.S.doc Version 5.2 Page 7 The numbers of care staff that have received NVQ training is low, however, three staff have started their NVQ training and five staff are on a rolling training programme. Both inspectors felt that the care staff would benefit from training to an NVQ Level in care. There has been no specific dementia awareness training. All care staff should receive some dementia care training to increase their awareness and understanding of the needs of the frail service users in their care who may have mild dementia or memory problems. This training may improve the communication skills of staff. The written feedback implied that staff ‘do not always act on what is asked of them’, and that staff capabilities ‘vary’, it ‘depends who is on duty’. Regarding communication with the trained staff the responses implied that service users rely upon care staff to pass messages to them, but ‘were not sure this always happened’, two people relied upon their visitors to speak to staff. One person had been upset by staff when they rang their nurse call bell more than once. Another person commented that the bell wasn’t answered very quickly. Service users commented that this occurred at times when staff were very busy. On day one service users in the middle floor lounge were not seated at the dining tables for lunch. One person came into the dining room and sat in a chair that was too low for them to comfortably reach the table. More attention should be paid to the comfort and service user experience of mealtimes on the middle floor. Two comments were heard about the lack of physiotherapy at the home, one commenting that it was no longer available. See also the section:‘Choice of Home’. The home could be cleaner, a new member of staff has been recruited to the domestic team and it is anticipated that more thorough cleaning will now be achievable. An urgent requirement was made on day one when the hot water delivery at three bath tap outlets was found to be in excess of 60 degrees Celsius. A suitable written response was made to CSCI by the manager to explain the urgent action to be taken; this was received before the close of the inspection period. Verbal explanations regarding the safety of service users in the meantime were also given. Wardrobes have not been secured to reduce the risk of toppling forwards and causing injury, risk assessment and appropriate action is required at this inspection. Yatton Hall DS0000020292.V321668.R01.S.doc Version 5.2 Page 8 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.V321668.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.V321668.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): 1,3,OP and 2 YA. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good level of information available to prospective service users. Service users are issued with a contract / terms and conditions. Pre admission assessments are made and service users will only be admitted if their assessed needs can be met. EVIDENCE: The company has a range of information for visitors to the home and for prospective service users. This information is displayed in the homes entrance hall for ease of access. Yatton Hall DS0000020292.V321668.R01.S.doc Version 5.2 Page 11 Service users are issued with contracts and terms and conditions of residence. The trial period is not stated in the terms and conditions of residence. The manager was asked about this in light of the recommendation made at the last inspection for the trial period for the younger adults to be three months in line with the National Minimum Standards for Younger Adults aged 18 – 65yrs. The inspector was informed that younger adults are always given sufficient time to settle in before confirming their placement. The homes literature for younger adults states that the trial period will be agreed. Contracts were sampled for two service users, these gave a clear breakdown of the charges for care and it is stated that the company retains the Registered Nurses Care Contribution as part of the total fee amount for privately funded service users. Pre admission assessments are made to ensure that care needs can be met at Yatton Hall. Examples of these assessments were seen on the care files for service users who were case tracked. Six persons responding in writing to CSCI, all stated that they have received a contract, five of the six said they received enough information about the home before moving in. One person commented that the literature mentioned the physiotherapist providing treatments as required however this service is no longer offered. The information available at the home was checked and it was confirmed that the physiotherapy service is still mentioned in the homes brochure, this is misleading. The limitations of the physiotherapy service which is now only available by G.P / hospital referral or privately at a cost to the service user, should be clear. A review is recommended. Yatton Hall DS0000020292.V321668.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 OP and 6,9,16,18 YA Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are in place for all service users and risk assessments have been undertaken. The medications administration records sampled were complete. Staff treated service users kindly and with respect. EVIDENCE: Care plans were in place for all service users and these were sampled. Yatton Hall DS0000020292.V321668.R01.S.doc Version 5.2 Page 13 Pre admission information and assessment is used in the care planning. Personal information and contacts are recorded. Risk assessments were seen for the risk of falling, risk of developing pressure sores, oral hygiene and nutritional risk and manual handling assessment. Daily information was recorded in detail and included incidents such as a fall and the subsequent contact made to inform the nearest relative of the event. The care plan examined for a younger adult demonstrated their signed agreement with the care planning detail. Care charts are left in the service users room so that personal hygiene can be recorded. In one instance the person had not been helped to shave, this service user was seen and this was bothering them. The plan shows no entries for washing or shaving and only two entries in the past eight days for oral care. The social care programme on day one was centred upon a one - one event in the morning for one service user and a quiz in the afternoon on the Younger adults unit; this event was open to all service users. Two service users were asked if they would be joining in the event but both had said no. The younger adults who were more able were seen moving around the home, going out and returning from time spent away from the home. One person returned from a trip out with a friend and said that ‘staff are kind’ and said that they felt ‘well cared for’. There was a real sense that more activities would be helpful and would be provide a more fulfilling time for the service users on the first two floors. Interactions between staff and service users were observed and heard to be friendly and caring. Visitors spoken with said that ‘the care staff are excellent’ and they were happy with the care provided. Medication Administration Records (MAR’S) were examined and were completed. All medications received had been signed for. The medications ordering and returns are systematic and well managed. Oxygen was stored beneath a counter in the treatment room; it was not secured but was safe from toppling over. Some was there for returning to the pharmacy, used masks and tubing should be removed. More secure storage for oxygen cylinders is recommended. Not all creams had been labelled with an opened on or discard by date, this is recommended. Yatton Hall DS0000020292.V321668.R01.S.doc Version 5.2 Page 14 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): 12,13,14,15 OP and 12,13,15,17 YA Quality in this outcome area is adequate. The activities available to the younger adults were good. The activities available to the older people at the home are limited. Visitors are welcome and service users are able to spend their time as they choose. The quality of the food has improved. Mealtimes on the middle floor could be better organised. This judgement has been made using available evidence including a visit to this service. Yatton Hall DS0000020292.V321668.R01.S.doc Version 5.2 Page 15 EVIDENCE: Activity time is limited and on day one the activities person was seen in the morning, playing Scrabble with one service user. In the afternoon a quiz was held on the younger adults unit. This was a popular event and the service users spoken with before lunch were looking forward to the challenge ahead. This event was open to the all the service users at the home but only one planned to attend. All other service users had no social input other than the contact with carers and from visiting relatives. This is not ideal and the social care provision should be reviewed. The mobile and more able service users were seen to spend their time as they wish and the home has a friendly relaxed atmosphere that supports this. Relatives and visitors were seen and spoken with. The relatives felt able to speak about the care at the home and were generally very positive about the care offered at the home. There was a sense that service users and relatives were aware of the reasons for the limitations of the service, such as the cleaning not being thorough because there had been a domestic staff shortage. It was reassuring to see that quality assurance surveys had been carried out by the company and that responses had been made to individuals. Lunchtime was observed on each floor on the first visit and on the middle floor at the second visit. The younger adults unit and the ground floor have dining rooms that are separate from the lounge and the tables are laid nicely. Service users asked said they were enjoyed their lunch. On the middle floor, the room is a lounge / dining room with some storage of wheelchairs and equipment. The service users sitting in armchairs were not moved to the dining tables at lunchtime. One person who had come into the dining room to have lunch sat in an armchair that was too low against the table height to make eating as comfortable as possible. These observations were fed back to the manager at the end of day one. On day two a dining chair had been provided for one service user and a second cushion had been found for use in the armchair used at the dining table. The kitchen looked clean and tidy and all equipment was reported to be in good working order. The appointment of a second chef was in progress and this would complete the catering staff team. Agency catering has been used and the manager stated that this had not been popular with the service users. The inspectors heard that the catering had been variable as the quality Yatton Hall DS0000020292.V321668.R01.S.doc Version 5.2 Page 16 depended upon ‘who was cooking’. It was noted that the quality of the food offered had improved and that it was well presented. The quality of the bread offered to service users was criticised as being poor; this comment was brought to the managers attention for her to discuss with the chef. The new catering staff are due to attend food hygiene training and updating and this had been requested. Yatton Hall DS0000020292.V321668.R01.S.doc Version 5.2 Page 17 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 OP and 22,23 YA Quality in this outcome area is good The home has a complaints policy and this has been used to investigate a complaint that came in via CSCI and was appropriately dealt with by the home. Staff have received Protection Of Vulnerable Adults (POVA) awareness training. All staff have Criminal Record Bureau (CRB) checks and recruitment was satisfactory. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy and procedure. This is available to all service users. Four complaints have been made to the home within the last twelve months; these have all been investigated within 28 days. Three were substantiated and one partly substantiated. One complaint had been channelled via CSCI back to the home for investigation. This had been suitably investigated and addressed. Yatton Hall DS0000020292.V321668.R01.S.doc Version 5.2 Page 18 Service user feedback was positive about raising concerns and the visitors spoken with said they were able to raise their concerns with the home. Staff spoken with had an awareness of the protection of vulnerable adults in their care. All staff had CRB checks; these were all seen as part of the recruitment screening. Yatton Hall DS0000020292.V321668.R01.S.doc Version 5.2 Page 19 Yatton Hall DS0000020292.V321668.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 OP and 24,30 YA Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home has been suitably adapted as a care home. There are comfortable communal areas on each floor. The home was hygienic but deep cleaning was identified as required in some areas. Bedrooms can be personalised. The bath hot water delivery was found to be excessively hot. Some wardrobes need to be assessed for stability. One communal area was cluttered with equipment. EVIDENCE: Yatton Hall DS0000020292.V321668.R01.S.doc Version 5.2 Page 21 The home is purpose built and has been suitably adapted as a care home. The environment was generally fairly clean and tidy. No unpleasant odours were detected at this inspection. Three toilets were noted to be out of action, the plumber arrived during the afternoon of day one. All toilets had been repaired and were working on day two. A number of areas were seen where deep cleaning was required. Three visitors brought this to the attention of the inspectors although, not as a complaint it was a valid concern. This was passed to the homes management for attention. The home had been short of domestic staff and had just recruited into a vacancy for a cleaner. It was hoped that this situation would soon be resolved. The home has regular maintenance management and records inspected for the fire detection system were satisfactory. The home’s manager reported having requested fire safe hold open devices and these had been fitted to priority areas, the remaining devices were ordered and were due to be fitted in the near future. There are comfortable communal areas on each floor. The middle floor lounge was cluttered in on half with equipment and the table seating was limited to armchairs on day one. This had improved on day two with a dining chair and extra cushion being added for the comfort of the service users. During the tour of the premises rooms were seen that were personalised with photographs and ornaments, these rooms were homely and comfortable. One room was seen with a walking aid on top of a wardrobe. A bathroom was seen with walking aids in the bath. Equipment that is in no longer used or in excess should be reviewed for more discreet and safer storage elsewhere. The management of waste, laundry and the provision of personal protective clothing such as gloves and aprons for staff to use are good. An urgent requirement was made on day one when the hot water delivery at three bath tap outlets was found to be in excess of 60 degrees Celsius. A suitable written response was made to CSCI by the manager to explain the urgent action to be taken; this was received before the close of the inspection period. Verbal explanations regarding the safety of service users in the meantime were also given. Wardrobes have not been secured to reduce the risk of toppling forwards and causing injury, risk assessment and appropriate action is required at this inspection. Yatton Hall DS0000020292.V321668.R01.S.doc Version 5.2 Page 22 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): 27,28,29,30 OP and 32,34,35 YA Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home has a skill mixed staff group. It would be of benefit to service users if more staff held NVQ qualifications in care and if all had access to dementia care awareness training. Staff recruitment was satisfactory. EVIDENCE: Fifteen staff had been recruited since the last inspection. All CRB checks and PoVA first checks were seen for the new recruits. The staff files held appropriate information and trained nurses had their Personal Identification Numbers (PIN) verified with the Nursing and Midwifery Council (NMC) register. There were nine care staff on duty in the morning on the first day and three trained nurses. The care staff divides into three groups to work on each floor. Yatton Hall DS0000020292.V321668.R01.S.doc Version 5.2 Page 23 Three care staff work together on the middle floor. This floor has a fairly dependent client group and it is recommended that the staffing level be closely monitored to ensure that care needs can be met with this staff number. One extra member of staff has been introduced onto the late shift, to bring the care staff number to eight. The home uses agency staff to cover the one care staff full time vacancy and staff on sickness leave. The home has a low percentage of the total care staff with NVQ training in care, this was 4.5 . National Minimum Standard 28 recommended achieving 50 by the end of 2005. The inspector was informed that three staff are working towards their NVQ and five staff have joined the rolling NVQ training programme. Staff had not received training in dementia care although some service users in their care had dementia care needs. Both inspectors felt that the outcome for service users would be improved if staff received such training and had a greater understanding of dementia and the impact it can have upon elderly people in their care. Staff have received supervision and the training for staff over the past twelve months included manual handling, medications training, diabetes and subcutaneous fluid administration and diabetes care. A range of training has been identified for the future and the inspectors were informed that fire training that was due had been rescheduled. Yatton Hall DS0000020292.V321668.R01.S.doc Version 5.2 Page 24 Yatton Hall DS0000020292.V321668.R01.S.doc Version 5.2 Page 25 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): Yatton Hall DS0000020292.V321668.R01.S.doc Version 5.2 Page 26 33,35,38 OP and 42 YA Quality in this outcome area is adequate. The management standards cannot be fully assessed until the CSCI Fit person process as the Registered Manager approves Mrs Brain. The maintenance of the home is well managed but there are health and safety requirements made at this inspection. Records are stored safely and access is appropriately restricted. The company monitors the service and is introducing a full auditing system. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager Mrs Brain’s application to become the registered manager is currently being processed by CSCI. The company undertakes quality assurance and one visitor spoke about this to the inspector and the operations director explained how the information fed back to the company is processed. The company has also just introduced a new audit tool to the care home. This assesses the home against the National Minimum Standards and as yet has not been used but is a detailed system. Mrs Brain is approachable and has got to know her staff and service users during her time in post. It was reassuring to see that Mrs Brain was aware of the shortfalls identified by the inspectors and was taking action to address these, a good example of this would be the very hot water where the fail safe valves had been organised and the plumber was due to fit them. Another example would be the fitting of fire door hold open devices which had been half completed and the remainder were on order and due to be fitted soon. The following health and safety matters were identified for attention: An urgent requirement was made on day one for the adjustment to the hot water delivery to a safe limit in three bath hot tap outlets. These were found to be in excess of sixty degrees Celsius and pose a risk to service users of accidental scalding. A written response to CSCI was made before the close of this inspection to explain the action that will be taken. The risk management of this was discussed with Mrs Brain and there were safe working practices in place to reduce this risk. A number of wardrobes were identified that were unstable and these pose a risk of accident should one topple forwards. A review and risk assessment is Yatton Hall DS0000020292.V321668.R01.S.doc Version 5.2 Page 27 recommended for all the wardrobes with action taken to secure the ones identified as a hazard. A number of wheelchairs were identified that needed to be cleaned and some needed repair. Footplates were identified that were unevenly positioned, one wheelchair had a misshapen footplate strap and one had a damaged table. These must be attended and brought up to a more service able condition for the benefit of the service users using them and who are reliant on the home to identify and organise this. The home has a maintained fire alarm system. Yatton Hall DS0000020292.V321668.R01.S.doc Version 5.2 Page 28 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 3 2 3 3 3 4 2 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 1 20 3 21 3 22 2 23 3 24 3 25 3 26 2 STAFFING Standard No Score 27 1 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 X 32 X 33 3 34 X 35 3 36 3 37 3 38 1 Yatton Hall DS0000020292.V321668.R01.S.doc Version 5.2 Page 29 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 13(3) Requirement Timescale for action 04/04/07 2 OP38 13(3) 3 4 OP27 OP22 18(1)(a) 23(2)(c) Hot water at bath tap outlets must be regulated to a safe temperature limit of 43 degrees Celsius to reduce the risk of accidental scalding. Wardrobes that are reviewed 04/04/07 and identified as unstable must be secured to reduce the risk of them toppling forwards and causing injury. The home must arrange for 04/04/07 sufficient staff to keep the home sufficiently clean. The registered person must 14/04/07 ensure that wheelchairs are maintained in clean condition and in good repair. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations The social activities provision for older persons at the DS0000020292.V321668.R01.S.doc Version 5.2 Page 30 Yatton Hall home should be reviewed to ensure that there is a range of activities and opportunities for social care needs to be met. 2 3 4 5 OP22 OP28 OP38 OP4 The storage of equipment should be safe and should not clutter the service users or communal areas. Care staff should be encouraged to undertake training and achieve NVQ Level 2. Fire door hold open devices installation should be completed for those remaining resident rooms where a choice or need is identified for the door to be held open. The homes literature should be clear about the service offered and any references to services no longer made available at the home should be clearly amended. Yatton Hall DS0000020292.V321668.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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. Yatton Hall DS0000020292.V321668.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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