Inspection on 09/06/08 for Yatton Hall

This inspection was carried out on 9th June 2008.

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

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

Other inspections for this house

Yatton Hall 05/05/09

Yatton Hall 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

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 28/09/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Yatton Hall High Street Yatton North Somerset BS49 4DW Lead Inspector Paula Cordell Unannounced Inspection 10:15 9 and 10th June 2008 th X10029.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000020292.V366211.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. DS0000020292.V366211.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Yatton Hall Address High Street Yatton North Somerset BS49 4DW 01934 833073 01934 877373 yatton.hall@fshc.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (If applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Grandcross Limited (wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Lisa Marie Brain Care Home 48 Category(ies) of Learning disability over 65 years of age (2), Old registration, with number age, not falling within any other category (35), of places Physical disability (13) DS0000020292.V366211.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) maximum 48 of either gender Physical Disability (Code PD) - maximum 13 of either gender Learning Disability over 65 years of age (Code LD (E)) - maximum 2 males only. The maximum number of service users to be accommodated is 48. 2. Date of last inspection 17th January 2008 Brief Description of the Service: 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 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 for the Younger Physically Disabled persons. The Registered Nurse Care Contribution paid to the home for privately funded clients is retained by home. DS0000020292.V366211.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced visit as part of a key inspection process. The purpose of the visit was to monitor the progress to the requirements from the last inspection in January 2008 and to review the quality of the care provided to the people living at Yatton Hall. There have been no complaints received by the Commission for Social Care Inspection since the last visit in January 2008. As the home was a service of concern, a meeting was held with Four Season’s representatives and ourselves to discuss what the service must do to improve. This was held shortly after the last visit. It is evident that the home has taken steps to address the concerns with the overall rating changing to an adequate service. It is evident that the Four Season’s senior management have been monitoring the performance of the home, ensuring appropriate and timely action is taken by the manager and her staff team. The inspection methods used during this visit included record checks, case tracking, and discussion with the manager, the area manager and five care staff including registered nurses, and people who use the service. The home has been sending information in respect of regulation 37 notices of events affecting the well being of the people who use the service. These were used as a focus for the site visit, along with comments from the returned questionnaires from people who use the service, relatives and the staff working in the home. The visit was conducted over a period of twelve hours and ended with structured feedback. What the service does well: Yatton Hall provides a safe and homely place for individuals to live. Staff are committed to their role in providing a quality service. Comments from individuals living in the home included-: “The manager cares about the people living in the home and is making improvements in the home. “The majority of the staff are wonderful and cannot do enough. DS0000020292.V366211.R01.S.doc Version 5.2 Page 6 There is a commitment to providing good care for people who live in the home. Staff comments included -: We each know what is happening with each person, senior staff support is very good. The home manager is always willing to discuss any issues and is open to new ideas. They provide a warm comfortable and happy environment. “Its a friendly place to work and Im glad to be part of the team. Good links have been established with the local community. It is evident that Yatton Hall serves the local community both in providing employment and for the care of the local people as they get older and require nursing care. What has improved since the last inspection? There have been significant improvements to address the areas of concern identified at the last visit in January 2008. The home has demonstrated compliance to the immediate requirements relating to the homes failure to meet hygiene standards in the kitchen and the requirements that were left by the Environmental Health Officer. Individuals are assured their safety in respect of identified risks within the home including falls and accidents. With clearer plans of care and risk assessments being developed which better evidences their protection. Staff are better informed about each person’s care plan, which now includes personal information and how the person prefers to spend their time and what staff can do to support them. This includes how staff can support individuals who may experience a lapse in their mental health. Care plans are now being better reviewed ensuring care plans are current and reflect better what is happening for that person. There has been some improvement in relation to the home developing clearer care plans and risk Assessments for individuals who present behaviours that may be perceived as challenging the service. However, this still remains outstanding for one person. Dignity and Respect has been an agenda item on team meetings and training ensuring that individuals living in the home are afforded this at all times. The staff are aware of policies and procedures in respect of this area including safeguarding and whistle blowing. Individuals can be assured that the home is taking into account their interests prior to moving to the home with life histories being developed. DS0000020292.V366211.R01.S.doc Version 5.2 Page 7 Individuals can be assured that the home is maintaining a record of complaints, which evidences the process of investigation and actions taken to address the concerns. Individuals can be assured that staff have a better knowledge on what constitutes abuse and the policies that are in place to ensure the protection of those people living in the home. There has been a significant improvement in the storage of equipment making the home more homely. Individuals now benefit from a team of staff that have received training in a number of areas and are better supported. A plan of formal supervision is now being implemented in the home. Individuals are better protected against the risk of fire with regular checks and fire training being offered to care staff. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000020292.V366211.R01.S.doc Version 5.2 Page 8 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) DS0000020292.V366211.R01.S.doc Version 5.2 Page 9 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): OP 1,3,6 YA 1,2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals have sufficient information to enable them to make a decision to move to the home and their care needs are assessed. 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. It was evident that this has been kept under review. Consideration should be taken to make this information more accessible to the individuals living in the home. DS0000020292.V366211.R01.S.doc Version 5.2 Page 10 Individuals spoken with said they had sufficient information prior to making a decision to the home. Many of the older people living in the home evidently came from the surrounding areas of Yatton whereas the younger adults with physical disabilities came from further a field. The home, at the time of writing this report, had occupancy of 38 people. The manager and the area manager said that the vacancies have been difficult to fill due to the block that was being placed on them by Social Services due to the rating of the service. In addition to the changes in government policy in that individuals were now choosing to get funding to enable them to stay in their own home with care support. From talking with the regional manager a review of the service is being undertaken. It would appear that the home has a waiting list for the younger adults with physical disabilities and not such a demand for services supporting older people. When this review is concluded the home must liaise with the Commission for Social Care Inspection to ensure that the certificate of registration and the statement of purpose is reflective of the service that is being provided. The home has a clear admission process, which includes encouraging the prospective person 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. This then informs the home’s care planning processes. There were good links between the assessment and the home’s care plan. In addition evidence was seen that the home works with other professionals, the individual and relatives in gathering information as part of the assessment process. It was noted that two people with a learning disability were unable to visit the home due to closure of their home. However, from talking with two newly admitted individuals it was evident that they and or their relatives had visited the home prior to making a decision to move to Yatton Hall. DS0000020292.V366211.R01.S.doc Version 5.2 Page 11 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 6,9, 16,18,19,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Significant improvement in the home’s care planning processes has meant that individuals changing care needs are being met. These improvements must continue to ensure that the home is working in a person centred way. Gaps in plans relating to supporting individuals with epilepsy and episodes of anxiety or aggression could put both the individual and staff at risk. Individual’s personal care and health care needs are being met. Individuals are protected by the home’s safe administration procedures. DS0000020292.V366211.R01.S.doc Version 5.2 Page 12 EVIDENCE: There have been significant improvements in the care planning processes, which evidently is benefiting the people living in the home. Although staff were concerned in some cases about the increase in paperwork, which means less time providing care, it was evident that they saw the benefit of writing clearer plans of care and a record of what care is delivered. Care plans had been rewritten and a more personalised approach applied. The plans seen detailed how the person liked to be supported with their personal, health, social and psychological well-being. In the main the home has addressed the requirements and concerns raised during the last visit. Staff have had assistance in writing the plans from the Care Director for Four Seasons Healthcare Ltd and have had training in person centred planning. Care plans include how the person communicates. Less apparent were aids to assist people who may have a cognitive impairment or through their physical disability are unable to verbally communicate. For example picture boards or photographs or symbols where appropriate. There are general Risk Assessments completed for each individual covering areas such as their risk of falling, moving and handling, eating and drinking and epilepsy. These had all been reviewed and updated to reflect any changes to the person’s well-being and care needs. There still appears to be a lack of person centred risk assessments, to support people to take risks as part of their lifestyle, for example one individual who does go out of the home without staff support, has no risk assessment in place to help ensure their safety. However, it was acknowledged that the plan of care detailed this information. Good practice would be for this to be transferred to an appropriate risk assessment format. Another example would be where individuals have responsible for finances, assist in making snacks/hot drinks or complete chores around the home for example baking or gardening. 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 at random and corresponded with the medication held in the home. Registered Nurses have the sole responsibility for administering the medication within the home. A policy and procedure on the safe administration of medication was seen at previous visits. Stock held in the treatment room relating to pressure area care was well labelled. Staff have received training on prevention of pressure sores. The home completes a weekly audit in relation to individuals with pressure sores. Good records were seen in care files on how the home is preventing pressure DS0000020292.V366211.R01.S.doc Version 5.2 Page 13 sores with the equipment that was in situ to assist with this. A registered nurse said that all staff are good at reporting slight changes so that this can be closely monitored. Two care plans were examined in relation to support in the event of an epileptic seizure. One had a medical abbreviation, which could be open to misinterpretation and lacked detail on when to administer oxygen or preventative medication. In conversations with care staff it would appear that oxygen is given either during the seizure or after. It is advisable that this is discussed with the epilepsy specialist so that this can be clearly written in the plan of care to ensure that it is effectively and appropriately used. The other care plan detailed what should not be done rather than clearly telling staff how to support the individual. Neither detailed what the staff should be monitoring for example the length (time) or type of seizure. Care files included a continence assessment. Training has been provided to staff on continence promotion. During the last visit a situation occurred on the floor where a member of staff was witnessed shouting at a person living in the home and was the sole member of staff on the floor. It was evident from talking with the manager that this has been fully investigated. A member of staff stated that sufficient staff are always available and breaks are planned throughout the shift ensuring adequate cover and support is available to the people living in the home and staff. Reassurances were given by the manager and the area manager that care plans relating to episodes of challenging behaviour have been developed. However, it was noted that for one person this was not the case. It was evident that staff, on a daily basis, have to support someone who is either verbally or physically aggressive. Whilst it is evident that the home is liaising with the appropriate professionals, the care plan lacked how the person should be supported in relation to the episodes of aggression. It was evident that staff continued to support the individual in a positive manner and without prejudice. This is commended. The home is in the process of reviewing the suitability of the placement. Training has been given to staff on supporting individuals with challenging behaviour. In addition policies and procedures are in place. These were not viewed on this occasion. However, clear guidelines must be developed. It was noticed during the last visit that staff were standing up whilst assisting individuals with their meal. It was evident from talking with staff and observation that this has now been addressed. Staff were observed assisting people in a more dignified and sensitive manner. It was evident that meal times in the home were sociable with good staff interaction. DS0000020292.V366211.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 12,13,15,17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals are supported to take part in activities in the home and the local community. Records do not fully capture this and the activity co-ordinator is evidently stretched to ensure that the home is meeting the social needs of the people living in Yatton Hall. Improvements in the planning and the preparation of the food have ensured that individuals have a healthy and varied diet. It is evident that this is still ongoing. EVIDENCE: DS0000020292.V366211.R01.S.doc Version 5.2 Page 15 Care plans seen had been developed to include how the person wants to spend their time including hobbies, interests and a history. There still could be improvements in relation to the younger adults in relation to what caused the head injury or physical disability, but it was evident that this was work in progress. Generally comments from people receiving a service were positive. One person said that they liked living in the home and had noted improvements over the last couple of months especially with the food. Staff are generally helpful and prompt in answering the call bell. Whilst another said they could wait up to 15 minutes in the morning (7am) until they are supported to get dressed. Staff and the manager were aware and were trying to come up with a solution to suit the individual. However, staff said they have to prioritise the work at this time based on the needs and with the staff numbers on duty at the time. This will be followed up at the next visit. What was evident from the conversations was that the home was trying to plan the care in a person centred way to suit the individual and their preferences. Other comments included“I enjoyed the barbeque recently and the trips to the garden centre” another said they enjoyed the karaoke evenings and trips to the pub. The home employs an activity coordinator to support all the individuals. It was evident from speaking with the activity coordinator, the staff and people who use the service that there is a combination of one to one and group activities organised. However, the amount of activities described were not captured in the daily running or the activity records for individuals. Activities included games afternoons, light exercise, bread and cake making, arts and crafts, trips to the garden centre and local shops. In addition external entertainers visit the home on a monthly basis. A person from the local church visits on a fortnightly basis. One of the individuals receives visits from ministers of their chosen faith. It was evident that individuals are supported with their religious and spiritual needs. This is included in the statement of purpose and discussed during the assessment stage prior to moving to the home. As mentioned previously there is only one activity co-coordinator in post to complete activities with all the individuals living in the home. Consideration should be taken to review whether this is meeting the needs of both the older persons and the younger adults with physical disabilities. DS0000020292.V366211.R01.S.doc Version 5.2 Page 16 Some of the younger adults attend external activities supported by care staff including dance voice, college courses or attend a day centre. One person said “I rarely join in the activities it does not interest me”. Observation of activities during the visit provided good evidence of people enjoying the time they spent together with good interactions between staff and the people using the service. Generally the home was relaxed, with staff calmly going about their work. It was evident that the call bells were continual on the first day. Three bells went into what the home calls an “emergency” where they had not been responded to within a reasonable time. The home does not monitor this to ensure that there is adequate staffing to support the people in the home. This was discussed with the manager and the area manager who have agreed that some monitoring would be undertaken. This will be further discussed in the section relating to staffing. From looking at records it was evident that where individuals are able they have been encouraged to make decisions relating to their care. However, as mentioned earlier consideration should be given to exploring how individuals who are non-verbal can be supported in this process with more individualised communication aids being developed. This could include pictures, photographs or symbols, where appropriate. Staff and people who use the service confirmed that there has been a great improvement in the food. Individual’s confirmed that they are asked what they want to eat on a daily basis with alternatives provided to the planned menu. One person commended the chef who speaks with individuals on a regular basis to ensure the menu includes preferences of individuals. It was evident that this particular person was much happier where previously they dreaded meal times and would source food from outside of the home. Another person said they liked the food although the meat was too soft and tends to be minced. Presently there are two main options but in talking with the chef it was evident that they were exploring a more extensive menu. This will continue to be a focus of future visits. The requirements relating to the kitchen area have now been met. A new chef has new been recruited to ensure that good food hygiene practices are adopted with better food being served. DS0000020292.V366211.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 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements have been made to the way that the home is responding and recording concerns enabling individuals to raise concerns and be confident that the home will act appropriately. Individuals can be confident that there are protected from abuse. Staff are awareness in safeguarding has improved. EVIDENCE: The home has a complaints procedure and it was evident that individuals were confident in relaying concerns to staff and the manager. The home has demonstrated compliance to improve the recording of all complaints and the action that is taken to address the concern. There have been four complaints since the last visit and it was evident that the home was addressing the concerns and working with individuals living in their home, their relatives and staff. The actions and the outcome of the complaint were clearly recorded. The last complaint the home received was April 2008. DS0000020292.V366211.R01.S.doc Version 5.2 Page 18 The home has responded to a requirement to ensure that staff have training in safeguarding (protection from abuse). Staff are in the process of completing a questionnaire, which is audited on their response. In addition an internal four Seasons’ Trainer has given training to staff. In addition there is a plan to ensure that staff attend the local authoritt’s safeguarding alerter course, however the manager said that the trainer at short notice has cancelled two of the courses. Staff when interviewed described clearly what constitutes abuse and the reporting processes in place. Staff were aware of the whistle blowing policy. The manager stated that a trainer within the organisation has delivered the training in safeguarding. The manager was not sure if the person had attended appropriate training to enable them to fulfil this role (a train the trainer course in safeguarding). The home has liaised with the local authority on a safeguarding issue, which led to a member of staff being dismissed with a referral being made to for the staff member to be put on the Protection of Vulnerable Adults Register. The home is still waiting for the outcome of the referral. It is evident that the home now responds appropriately to issues relating to safeguarding. DS0000020292.V366211.R01.S.doc Version 5.2 Page 19 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): 19-26/24-30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst there are no requirements relating to the environment it was evident that some areas were looking in need of decoration and a programme of modernisation. An action plan is in place with much work already being undertaken. However, this remains ongoing. Yatton Hall does provide a comfortable, safe and clean environment. EVIDENCE: DS0000020292.V366211.R01.S.doc Version 5.2 Page 20 Yatton Hall is situated in the centre of Yatton village. There is level access throughout the building and the gardens. There is a passenger lift, which services all three floors. The home has three floors, which is split into caring for older people on the first and second floor, and the third floor (top floor) is designated as a unit for younger adults with a physical disability. Individuals from the younger adult unit were accessing the ground floor both to socialise with friends in the home and to make use of the smoking facility, which is situated in the garden to the front of the building. Some areas of the home were looking tired and in need of decoration namely corridors. There are no requirements in relation to the environment as it was noted that the home was undergoing an extensive refurbishment plan. This included decoration to vacate bedrooms, the communal areas with new furniture being purchased for the lounge areas on the ground floor. In addition the home is seeking quotes for the hallways. The home has responded to a requirement to ensure that there is level access leading to the smoking area. Whilst it is evident that this has been done and now individuals in a wheelchair can better access this area those that may be unsteady on their feet may find the slight ridge a tripping hazard and this must be monitored and risk assessed. It was noted that the ash tray/bin was overflowing with cigarette packets etc. Routine emptying of this must take place to prevent the risk of fire. This was pointed out twice to senior management. Bedrooms are personalised with people’s belongings. Presently all rooms have single occupancy although there are two double bedrooms in the home. All bedrooms have been fitted with an emergency call alarm. Not all rooms are ensuite. Some of the rooms on the floor where the younger adults live were more personalised in the colour scheme, which reflected the choice of the individual. Bathrooms and toilets are situated throughout the home and can be locked but overridden by staff in the event of an emergency. On the day of the visit toilets had adequate toilet rolls and hand washing facilities. Although a member of staff said this was not always the case even though they may have just been cleaned. The home was clean and free from odour. Domestic staff are employed on a daily basis to clean the home enabling the care staff to concentrate on supporting the people living in the home. The home has a separate laundry facility with appropriate equipment. Separate laundry staff are employed. DS0000020292.V366211.R01.S.doc Version 5.2 Page 21 An opportunity was taken to complete an inspection of the kitchen area. The home has had a follow up visit from Environmental Health in relation to the poor practices that were being adopted as noted from a visit in the latter part of last year. The manager and the chef said that the report was more positive with no further requirements. However the home was still waiting for this report. It was evident that there have been improvements to the food handling practices and the cleanliness to the kitchen. Policies and procedures were in place including a food risk assessment and a record demonstrating cleaning was routinely being completed along with food and fridge temperatures. A new chef has been employed and it was evident that they were ensuring that the kitchen cleanliness and food handling practices were now being adopted. Good feedback was received from staff, people living in the home and the manager on the changes that have occurred in the kitchen. DS0000020292.V366211.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): 27,28,29,30/32,34,35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adequate staff support the individuals living at Yatton Hall. Improvements have been made in relation to training however this could be enhanced with more staff completing a National Vocational Award. Support for staff in relation to supervision has improved. EVIDENCE: The home continues to struggle to recruit staff. From talking with the manager and the area manager it has not been from the lack of trying. An open recruitment day was held recently and four staff were successfully appointed. The home has a shortfall of 170 staff hours, not including two staff who are on long term sick and one member of staff on maternity leave. DS0000020292.V366211.R01.S.doc Version 5.2 Page 23 Staff working extra hours, staff being redeployed from another of Four Season’s homes and agency, is covering this shortfall. On the day of the visit four out of the ten staff were agency. Three staff said that this is often the case. From the home’s internal audit it was evident that the home was using on average 85 hours of agency cover per week. Two staff said that some staff leave for better remuneration and acknowledgement, in regards to pay, that they have achieved a National Qualification in care. This was relayed to the area manager. Exit interviews are conducted to enable the organisation to audit why staff leave. In addition there are systems to measure the staff absences within the home, which in the past has been significantly higher than at present according to the manager and the area manager. It was felt that the better monitoring was improving staff absences. During the two-day visit there were 10 staff on duty including two registered nurses. Discussion with the manager and the area manager on the staffing levels and call bells the inspector was informed that a review has been recently completed on the staffing. This has led to an increase to 11 staff, which will include the two registered nurses. The manager said that this will commence with the next duty rota. Recruitment information was viewed for six staff that had recently commenced in post. It was evident that a thorough recruitment process had been undertaken, including pre-employment checks (references, application and a criminal bureau check) and records of the interview that was conducted. Staff complete a probationary period with an appraisal of their work to confirm they are a permanent member of the team when this period has been concluded. The manager stated that the probationary period is usually three months but can be extended where there are concerns or employment terminated. Staff were knowledgeable about the care needs of the people living in the home. From conversations with staff it was evident that they had attended a fair amount of training since January 2008. This included person centred care, supporting individuals that challenge, internal safeguarding training, infection control, epilepsy, diabetes and care planning. The manager was planning further training in supporting individuals with head injury and learning disabilities. This will be followed up at the next visit. Training records provided evidence that staff have attended mandatory training in health and safety, first aid and manual handling and where relevant food hygiene in addition to the training organised since January 2008. In addition staff have completed their induction to care. The home has five out of twenty two care staff that have completed a National Vocational Award in Care. The manager stated that a further two staff are in the process of completing the award. The home is not meeting the government target that at least 50 of the workforce have an NVQ in care. From conversations with the manager it was evident that staff were keen to DS0000020292.V366211.R01.S.doc Version 5.2 Page 24 complete the award but there was a lack of assessors. A plan must be developed to address this shortfall. Regular staff meetings take place with good records being maintained. It was evident that the home has developed a plan to ensure that all staff have received supervision. The majority of staff have had two formal supervisions since the last visit. The home has demonstrated compliance to a requirement from the last visit. DS0000020292.V366211.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): 31,33,35,38/37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. DS0000020292.V366211.R01.S.doc Version 5.2 Page 26 The management has significantly improved. Good auditing systems are in place to enable this home to move forward and improve the care to the people living in Yatton Hall. An individual could be put at risk due to the poor record keeping in relation to their personal allowances. Health and safety is evidently paramount in the home again significant improvements have been noted. However, individuals should be assured that night staff are competent in the event of a fire. EVIDENCE: Mrs Lisa Brain is the registered manager. She has been in post for approximately two years. She is a registered general nurse and has achieved her Registered Manager’s Award. In addition Mrs Brain has attended the in house and mandatory training with her staff team. Mrs Brain and the area manager 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 staff and the individuals discussed during the visit. It was evident that Mrs Brain was being proactive in changing the service to ensure positive outcomes for people living at Yatton Hall. Comments from both people living in the home and staff were positive. Staff stated that the manager tries her best, however this is not always the case of the senior management who put up barriers sometimes for the manager”. Another said, “The manager has an open door policy and is willing to listen to new ideas”. A person using the service said “the manager is now making some changes for the better and I am much happier here, she will try and get it right”. The provider is completing the monthly visits in respect of regulation 26 and copies are being sent to the Commission for Social Care Inspection. In addition the area manager, to ensure that the standards of care in home continue to improve, is completing weekly monitoring visits. As part of these visits the manager and the area manager review the progress to the improvement that was drawn up in consultation with the Commission for Social Care Inspection. Other quality initiatives include weekly information which is sent to the area manager on care planning and reviews, prevalence of pressure sores, falls, safeguarding concerns, complaints, staffing hours, sickness and absence monitoring to name a few. The manager and her staff team complete internal audits on other areas including health and safety, nutritional assessments, care plans and management. People using the service and their relative’s views are sought by an annual questionnaire to enable them to comment on the care provided at DS0000020292.V366211.R01.S.doc Version 5.2 Page 27 Yatton Hall. The manager stated, “This has recently been completed. Four Seasons’ operational staff external to the home and in the process of reviewing this information. All this information is then incorporated in to a plan of action for the home. Copies were seen of the action plans and the progress reports. Supervision and staff meetings have improved. This was discussed in the previous section. All staff spoken with stated that the home is a much better place to work since January 2008 and the last visit conducted by the Commission for Social Care Inspection. One member of staff said, “I have worked for a few care homes but the staff at Yatton Hall all work hard and it is one of the best in respect of ensuring the standards of care are good and for the person”. Another said “it is like one big family where the care to the people living in the home is really good”. Staff described a cohesive team spirit with better support mechanisms being in place. Individual’s finances were looked at with the administrator for the home. Good systems were in place to ensure that individual finances could be accounted for. Receipts were being kept along with signatures of the individual or staff where appropriate. A senior manager employed by Four Seasons audited the systems on a regular basis. However, when visiting one of the units a member of staff was looking in an envelope, which contained money belonging to a person living at Yatton Hall. From the discussions staff were concerned that the individual would lose their money when out in the community and so had decided to look after part of it. There was no risk assessment supporting this decision or records of the expenditure and it was kept in the medication cupboard. Whilst a record was developed during the visit, the decision process must be fully recorded involving the individual and to ensure that the money is held securely thus protecting the individual and the staff team. From reading the fire logbook it was evident that the appropriate checks were now taking place on the fire equipment. Fire training was now taking place for staff. The home has demonstrated compliance to a previous requirement relating to this. However, whilst a large number of staff have attended a fire drill in the last six months this was not so for four members of night staff. An immediate requirement was left with the home to address this. Risk assessments were in place for manual handling, fire and substances hazardous to health (COSHH) and these had been periodically reviewed. Other areas that demonstrated that health and safety was paramount, was the routine checks on aids and adaptations, the landlord’s gas certificate, electrical equipment testing and the routine environmental checks. Staff complete routine checks on food and fridge temperatures. These were satisfactory. DS0000020292.V366211.R01.S.doc Version 5.2 Page 28 Routine health and safety checks are completed on the building to identify any hazards and routine maintenance. The home employs a person whose responsibility it isto complete minor maintenance within the home. The home is informing the Commission for Social Care Inspection of events that affect the wel-being of the individuals living in the home. DS0000020292.V366211.R01.S.doc Version 5.2 Page 29 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 X 4 X 5 X 6 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 ENVIRONMENT Standard No Score 19 2 20 3 21 3 22 3 23 3 24 3 25 3 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 2 36 3 37 3 38 2 DS0000020292.V366211.R01.S.doc Version 5.2 Page 30 Yes 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 OP7 Regulation 15 (1) Requirement For care plans in relation to epilepsy to be clear on how the person is to be supported in relation to treatment and clear direction on what is to be recorded in respect of ongoing monitoring. To review the use of oxygen in the treatment of a seizure ensuring the plan clearly details at what stage it is to be given and the reasons why. Consult with an appropriate professional on its use for each individual. The registered person shall ensure that care plans/risk assessments are place detailing the triggers and strategies for staff to use to support people living in the home with behaviour, which may challenge them or the service. Outstanding since 28/02/08. To ensure that individuals are supported to participate in meaningful social occupation. For individuals to be supported to explore more long term aspirations in relation to their DS0000020292.V366211.R01.S.doc Timescale for action 10/07/08 2. OP7 15 (1) 10/07/08 3. YA23 13 (7) (8) 10/07/08 4. 5. YA14 YA12 16 2 (n) 16 2 (n) 12 (1) (a) 10/09/08 10/09/08 Version 5.2 Page 31 chosen lifestyle. 6. OP35 17(2) sch. 4.9 Ensure that financial records are maintained in respect of one person. For a risk assessment to be developed on the reasons why and how staff are to support the person. For personalised risk assessments to be undertaken in relation to activities that the individuals may undertake as described in the main body of the report. To develop an action plan on how the home will ensure that staff complete a National Vocational Award in Care. 10/07/08 7. YA9 OP35 13 (4) 10/08/08 8. YA35 OP28 18 (1) (c) (i) 10/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP28 YA13 YA12 YA23 YA8 Good Practice Recommendations Care staff should be encouraged to undertake training and achieve NVQ Level 2. For the people that fall within the younger adult category to be consulted on whether they would like an annual holiday. Consider the appointment of an additional activity coordinate who will support the people living in the younger adults unit. For the person responsible for training staff in safeguarding to attend an appropriate train the trainer course (or provide evidence that this has been completed). Explore how the home can develop and improve the communication for individuals that are non-verbal to enable them to be more involved in the planning of their care and the day to day running of the home. DS0000020292.V366211.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. DS0000020292.V366211.R01.S.doc Version 5.2 Page 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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