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Care Home: Hay House Nursing Home

  • Broadclyst Exeter Devon EX5 3JL
  • Tel: 01392461779
  • Fax: 01392460040

Hay House is registered as a care home that provides accomodation with nursing for up to 35 people over the age of 65, with dementia or a mental disorder. The building is Georgian and is set in an elevated position with views to Broadclyst and Killerton. The house has been extended and adapted for use as a care home and provides both shared and single bedrooms, 16 of which have en-suite facilities. There is a passenger lift linking the floors aswell as a wide staircase. Communal facilities are made up of a main lounge, a dining room, a smaller lounge and a large entrance hall. There are Registered Nurses on duty throughout the day and night. The fees charged at this home range from 533.00 - 850.00 pounds per week. 0 3 1 1 2 0 0 9

  • Latitude: 50.777000427246
    Longitude: -3.4409999847412
  • Manager: Mrs Karen Davey
  • Price p/w: £850
  • UK
  • Total Capacity: 35
  • Type: Care home with nursing
  • Provider: Chartbeech Ltd
  • Ownership: Private
  • Care Home ID: 7764
Residents Needs:
Dementia, mental health, excluding learning disability or dementia

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for Hay House Nursing Home.

Random inspection report Care homes for older people Name: Address: Hay House Nursing Home Broadclyst Exeter Devon EX5 3JL one star adequate service 03/11/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Judith McGregor-Harper Date: 2 6 0 5 2 0 1 0 Information about the care home Name of care home: Address: Hay House Nursing Home Broadclyst Exeter Devon EX5 3JL 01392461779 01392460040 info@hayhousecare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Karen Davey Ms Rachel Somers Type of registration: Number of places registered: Conditions of registration: Category(ies) : Chartbeech Ltd care home 35 Number of places (if applicable): Under 65 Over 65 35 35 dementia mental disorder, excluding learning disability or dementia Conditions of registration: 0 0 On the termination of the placement of the named service user, the registered person will notify the Commission in writing and the particulars and conditions of this registration will revert to those held on the 8th November 2004. Staffing minimum as agreed with the previous registration authority 29/01/2002 and detailed in the variation of registration report of the same date, is observed. The manager, Ms Rachel Somers, must obtain the Registered Manager`s Award by 2005 The maximum number of persons accommodated at the home, including the named service user, will remain at 35 Care Homes for Older People Page 2 of 12 There is a named Registered Mental Nurse as a lead for mental health care at the home. To admit one named person outside the categories of registration as detailed in the notice dated 5th November 2004 Date of last inspection Brief description of the care home Hay House is registered as a care home that provides accomodation with nursing for up to 35 people over the age of 65, with dementia or a mental disorder. The building is Georgian and is set in an elevated position with views to Broadclyst and Killerton. The house has been extended and adapted for use as a care home and provides both shared and single bedrooms, 16 of which have en-suite facilities. There is a passenger lift linking the floors aswell as a wide staircase. Communal facilities are made up of a main lounge, a dining room, a smaller lounge and a large entrance hall. There are Registered Nurses on duty throughout the day and night. The fees charged at this home range from 533.00 - 850.00 pounds per week. 0 3 1 1 2 0 0 9 Care Homes for Older People Page 3 of 12 What we found: This was an unannounced random inspection carried out on one day by one inspector. Our focus of this inspection was to review whether requirements made at the unannounced key inspection on the 3rd November 2009 and requirements not met at the key inspection visit from previous inspection had now been met. In addition to assessing evidence of compliance with previously unmet regulations we focused the remainder of our inspection on viewing records in relation to assessment and admission of people moving into the home, on-going and changing care needs, risk assessment of the individual, medication management and management health and safety measures in accident prevention. Choice of home. We looked closely at the care and support plans of four people. Three currently live at Hey House and one person resided at the home until April 2010. One of the plans we read was for a person who had recently moved into the home. We saw that the home had taken appropriate steps to assess the person and to gain information from health professionals about the persons current health care needs. We saw that the person had a past history of exhibiting self-harming behaviour. We saw that a care plan was put into place of monitoring challenging behaviours and for reporting symptoms of mental health deterioration. The daily records showed that community health care professional specialists were involved in on-going review of the person. We saw that the care plan was reviewed following an incident of self-harming behaviour at the home. We met the person, who appeared in good humour and who was socialising with other people living in the home in one of the homes lounges. At the last inspection of the home in November 2009 we made no requirements to the home regarding its admission processes followed. There are also no unmet requirements under the Choice of Home National Minimum Standards from previous inspection visits. Health and Personal Care. At the last inspection we made four statutory requirements within the Standards grouped as Health and Personal Care. There were also five additional unmet requirements in this outcome group from other previous inspection visits that had similar themes to requirements made in the November 2009 visit. Unmet requirements were in relation to people having a plan of care that reflected current needs; that the plan was kept under review; that peoples ability for decision making must be assessed; that peoples health and welfare must be met; and that peoples medication must be properly managed. At this random inspection visit we checked to see if the requirements had been met. We examined closely four individuals care and support plans that included risk assessments. We also looked closely at daily records written by duty staff, staff rosters, accident records and accident analysis carried out by the proprietor. Prior to the inspection we had examined notifications we had received about significant events in the home in order to compare them with accidents or incidents recorded at the home. We looked at medication records and we met three of the four people whose care records we read. We also talked with the homes management about what actions they had taken in order to meet requirements we had made on previous inspection visits. Care Homes for Older People Page 4 of 12 It is pleasing that the management of the home had taken appropriate action to meet the previous requirements. Quality of written records had greatly improved. We could see from care plans that the home accepts people with dementia and/or mental health needs who may exhibit behaviours that pose risk either to themselves or other people. We saw that there is now a clear system for reporting accidents and incidents and we could see that daily records reflected instances of accidents recorded in the accident book. We saw that accidents are now better integrated into care plan reviews and that care plans to meet peoples emotional or mental health needs considered deterioration of mental health. We saw that GP advice and support was obtained and followed when a person became unwell. Notably we could see that efforts had been made to identify any patterns or trends in violence between people living at the home in order that staffing levels or staffing routines could be amended to attempt to reduce occurrences of violence in the home. We saw that body maps had been used to record injuries to people. We saw that people had been assessed for risk of falls and that a short paragraph was included in plans of care of how to reduce this identified risk. We could see that peoples behaviour did not always mean that risk could be fully eliminated. We acknowledge that a great deal of time has been spent on improving the quality of peoples care plans, in particular, in assessing risk of violence and injury at the home. We had highlighted this as a priority for action at the last key inspection. We did observe, however, that care planning in relation to continence promotion or management of incontinence was not always person centred. On the day of the inspection a continence specialist was visiting the home. We told the acting manager that we would recommend in this report that care plans for elimination be more person centred with realistic goal setting. The acting manager said she would take up the opportunity to discuss this with the continence specialist. We looked at medication records. We could see that as required medicines were not used as a first line treatment for challenging behaviour but that staff distraction techniques or one-to-one staff input to effect a positive change in a persons behaviour was used instead. We saw that a person whose care plan we had case tracked had received appropriate regular analgesia for pain control following a fracture, which was prescribed as required. This was good practice as the care plan had identified that the person was not consistently able to express when they felt pain. We saw that the requirement we made at the last inspection with regard to ensuring that people receive the medication that they are prescribed was met. We noticed that there was inconsistent witnessing of staff hand transcribed medications on medication charts. We also noticed that nursing staff had not recorded variable dose amounts to enable the therapeutic dose of a medicine to be established. We recognise that the home is in the process of obtaining pre-printed medicine charts from the dispensing pharmacy. However, we are making a new requirement with regard to medication management that hand transcribed medicines are checked by competent second staff member to reduce risk of human transcribing error. Also, we require that variable doses be recorded in order to establish a therapeutic dose of prescribed medication. Daily life and Social Activities. There are no unmet requirements in this outcome group from previous inspections and so we did not inspect these Standards in detail. The home continues to employ a capable Care Homes for Older People Page 5 of 12 and dedicated activities coordinator who was on duty on the day of this unannounced random inspection. Since the last inspection the management of the home have acted in order to seek an assessment of Deprivation of Liberty for one person under the Mental Capacity Act, with regard to a care planning strategy of accompanying the person lacking capacity whilst walking within the homes grounds for their own personal safety and in at times preventing their exit from the home. We spoke to the management about the assessment and they told us that this was a useful and educational process for them in understanding their legal obligations. Complaints and Protection. Since the last inspection visit in November 2009 the home has appropriately followed the Devon alerters safeguarding pathway in making a safeguarding referral with regard to a violent incident between two people residing at the home. At the previous inspection we made a requirement that all forms of restraint be recorded, stating the reason why the restraint is used. In the four care files we inspected we did not see that people were subject to physical forms of restraints ( for example, bed rails or lap belts in wheelchairs), nor were people subjected to use of medication as a first line of behaviour management if people became agitated or aggressive. We have previously stated that the service appropriately sought an assessment for a person in order to find out if their liberty was being unjustly curtailed under the Mental Capacity Act (Deprivation of Liberty Safeguards). The home has demonstrated since the last inspection that it has met the requirements we made and that restrictive practices used in the home are appropriately recorded. Environment. At the inspection the proprietor informed us that foot operated bins for the storage of soiled continence products have been purchased and distributed in the home. We had made this a requirement at the last inspection in order to suitably manage and control infection. We looked at communal lounges in the home and saw that they were clean and homely. During the inspection we had the opportunity to ask a community based visiting health professional for their opinion of the cleanliness of the home. They reported that they had not noticed a problem with cleanliness nor malodour at the home on their visits. Staffing. Since the last inspection staff training has taken place on the subject of person centred planning. We were able to see that improvements had been made in care plans in assessing risk in the home of challenging behaviours and plans of care to support peoples emotional and mental health needs. We also saw that care plans are now reviewed as needs change. Training for staff in the management of diabetes booked for June 2010. We were advised during the inspection that a training session on Parkinsons Disease has been booked in July 2010. We had highlighted these areas that staff required additional training in at the Care Homes for Older People Page 6 of 12 last inspection. The home has successfully recruited into a vacant full-time registered nurse post. This means that there are no staffing vacancies and that people receive consistency of care from the regular staffing team. Management and Administration. We made a requirement at the last inspection that the Commission receive an application for a registered manager. We have received an application from the acting manager and this is being processes pending decision on the application. As part of this random inspection we needed to assess whether the home is managed in such as way as to protect the health and welfare of people living at Hay House. We found that the acting manager had organised a review of care plans and the four care plans we case tracked demonstrated that they contained a greater understanding of a person centred approach to care (one that considers the individual needs of the person and that keeps records under regular review to adapt to a persons changing needs). We saw that the homes management (proprietor and acting manager) had used a useful pragmatic tool for analysing monthly accidents and falls incidents in the home that considered not only staffing levels but also staffing deployment in the home during staffing shifts. We saw that the management adopted a flexible attitude toward staffing needs on the home on a monthly basis to reduce risk identified in trends in the falls or incident analyses. There were 8 accidents in the home during March 2010 and 11 accidents in the home during April 2010. We found that the managers had followed appropriate safeguarding processes since the last inspection and we have been notified of significant events that have occurred in the home. At this random inspection we found that the unmet requirements made at previous inspections have now been met. We have made a new requirement in relation to medication record keeping and we will continue to monitor information we receive from or about the service to check that the current improvement in outcomes for people living at the service appears to be sustained. What the care home does well: What they could do better: Medication records must be consistently accurately completed. We acknowledge that the imminent change to the format of medication administration records may assist the home with this. Care Homes for Older People Page 7 of 12 People would also benefit from a person centred approach to the management of their continence needs. Not all care plans we read adopted an individual approach to peoples elimnation needs. Again, we recognise that the home has taken positive steps in liaising with community based health care professionals in the field of continence promotion. It would benefit the acting manager to review requirements from previous inspection reports in order for her to reflect upon how she will act strategically in order to sustain or improve current outcomes for people who live at the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 12 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 12 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 You must record the amount 30/07/2010 of a medicine administered to a person if a variable dose is prescribed. This is in order to establish a therapeutic dose of medicine required for each person. Hand transcribed entries on a medicine administration record must be countersigned by a competent witness. This is so that the risk of hand transcription error is reduced. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 7 33 All care plans for promoting continence or managing incontinence should be person centred. To sustain improvements in outcomes for people who live at the home it would benefit the home to ensure that Page 10 of 12 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations quality assurance processes are robust including reflection upon findings made in previous Commission inspection reports. Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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