Care Home: Haydock Nursing & Residential Care Home

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What has improved since the last inspection? All residents had been issued with a copy of their statement of terms and conditions or contract; this would inform them of their rights and obligations during their stay at Haydock. Residents and their relatives had been involved in the development and review of the care plans and involved in decisions about care. The care plans had been improved to include resident`s individual choices and preferences; this would help to ensure they received the care they needed and wanted. A number of staff had received safeguarding adults training and other sessions were planned; this would help staff to recognise and respond to any signs of abuse or neglect. Some areas of the home needed improvement although there was a development plan that supported ongoing and future improvements; this would ensure the home was a pleasant place to live.Haydock Nursing & Residential Care HomeDS0000067797.V374784.R01.S.doc Version 5.2 Page 7A number of systems had been introduced to check whether staff were adhering to policies and procedures and whether residents needs were being met. The provision of safety training for staff had improved and any gaps had been identified; this would ensure staff had the skills and knowledge to keep people safe. What the care home could do better: Detailed care plan audits were not yet in place; this would help to monitor the standard and content of care plans. The medication policies and procedures needed to be reviewed to reflect current practices within the home; this would ensure staff were provided with safe guidance in all aspects of management of medicines. All the required recruitment checks need to be in place before new staff started work; this would ensure residents were protected from unsuitable people. Key inspection report CARE HOMES FOR OLDER PEOPLE Haydock Nursing & Residential Care Home Pleckgate Road Ramsgreave Blackburn Lancashire BB1 8QW Lead Inspector Mrs Marie Matthews Unannounced Inspection 2nd April 2009 09:30 DS0000067797.V374784.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Haydock Nursing & Residential Care Home Address Pleckgate Road Ramsgreave Blackburn Lancashire BB1 8QW 01254 245115 01254 245510 haydock001@aol.com 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) Grange Healthcare Ltd Mr John Hardy Care Home 50 Category(ies) of Dementia (50), Old age, not falling within any registration, with number other category (50) of places Haydock Nursing & Residential Care Home DS0000067797.V374784.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 of the following gender: Either. 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 number of places Dementia Code DE The maximum number of people who can be accommodated is: 50 Date of last inspection 28th April 2008 Brief Description of the Service: Haydock Nursing Home provides both nursing and personal care for up to thirty-eight residents who are elderly and up to twelve residents who suffer from a dementia. The home is registered for up to fifty residents in total. Haydock Nursing Home is owned by Grange Healthcare Limited. A manager is responsible for the day-to-day management of the home. Haydock Nursing Home is a two-story purpose built home situated on the edge of a small estate in the Brownhill area of Blackburn. There are open countryside views from all the rooms located to the rear of the home. There is easy access to bus stops and shops. There are places of worship located within a short distance. All rooms have an en suite facility. Access to the first floor is via a passenger lift or a stair lift. There is a self-contained unit located on the first floor for up to twelve residents who suffer from dementia. Information about the services offered by the home is provided in the form of a service user guide and is available, with a summary of the most recent inspection report, to existing and prospective residents and their relatives. On the day of the inspection the weekly fees ranged from £386.50 to £650.00. Items not included in the fee included personal toiletries, hairdressing and newspapers. Haydock Nursing & Residential Care Home DS0000067797.V374784.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 2 star. This means the people who use this service experience good quality outcomes. The key unannounced inspection, including a visit to the home, took place on 2thnd April 2009. The inspection process included looking at records, a tour of the home, discussions with the registered manager, one visitor and nine residents. Information was also included from survey forms filled in by two staff and five residents. The inspection also looked at things that should have been done since the last visit and a number of areas that affect people’s lives. There were forty-two residents living in the home on the day of the inspection. What the service does well: People were given clear information about services available at the home to be able to decide whether it was a suitable place for them and whether their needs would be met; it was available in various formats to ensure everyone could understand what was available. A full assessment was carried out of residents’ needs before they came to live at the home. This meant that arrangements could be made to ensure that they received the right care and that any equipment needed was obtained. People would be given the opportunity to visit the home before deciding to live there; one resident said ‘we were shown round by the manager and inspected all the facilities, he (the manager) even suggested additional aids that could be fitted in my room’. Residents’ social interests and needs were being met; residents said routines were flexible and comments included ‘we can do what we want’ and ‘there are no restrictions you can choose your own routine’. Staff respected residents’ rights to privacy and dignity; one resident commented ‘I have always received a polite and ready response from staff’. One visitor said she was always made to feel welcome she said ‘it’s a nice place with nice people’. Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 6 The menu showed that residents were offered a varied and nutritious diet; comments from residents included ‘you can have anything you want’, ‘the food is good there is always plenty of choice’, ‘I like the food’, ‘no complaints about food there is plenty to choose from’ and ‘the meals are excellent in variety, presentation and service, I rate them as a five star hotel’. Residents were aware of how to raise concerns and were confident they would be responded to appropriately; they said the registered manager regularly asked whether they were happy or not. During a tour of the home it was clear that the home was maintained, safe and comfortable and was equipped with specialist equipment and adaptations to meet resident’s individual needs; residents’ rooms were clean and bright and most had been personalised with treasured possessions. Records showed that most of the care staff had a recognised qualification (NVQ) in care and were given training that was relevant to their role; this helped them to look after residents properly. The staff team were well supported and provided in sufficient numbers to be able to meet residents’ needs. Records showed that people were consulted about the day-to-day running of the home and they were able to express their views and opinions about the service provided. Residents were happy with the care they received and said staff listened and acted on what they said. Comments included ‘staff are very nice’, ‘staff are lovely’, ‘they always come when you call’ and ‘very good care its individual to each person’. What has improved since the last inspection? All residents had been issued with a copy of their statement of terms and conditions or contract; this would inform them of their rights and obligations during their stay at Haydock. Residents and their relatives had been involved in the development and review of the care plans and involved in decisions about care. The care plans had been improved to include resident’s individual choices and preferences; this would help to ensure they received the care they needed and wanted. A number of staff had received safeguarding adults training and other sessions were planned; this would help staff to recognise and respond to any signs of abuse or neglect. Some areas of the home needed improvement although there was a development plan that supported ongoing and future improvements; this would ensure the home was a pleasant place to live. Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 7 A number of systems had been introduced to check whether staff were adhering to policies and procedures and whether residents needs were being met. The provision of safety training for staff had improved and any gaps had been identified; this would ensure staff had the skills and knowledge to keep people safe. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Standard 6 was not applicable. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were given clear information about available services that would help them to decide whether the home was suitable for them. Detailed information was collected about residents before they were admitted to determine whether they could be looked after properly. Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 10 EVIDENCE: There was a range of useful and detailed information about the services provided at Haydock Nursing & Residential Home; this would help people to make informed decisions about whether it was a suitable place for them to live. There was a quarterly newsletter named the ‘Haydock Gazette’ which kept people informed about what was happening both inside and outside the home and a ‘hotel services’ pack that contained useful information about housekeeping procedures, menus and available choices. The information was available in various formats, including Braille and audio, and there were staff that could translate the information fluently into other languages if needed. Residents said they were given enough information. One resident commented ‘I have a copy of the comprehensive service user guide, contract and all the excellent services provided by Haydock’. Three residents files were looked at in detail. All residents were given a copy of their statement of terms and conditions or contract; the contract would inform people of their rights and obligation during their stay at Haydock. Detailed information was collected before new residents were admitted to the home; this would help to determine whether they could be looked after properly. Senior staff gathered information from a range of sources involving prospective residents and their relatives; this would make sure all aspects of their needs were considered. New residents were then sent written confirmation that their needs would be met. The registered manager said prospective residents would be given the opportunity to visit the home. One resident said ‘we were shown round by the manager and inspected all the facilities, he (the manager) even suggested additional aids that could be fitted in my room’. The provision of training for staff had improved. Records showed that staff had a range of skills and experience to look after residents properly. Dementia training had been provided for a number of staff; this would help them to understand and respond appropriately to residents who needed specialised care. Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. 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 feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, and 9. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s health and personal care needs were met although medication procedures could be improved to provide safer practice guidance for staff. EVIDENCE: Three residents individual care files were looked at in detail. The care plans had been developed from the initial assessment information, involved the resident or their relatives and clearly recorded the action to be taken by staff to meet residents’ health and personal care needs. There was information about residents’ personal preferences, routines and likes and dislikes; this ensured they would get the care they both wanted and needed. The care plans Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 12 had been reviewed by staff and updated to make sure the information was up to date. Residents said staff listened and acted on what they said. One resident said ‘it is very good care and its individual to each person’. Assessments were in place to identify any risks to individual residents and these were supported by a plan of action that would help staff to prevent or reduce any risks. Residents were provided with a range of specialised aids and adaptations to maintain their comfort and safety and to help them to maintain their independence wherever possible. Records showed that people’s health was monitored and that the advice and support from healthcare professionals had been sought when needed. Residents commented they received the care and medical support they needed, one resident said ‘I have received great help and support from home staff and prompt and regular supply of medicines’. Staff were trained in healthcare matters. There had been some concerns identified recently in relation to care practices; measures had been put in place to ensure residents received the care they needed. Detailed care plan audits were not yet in place and this was discussed with the registered manager. The medication policies and procedures provided safe guidance for staff in most aspects of management of medicines. Procedures were still needed to support staff with ‘PRN’ or ‘as needed’ medicines, transcribing or handwritten directions and medicines taken out of the home (leave). Procedures did not support staff with the current use of the monitored dosage system; the registered manager said procedures would be reviewed once training in the system was completed. Records were accurate and showed that medicines were managed safely although there was no evidence that residents had given consent for staff to manage their medicines. It was again recommended that medicines for disposal were checked and signed for by two staff to ensure there was no risk of mishandling. Medicines were stored safely and at the appropriate temperatures. There were protocols to support staff with their decisions to administer ‘as needed’ medicines although handwritten entries were not always witnessed. Staff had received training to support them with safe management of medicines. Care staff who administered medicines had been trained to do so although there were no assessments of competency for this and other nursing tasks that they performed; it was again recommended that assessments of competency should be completed to confirm care staff had understood the information. The registered manager advised that the community pharmacist conducted regular audits to monitor whether systems were safe and the deputy manager audited whether medicines had been administered properly. Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 13 Staff responded to residents and visitors in a friendly but respectful manner and resident’s privacy was respected. There were procedures to support staff with all aspects of respecting people’s privacy and dignity and meeting their needs. One resident commented ‘I have always received a polite and ready response from staff’ another said she had been unwell and her doctor had visited her in the privacy of her own room. Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. 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 maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents’ social interests and needs were met with daily routines that matched their preferences and choices. Residents’ dietary needs and preferences were met. EVIDENCE: The home did not have an activities co-ordinator although a current member of care staff was due to take on this role. There was a programme of weekly activities advertised on the notice board although the registered manager said they had tried to move away from the programme and provide a more personalised approach; records supported this. Each resident’s care plan recorded information about their lives, routines and preferences; this would help staff to plan suitable activities for them. Residents Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 15 also had a ‘recreational activities record’ showing a range of daily activities that they had participated in; these activities were individual to each person and included shopping, trips to the hairdressers, beauty therapy, swimming, baking and board games. Residents made varied comments about the activities provided; comments included ‘sometimes’ activities are available and ‘there are a number of published activities available’; one resident confirmed there were special events held and he was able to visit the local church and swimming baths. One resident said she and other residents had recently enjoyed entertainment provided by a singer and said ‘we had a good laugh’. The registered manager said residents were accompanied to the local shops and hairdressers wherever possible; a number of residents were enjoying the fine weather with short walks and visit to the local shops and hair salon. Weekly visits from ministers were arranged for those who were unable to go to their church; one resident enjoyed playing hymns on the dining room organ. One resident said he had brought in his computer and ‘I would be lost without it’. Residents said they were able to maintain contact with their friends and family and could visit at any reasonable time; there were a number of seating areas for this purpose. One visitor said she was always made to feel welcome she said ‘it’s a nice place with nice people’. Many of the bedrooms were personalised and some had telephones in their rooms to help them maintain contact with friends and family; others were given support to keep in touch with people. Residents said routines were flexible; comments included ‘we can do what we want’, ‘it will never be like living in your own home but it’s the next best thing’ and ‘there are no restrictions you can choose your own routine’. The menu showed that residents were offered a varied and nutritious diet with different choices and alternatives throughout the day. The records of food served were still incomplete and did not support choices were always offered. Comments about the meals were very positive including ‘you can have anything you want’, ‘the food is good there is always plenty of choice’, ‘I like the food’, ‘no complaints about food there is plenty to choose from’ and ‘the meals are excellent in variety, presentation and service, I rate them as a five star hotel’. Each resident was supplied with a ‘hotel services’ pack informing them of the menu, meal times and choices available. The lunchtime meal served was nutritious and attractively presented and residents said they had enjoyed the meal. Dietary needs were recorded in the care plan and residents confirmed that special occasions were celebrated. A number of residents needed assistance with their meals and staff were seen giving unhurried support. Dining areas were bright and tables were attractively set; improvements were planned for the ground floor dining areas. There were Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 16 kitchenette areas on both floors where residents and their visitors could make a drink. There was an audit system in place to monitor standards in the kitchen; this would help staff to maintain and improve the service. Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 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’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were protected by safe policies and procedures and by staff awareness. EVIDENCE: The complaints procedure was clear and accessible to people and available in different formats such as audio and Braille. Residents were aware of how to raise concerns and were confident they would be responded to appropriately they said the registered manager regularly asked whether they were happy or not. One resident said ‘ I would talk to John (the manager) he is down to earth, you can tell him anything’. There had been one recent complaint regarding care practices and communication. This had been responded to according to the procedure and measures had been put in place to ensure residents’ needs were met. The safeguarding policies and procedures were detailed although it was recommended again that the local authority contact information should be included as the initial contact in the event of any suspicion of abuse or neglect. Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 18 Staff had procedures to support them with reporting poor practice within the home; this would ensure residents were protected from harm. Staff knew how to respond in the event of a safeguarding alert. There had been two safeguarding referrals made in the past twelve months; these had been dealt with properly ensuring people were safe and protected. Staff survey and training records showed that up to half of staff had received appropriate training to help them to identify and respond properly to any signs of abuse or neglect; further training was planned that would ensure all staff were up to date. Additional training was given to help staff to ensure residents human rights and choices were respected; this would help staff where residents were not always able to make decisions for themselves. Procedures were in place to support staff with dealing with physical and verbal aggression, the use of restraint and dealing with resident’s money. A number of staff had received training to help them to manage any challenging behaviour; this would help to keep staff and others safe. Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 and 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lived in a safe, clean and comfortable environment. EVIDENCE: During a tour of the home it was clear that the home was maintained, safe and comfortable and was equipped with specialist equipment and adaptations to meet resident’s individual needs. There was a development plan and a programme of maintenance, repairs and refurbishment that had been completed or planned for this year; this would ensure that the home would provide a pleasant place for residents to live in. Records showed that requests Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 20 for repairs and maintenance were referred each week to the handyman who was based at another home; records should include the dates that work was completed. Grounds were tidy, safe and accessible with seating areas for residents and their visitors to enjoy the warmer weather and the views of the countryside; the registered manager said there were plans to develop a sensory garden this year. The fire safety officer and environmental health officer had visited the home; the registered manager advised that any recommended work had been complied with. There were a variety of bright and comfortable communal areas that met the needs of residents and gave opportunities for residents to meet with their visitors in private. Toilets and bathrooms were close to lounge and dining areas and clearly signed. All rooms had en suite facilities; some were equipped with hand basins and others with showers or baths. Residents were provided with specialised aids and equipment to assist with their comfort and safety and to help them to maintain their independence wherever possible. All rooms were fitted with nurse call systems for residents to use to summon assistance from staff and the registered manager advised that assessments were in place to explain the reasons for non-provision of call leads. The unit on the first floor provided specialised care for residents with dementia; this unit was staffed separately and could be accessed using a key code to ensure people were safe. There were memory boxes that included personal items and photographs outside some of the bedroom doors to help residents to easily recognise their rooms and areas were clearly signed. Resident’s bedrooms were clean and bright and most had been personalised with treasured possessions to enhance the homely feel. Residents were happy with their rooms and rooms to the rear of the house had extensive views over the fields. Residents’ doors had suitable locks in place and one resident told the inspector that he had been given a door key; secure storage space was also provided for storage of personal items. The provision of keys was not routinely risk assessed although residents could have a key to their room if they wished. Areas were clean and odour free. Domestic and laundry staff were employed in suitable numbers. One resident commented that her room was always clean and tidy and her clothing was always returned clean and ironed she said ‘staff work very hard’. Surveys indicated the home was always clean and fresh. Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 21 Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team were competent, well supported and provided in sufficient numbers to meet residents’ needs. The recruitment procedures were clear but records did not always support that safe practices had been followed. EVIDENCE: Rotas showed the home was staffed with sufficient numbers of staff to meet the needs of the residents. Survey information indicated staff were ‘usually’ and ‘sometimes’ available and service users said there were ‘enough staff’. Staff were divided into teams and each resident had a key worker; this would help to provide continuity of care for residents and their visitors. The staff group was a mix of male and female staff of various ages and cultural backgrounds to assist residents with individualised personal care. Comments included ‘staff are very nice’, ‘staff are lovely’ ‘they always come when you call’ and ‘very good care its individual to each person’. Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 23 The recruitment procedure was clear and two staff said a safe recruitment process had been followed. Three staff files looked at in detail. Applicants had been interviewed and records showed that a fair selection process had been followed. However two of the staff files did not include a copy of the Protection of Vulnerable Adults check and a reference on one file had been received following start of employment; these checks should be in place to support that a safe recruitment process had been followed and to protect residents from unsuitable people. Recent photographs, as a means of identification, should be maintained on all staff files. Not all staff had contracts of employment although the registered manager said these were being updated in line with new legislation and would be issued soon; staff needed this information to ensure they were aware of their rights and responsibilities whilst employed at Haydock. Records showed that most of the care staff had a recognised qualification in care and staff said they were given training that was relevant to their role; this would increase their skills and knowledge and help them to look after residents properly. New staff had received structured induction training to give them the skills they needed. Records supported that the provision of training for all staff had improved; this would ensure staff were skilled and competent to meet people’s needs. Records showed that staff met regularly with their manager to discuss their work; this would help to identify if they needed any additional training or support. Staff said they received the support they needed. Staff meetings had been held and minutes were recorded; this gave staff the opportunity to voice their opinions and be involved in decisions about the way the home was run. Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. 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 the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was safe and well managed. Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 25 EVIDENCE: Mr John Hardy had recently been registered with the Commission for Social Care Inspection to manage the day-to-day running of the home. He has had twenty-five years of experience in the management of care, has suitable management qualifications and is a registered nurse. It was clear that he was responsive to the needs of the residents; residents made positive comments regarding Mr Hardy’s contribution to improving the home including ‘I have a good rapport with John’ and ‘he is a good bloke’. Records showed that people were consulted about the day-to-day running of the home and they were able to express their views and opinions about the service provided. The results of the quarterly resident and relative survey were displayed on the notice board and referred to in the newsletter; people were able to comment on a range of areas that affected them such as care, staffing and meal times. Meetings with residents and relatives were not held although people were kept up to date through the quarterly newsletter, various leaflets and posters. There was a business plan and an annual development plan that showed plans for improvement over the next twelve months. Annual audits were linked to the National Minimum Standards and had identified where changes were needed to improve the home and outcomes for residents and their visitors. There were a number of audits systems that monitored whether staff were following procedures and meeting residents needs; audits in relation to care planning need to be developed. Policies and procedures were in place to support staff with safe practice; these were reviewed in line with new legislation and any shortfalls were referred to under the relevant section in the report. The home had achieved an external quality award Investors In People award; this monitored how staff were developed and how the business was managed. The registered manager advised that the home did not take responsibility for management or safe keeping of resident’s finances; residents or their relatives would be encouraged to manage their own finances. The annual quality assurance assessment was detailed and contained relevant information; it gave us a good picture of any changes made over the past twelve months and where improvements could be made. The registered provider monitored the management of the home each month and a report was produced indicating the results of the visit; this helped to identify any areas in need of improvement and areas of good practice. Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 26 Action had been taken to respond to any requirements and recommendations made following the last key inspection visit; this showed that the registered person was committed to improving the home. Records were generally accurate and were stored securely; any concerns had been referred to under the relevant outcome area. It was noted that the registered manager had not always notified the Care Quality Commission of any incidents affecting service users well being; incidents must be notified to the Commission under Regulation 37. Records support that the home was safe and well maintained. Records showed that the provision of safety training had improved and further sessions were planned to ensure all staff were competent and aware of safe practice. Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 27 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 3 3 3 3 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 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 3 X 3 3 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X N/A 3 3 3 Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13 Requirement The medication procedures must be reviewed to reflect current practice within the home; this will ensure staff are supported with safe practice guidance. New staff must only be employed when all the required checks are in place; this will ensure residents are protected from unsuitable people. The Care Quality Commission must be notified in writing of any incident as listed under Regulation 37. Timescale for action 18/05/09 2. OP29 19 18/05/09 3. OP37 37 18/05/09 Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 29 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 OP9 Good Practice Recommendations There should be procedures to support staff with the safe administration of ‘when required’ or ‘PRN’ medicines, medicines given away from the home (leave) and witnessing handwritten directions. A second member of staff should witness all hand written directions on Medication Administration Record (MAR) charts. Records of medicines for disposal should be witnessed to prevent mishandling. There should be evidence to support residents have been given the choice to self medicate or that consent had been obtained for staff to manage their medicines. Assessments of competency should be available for all care staff that have completed medication training and for those who undertake other nursing tasks. 2. 3. OP15 OP18 There should be records to support that residents are given choices and alternatives at each mealtime. The safeguarding procedures should include the contact information of local agencies that would need to be contacted in the event of any abuse or suspicion of abuse. The records of completed repairs should be signed and dated on completion. Photographs, as a means of identification, should be included each staff file. An audit system should be introduced to monitor the standard and content of resident’s care plans. 4. 5. 6. OP19 OP29 OP33 Haydock Nursing & Residential Care Home DS0000067797.V374784.R01.S.doc Version 5.2 Page 30 Care Quality Commission Preston Regional Office 2nd Floor Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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