Care Home: Haye Corner Residential Care Home

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What the care home does well The environment has been refurbished and updated and presents a pleasant homely and clean environment. The home has an ongoing maintenance and programme of refurbishment in place. The surrounding gardens are well maintained and give residents a pleasant outlook and a safe environment to take walks.The service has a comprehensive care planning system in place that all staff have received training on and use effectively. The service provides a varied and appropriate training programme for staff and 80% of staff have achieved the National Vocational Qualification (NVQ) level 2 and above. Service users and relative`s surveys returned to the CSCI said: `At the present time I cannot fault the caring service`. `The staff are very attentive and the manager is very good`. `Overall the service is very good`. `Since the manager has taken over the home is a lot cleaner`. `The care at Haye Corner is excellent my mum is happy, and enjoys the company of the carers and her well being has improved since being in Haye Corner`. `The staff are very capable of meeting mum`s needs`. `My mother has been cared for very well`. `The home has a friendly atmosphere which makes it feel like home with a large family in it`. `The staff treat my husband well and with patience and has learned his likes and dislikes. He has settled there better than I could have hoped for and it is down to the friendly care given by everyone working there`. `They look after me well and I like the food`. `My room is nice and is cleaned well`. All risk factors in the environment of the home have been identified and documented in the risk assessment undertaken by the manager. What has improved since the last inspection? The manager has implemented a quality assurance system that regularly reviews and ensures the standards in the home are maintained and that service users and relatives are able to contribute to this by attending meetings, completing satisfaction questionnaires and the manager being available to speak to if issues about the home should arise. The representative of the proprietors visit the home regularly and undertake a monthly inspection of the premises, speak to service users, staff and any relatives present and prepare a report of that visit, a copy of which is left in the home for inspection. The manager has implemented a new care planning system which is comprehensive in content and covers all aspects of the service users` physical, psychological and mental health needs. The home has introduced a new system for the administration of medication, which the AQAA state is safer and more accurate. Staff have received training on the new system. The activities programme has been extended and the home has purchased more games and books. The numbers of staff on duty in the afternoon has increased to enable one person to organised and undertake activities with the service users every afternoon. The maintenance and renewal of fixtures and fittings in the home has continued over the last year and the home has a planned programme of refurbishment and renewal on a year to year basis which the manager is involved with the planning of. The manager has implemented a staff training programme to meet the training needs of her staff, which is identified through regular appraisal and supervision with her. The manager is now registered and has completed her Registered Manager`s Award. She has implemented a number of changes in the home to improve the quality of the service. Staff are respectful and say they feel fully supported by the manager and have regular supervision meetings with her. The home now uses full fat milk as part of the service users` daily diet. The ground floor shower room has now been fitted with a radiator to ensure the temperature of the room is comfortable for service users when showering. A ramp has been constructed from the patio doors in the dining room leading down to the garden to ensure service user`s safety. What the care home could do better: The registered person should implement systems or equipment to ensure that the food is delivered and served at acceptable temperatures to service users at meal times. CARE HOMES FOR OLDER PEOPLE Haye Corner Residential Care Home 21 Crofton Lane Hill Head Fareham Hampshire PO14 3LP Lead Inspector Jan Everitt Unannounced Inspection 2nd April 2009 09:30 X10015.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 Haye Corner Residential Care Home DS0000068989.V374729.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. 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. Haye Corner Residential Care Home DS0000068989.V374729.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Haye Corner Residential Care Home Address 21 Crofton Lane Hill Head Fareham Hampshire PO14 3LP 01329 662175 01329 516970 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) Mrs Maureen Winifred Flanagan Mr John Joseph Flanagan Stoilka Radeva Care Home 20 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Haye Corner Residential Care Home DS0000068989.V374729.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only – (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 2. Old age, not falling within any other category (OP) The maximum number of service users to be accommodated is 20 Date of last inspection 15th April 2008 Brief Description of the Service: Haye Corner is a residential care home that is a single storey building that was once three bungalows that have been joined together to make one large area. The home is situated in the seaside village of Hill Head very close to the sea front. The village of Stubbington is nearby with a good range of shops and facilities. The home has ten single bedrooms and five twin bedrooms. Each room has a washbasin, television and phone points. Communal areas include two lounges, a conservatory, plus two dining areas. There is one assisted bathroom, one shower/wet room and there are two separate toilets. Externally there is a patio area and a well-kept garden for residents use. The home is registered to provide care for up to twenty residents with old age and mental frailty. The current fees for the home range from £435 - £588. The fees do not include hairdressing, chiropody and other personal items. Haye Corner Residential Care Home DS0000068989.V374729.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 unannounced, inspection visit to Haye Corner Residential Home, took place over a one-day period on the 2nd April 2009. The registered manager was present in the home and assisted throughout the visit. The manager had returned the Annual Quality Assurance Assessment (AQAA) to the CSCI and the focus of this visit was to evidence the information stated in this document and other information received by the CSCI since the last fieldwork visit, which was a key inspection in April 2008. Documents and records were examined and staff’s working practices were observed. We looked around the building. Due to service users having a diagnosis of dementia, verbal feedback was sometimes difficult to establish. However feedback was gained from verbal and non-verbal communication and from observations throughout the visit. Those service users spoken to were generally complimentary about the home and the care they receive. One visiting relative also expressed his satisfaction with the care his relative was receiving. Surveys had been distributed to service users, staff, care managers, GP and other visiting professionals. Five service user surveys, (all of which were completed by relatives on their behalf), three staff and one visiting professional surveys were returned to the CSCI. The outcome of the surveys indicated that there was generally a high level of satisfaction with the service and that people were pleased with the care the home provides and that the home usually manages people with dementia very well. There were 16 residents living in the home. None were from an ethnic minority group. What the service does well: The environment has been refurbished and updated and presents a pleasant homely and clean environment. The home has an ongoing maintenance and programme of refurbishment in place. The surrounding gardens are well maintained and give residents a pleasant outlook and a safe environment to take walks. Haye Corner Residential Care Home DS0000068989.V374729.R01.S.doc Version 5.2 Page 6 The service has a comprehensive care planning system in place that all staff have received training on and use effectively. The service provides a varied and appropriate training programme for staff and 80 of staff have achieved the National Vocational Qualification (NVQ) level 2 and above. Service users and relative’s surveys returned to the CSCI said: ‘At the present time I cannot fault the caring service’. ‘The staff are very attentive and the manager is very good’. ‘Overall the service is very good’. ‘Since the manager has taken over the home is a lot cleaner’. ‘The care at Haye Corner is excellent my mum is happy, and enjoys the company of the carers and her well being has improved since being in Haye Corner’. ‘The staff are very capable of meeting mum’s needs’. ‘My mother has been cared for very well’. ‘The home has a friendly atmosphere which makes it feel like home with a large family in it’. ‘The staff treat my husband well and with patience and has learned his likes and dislikes. He has settled there better than I could have hoped for and it is down to the friendly care given by everyone working there’. ‘They look after me well and I like the food’. ‘My room is nice and is cleaned well’. All risk factors in the environment of the home have been identified and documented in the risk assessment undertaken by the manager. What has improved since the last inspection? The manager has implemented a quality assurance system that regularly reviews and ensures the standards in the home are maintained and that service users and relatives are able to contribute to this by attending meetings, completing satisfaction questionnaires and the manager being available to speak to if issues about the home should arise. The representative of the proprietors visit the home regularly and undertake a monthly inspection of the premises, speak to service users, staff and any relatives present and prepare a report of that visit, a copy of which is left in the home for inspection. The manager has implemented a new care planning system which is comprehensive in content and covers all aspects of the service users’ physical, psychological and mental health needs. The home has introduced a new system for the administration of medication, which the AQAA state is safer and more accurate. Staff have received training on the new system. Haye Corner Residential Care Home DS0000068989.V374729.R01.S.doc Version 5.2 Page 7 The activities programme has been extended and the home has purchased more games and books. The numbers of staff on duty in the afternoon has increased to enable one person to organised and undertake activities with the service users every afternoon. The maintenance and renewal of fixtures and fittings in the home has continued over the last year and the home has a planned programme of refurbishment and renewal on a year to year basis which the manager is involved with the planning of. The manager has implemented a staff training programme to meet the training needs of her staff, which is identified through regular appraisal and supervision with her. The manager is now registered and has completed her Registered Manager’s Award. She has implemented a number of changes in the home to improve the quality of the service. Staff are respectful and say they feel fully supported by the manager and have regular supervision meetings with her. The home now uses full fat milk as part of the service users’ daily diet. The ground floor shower room has now been fitted with a radiator to ensure the temperature of the room is comfortable for service users when showering. A ramp has been constructed from the patio doors in the dining room leading down to the garden to ensure service user’s safety. 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. Haye Corner Residential Care Home DS0000068989.V374729.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 Haye Corner Residential Care Home DS0000068989.V374729.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. JUDGEMENT – we looked at outcomes for the following standard(s): St 3 Quality in this outcome area is good. St 6 does not apply to this service. This judgement has been made using available evidence including a visit to this service. Service user’s needs are fully assessed before moving into the home to ensure the home can meet their needs. EVIDENCE: The manager undertakes a pre-admission assessment prior to the service user going to the home to live. Service users and relatives are encouraged to visit the home, take in the information that is provided for them in the service user guide and statement of purpose before they make a decision about living at the home. Haye Corner Residential Care Home DS0000068989.V374729.R01.S.doc Version 5.2 Page 10 A sample of pre-admission assessments was viewed for the two most recently admitted residents in the last six months. One of these service users visited the home with his wife and he was assessed on this visit. Some admissions are directly from hospital and the manager will visit the clinical area to gather information and undertake an assessment. The assessments seen by us were comprehensive and took into consideration all aspects of the person’s physical, psychological and emotional needs. The manager told us that information is sometimes received from the care manager prior to admission and this was evidenced in one of the files viewed. Reviews of the service user’s needs, by the care managers following admission, were also evidenced in the files. Haye Corner Residential Care Home DS0000068989.V374729.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. JUDGEMENT – we looked at outcomes for the following standard(s): St 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has care plans in place to ensure the personal and healthcare needs of residents are identified and met. The practices and policies of the home ensure that the home manages medication safely and effectively. The home’s ethos and staff working practices ensure that residents’ privacy and dignity is promoted. EVIDENCE: The AQAA told us that service user’s health, personal and social care needs are set out in individual care plans which are reviewed at least monthly. The manager has completed the introduction of the new care planning system over the past year. A sample of three care plans were viewed for the service users case tracked. These demonstrated that the health, emotional, personal Haye Corner Residential Care Home DS0000068989.V374729.R01.S.doc Version 5.2 Page 12 and social care needs of the service users are assessed. Care plans and the actions documented are very specific of what the needs are over a 24 hour period and document in detail how the service user spend the day with choice and preferences of how the care should be provided taking into account people’s personal preferences. Personal risk assessments for nutrition, moving and handling, pressure sores, falls and behaviour are also documented in the care plans and how risks identified must be managed. These are reviewed monthly. A care plan for one service user could demonstrate that they had been assessed at risk of falls because of wandering at night. As part of the management of this, a pressure mat had been placed beside the bed and will alarm and alert the carer of any movement near the bed. The manager told us that she has a number of these mats in use as about 80 of the service users are unable to use the call bell alarm function effectively, if they wish to get out of bed at night and the mats are used on a risk assessed basis as a proactive measurement for people who are at risk of falls, especially at night. The daily notes are recorded in the daily dairies and these describe how the service user has spent the day. The daily diaries also record in separate notes if the service user has been seen by any of the primary healthcare team that day. It records their current medication, visits from chiropody, optician or a visit to the dentists. The manager told us that some relatives are involved with the assessment and care planning process as a number of the service users are unable to give accurate information because of their mental frailty. Surveys returned from service users were in the main completed by the relatives who indicated in these that they are happy with the care plans and the care their relatives receive. Social histories are documented in the care plans and religious needs are identified in the assessment records. Records are maintained of all visiting health care professionals and the outcome of the visits is recorded. Service users have access to a number of GPs who visit the home. A survey returned from a relative said that ‘when a health problem arises a doctor is asked to visit. If there is a hospital appointment the manager arranges the transport’. The district nurse visits when requested. She attended the home on the day of this visit and said that she is currently treating one service user and is consulted on anything that the home are not sure about. A survey returned from a visiting health professional said that ‘the service always contacts us for Haye Corner Residential Care Home DS0000068989.V374729.R01.S.doc Version 5.2 Page 13 advice and in their experience the home has a good partnership with the primary healthcare team’. The community psychiatric nurse (CPN) attended the home at the time of this visit to review a number of service users. She was spoken with and reported that she was impressed with the home and how they manage some of the various challenging behaviours that the client group could present with and that they can contact the CPN team should they need advice and who are willing to visit the home on request. The service users have access to an optician, chiropodist and a dental technician for denture repair and cleaning. If a dentist is required for a person’s own teeth, they have access to an NHS dentist at the local hospital. All visits and attendances to outside clinics are recorded in the care plans. The policies and procedures of the home guide the management of the medication. The home now has a blister pack system in place for the administration of medication, which the AQAA state is safer and more accurate. Staff have received training on the new system. The manager co-ordinates the ordering, receiving and checking of all medications in the home. With the new system she does not see the prescription before it is sent to the pharmacist for dispensing, it was discussed with her that the Royal Pharmaceutical Society guidelines state that it is good practice to see the prescription before dispensing to ensure unwanted medication is not delivered. We looked at the mediation administration records, which were documented appropriately and there was evidence that these are audited regularly by the manager. The home has a new storage trolley supplied by the pharmacist and this was well organised and clean. The home has a medication fridge in place and temperatures are checked appropriately. The stock cupboards were viewed and there was no evidence of over stocking and indicated good stock control was in place. The home was not storing any controlled drugs at the time of this visit. The night sedations were recorded in the controlled drugs book and are seen as safe practice to maintain records of this. The controlled drugs book was observed to be a loose leaf book although well recorded. We discussed with the manager that the Royal Pharmaceutical Society advices that controlled drugs records should be kept in a bound book with numbered pages and this should be considered if the home should ever need to store controlled drugs. Part of a drug administration round was observed by us and the care worker was demonstrating safe practice. Training manuals were provided to all staff by the provider of the medication system to work through and further training was given by a training provider. Staff spoken to and the training records Haye Corner Residential Care Home DS0000068989.V374729.R01.S.doc Version 5.2 Page 14 confirm that all staff have received training in the safe administration of medicines and are familiar with the procedures that guide good practice. Care plans document the service user’s preference of how they wish to spend their days and times for getting up and going to bed and food dislikes and likes. One service user told us she prefers to stay in her room and take her meals there and this is respected. Staff were observed to be familiar with the service user’s needs and daily routines. We observed a good rapport between the staff and service users and staff were respecting the service user’s privacy and dignity. A comment from a service user’s relatives said ‘Every one of the staff knock on the door before entering his room’. Screens were observed to be in place in rooms that were occupied by two people. Haye Corner Residential Care Home DS0000068989.V374729.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): St 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a range of social activities to meet service users’ recreational needs. Service users are able to exercise choice and make decisions about their lives. Visitors are made welcome to the home and they can see service users in private. A varied menu is available and a nutritious food is served to service users. EVIDENCE: The AQAA stated that the home strives to arrange the daily life of all service users in response to their individual cultural interests and individual abilities. The home has offered more activities in the past year and new games and books have been provided. A monthly programme of activities was seen to be advertised on the notice board in the main hallway. Two outside persons attend the home and practice physical exercises, floor games, quiz games, arts and crafts and group activities to stimulate the service user’s mental and physical being. Haye Corner Residential Care Home DS0000068989.V374729.R01.S.doc Version 5.2 Page 16 The local church does attend the home regularly to offer Holy Communion and religious beliefs and needs are documented in the care plans. The manager told us that the care staff organise quizzes and daily activities in the afternoons and an extra member of the care staff is on duty to undertake this. The manager told us that she plans to organise more outings this summer and a garden fete. She told us that transport is now available for her to book. The sea front is very close and service users are escorted or taken in wheelchairs down to the beach if the weather is fine. On the day of this visit service users were requesting to sit out in the garden as the weather was warm. It was observed that a number of service users chose to sit on the patio whilst another was happy walking up and down the pleasant gardens. The care plans record when service users attend any activity and the level of participation by them. The person who attends the home for activities also keeps records of the activities and who has attended and what they have participated in and gives a report to the manager following each visit. These records were seen by us and evidenced that the service users do enjoy the activities especially the music. A comment from a relative said ‘staff do encourage the residents to join in the activities arranged but it is up to them if they wish to’. Social histories are recorded in the care plans and are extensive as far as it is possible to obtain information about the person’s past life and recreational past times. If there are no relatives involved it can be difficult for the home to obtain detailed information. The visitor’s book records that the home has visitors most days. The home does get the same regular visitors most days that are close relatives of the service users. The manager told us that she likes to keep communications open regularly with the relatives to discuss any issues they may have. One visitor told us that he is happy with the care his mother is receiving, although he is unable to stay long each day he does come into the home every morning to deliver his mother’s newspaper. The manager said that the home could order this for her but she enjoys the routine of his coming into the home each morning quickly to say hello and deliver the paper. The hairdresser is a regular visitor and this is advertised on the notice board. None of the service users go into the community independently except for medical appointments, to which they are always escorted or family may choose to take them out. The manager told us she hopes to take the service users out on outings in the better weather. Haye Corner Residential Care Home DS0000068989.V374729.R01.S.doc Version 5.2 Page 17 The AQAA stated that the home encourage service users to exercise choice in all aspects of their lives. From observations of the visit and speaking to service users it was evident that service users are very happy with their home and that they are able to choose what they do each day. The manager and staff promote service user’s independence and to make choices in how they wish to live their lives and undertake their activities of daily living. An example of this was one of the service users, who was very independent with meeting her own hygiene needs, was observed by the manager to be wearing a stained blouse. However much the manager tried to suggest to the service user that the blouse she was wearing needed changing nothing would persuade her to change it and was quite adamant that the blouse was clean enough for her. This lady’s choice and wishes were respected by the manager. Service user’s preferences are recorded in care plans of when they like to get up or the time for going to bed and some service users wish to remain in their rooms for meals. There is a choice of where to sit for meal times and most choose to take their meals in the dining room. The home has appointed a new chef and is recruiting for a week-end chef. On the day of the visit the senior carer was being the cook for the day whilst the chef was day off and said she had been stand in cook when necessary for some years. The kitchen was visited and was very domestic in size. It was clean and well organised. The menus are displayed on the wall outside the lounge area and these demonstrated that the menu is on a four week rota. The menus described a wholesome nutritious diet being offered to service users with an alternative choice. The cook said everything is prepared fresh and she is willing to cook whatever a resident fancies. The store cupboard was low in stock but the manager said the weekly delivery was due the next day and that she ensures there is always sufficient stock in the home of the basic dietary needs. The home now uses whole fresh milk and there was evidence in the cupboards that wholesome well reputed brand food is purchased. The lunch time meal was observed and was well presented and wholesome. Most of the service users had chosen to go to the dining room to eat and were observed to be enjoying their meals. One service user had chosen to have an alternative meal which she told us she had enjoyed. It was observed that one lady had a plate guard which enabled her to eat independently. There were no special diets required at the time of this visit but some service users needed a pureed diet that was presented in separate portions to enable them to recognise what they were eating. Haye Corner Residential Care Home DS0000068989.V374729.R01.S.doc Version 5.2 Page 18 The home is currently working with Southampton University on nutritional assessment and improving the nutritious status of service users who are identified as in a high risk group. A nutritional risk assessment is undertaken on all service users and weights are routinely recorded monthly in the care plans. For those who are identified at risk a regimen has been planned to monitor their nutritional status. The surveys returned by relatives told us that they consider the food that is served is good. The dining room has been moved further away from the kitchen and as a consequence one service user told us that the meals are sometimes not very hot. This was discussed with the manager and she agreed and told us the proprietors are in the process of buying a hot trolley to transport the food from the kitchen to the dining room. The training files evidence that all staff have undertaken the food handling and hygiene training in 2007 and all staff training is being updated by the new training provider this year. Haye Corner Residential Care Home DS0000068989.V374729.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): St 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure, which people felt they could use if necessary. Service users are protected from abuse by the policies and procedures of the home and staff awareness and training EVIDENCE: The AQAA states that the home has a complaints log that is kept in the main entrance next to the visitor’s book for any issues to be recorded. No complaints have been recorded in the last twelve months and the CSCI did not receive any complaints. The home has a complaints policy and procedure which has been reviewed and this is included in the Service User’s Guide. We discussed with the manager about changing the name on the complaints procedure to reflect the change of the regulatory commission from the CSCI to the Care Quality Commission. (CQC). Haye Corner Residential Care Home DS0000068989.V374729.R01.S.doc Version 5.2 Page 20 The surveys returned indicate that the relatives are aware of the complaints procedure and would know who to go to if they had any concerns. The manager has implemented a quality assurance system and as part of that she distributes surveys to service users and relatives and, she reports, this gives her the opportunity to identify any remarks or issues that may arise in the surveys and allows her to address and resolve them before they become a complaint. The AQAA states that the home has the policies and procedures for the Safeguarding of Vulnerable Adults. This includes the Whistle Blowing policy, physical intervention and restraint, handling and dealing with aggression. Staff also have an awareness of the Mental Capacity Act and the Deprivation of Liberty Safeguards. Each member of staff has been issued with a booklet with information on the Mental Capacity Act and the Deprivation of Liberty Safeguards in force from 1st April 2009. Staff surveys returned to us indicated that they are aware of the safeguarding reporting procedures and to whom they would go if they suspected or witnessed any form of abuse. Training files evidenced that staff have received training on abuse and that this forms part of their induction programme initially and further training is provided by the training provider in a more formal training session. The manager told us that she has identified that staff need further training in challenging behaviours and more training on dementia care, which she will arrange for the coming year. The manager told us that only one service user had bed rails with bumpers in use and these were being used following a risk assessment and documented evidence that the relatives had been consulted and had agreed with their use. We observed service users wandering about the home freely and out into the secured garden without any restraint. Haye Corner Residential Care Home DS0000068989.V374729.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): St 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a pleasant homely environment that is well maintained and clean. EVIDENCE: The AQAA states that the home has a continuous maintenance programme for improving the environment and for service users to live in a pleasant homely environment free from offensive odours. The home is all on one level and therefore there are no steps or stairs to negotiate. We toured the home and visited a number of bedrooms. The home is clean and pleasantly decorated. The lounge has recently been relocated to Haye Corner Residential Care Home DS0000068989.V374729.R01.S.doc Version 5.2 Page 22 the middle area of the home where service users prefer to congregate and they are closer to the activity in the home that they can observe. This has created more space for the dining room at the end of the building, which is a very pleasant sunny room overlooking the gardens. However, the dining room is now further from the kitchen and a hot trolley is to be purchased to ensure food is delivered to the service users at the right temperature. The home has made improvements over the last year by installing heating in the shower room, the electrical system has been fully tested, a new cooker and hood installed, ramps have been built by the back doors to reduce the risk of trips and ongoing decoration of rooms as they are needed. The rooms visited had been personalised with the resident’s own belongings and most rooms looked out onto the well maintained gardens. It was observed that when visiting the shower room personal toiletries had been left in the bathroom, the manager told us that these would be removed to the service user’s room that they belonged to. The manager told us that the home has an improvement plan in place for the coming year for continuous redecoration and replacement of carpets. The home has policies for infection control, smoking, disability access, alcohol and substance misuse. The AQAA documents that all staff have received infection control training. Training files evidence that staff receive infection control training yearly. Hand washing facilities are appropriately placed in toilets and bathrooms and gloves and aprons are available for staff to use. Staff practices observed would suggest that staff are aware of the principles of infection control. Staff surveys returned indicates that they consider they are receiving appropriate training. The home employs a person for cleaning the premises. It was observed that the chemicals hazardous to health that are used in the home for cleaning are secured in a locked environment when not in use. The home has a service user who, because of the time he spends in bed, his relatives have purchased a profile bed for his use. The manager told us that should she assess a resident as at risk from tissue breakdown, the district nurse would supply an air mattress for the home to use. The home has an overhead hoist in the whet room and a mobile hoist which is currently being used for one service user. Haye Corner Residential Care Home DS0000068989.V374729.R01.S.doc Version 5.2 Page 23 Haye Corner Residential Care Home DS0000068989.V374729.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): St. 27, 28, 29 & 30 Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. Service users are cared for by staff who have received training and are competent to do their job and who are in sufficient numbers to meet the needs of the service users currently in residence. Service users are protected by the policies and practices of the recruitment of staff. EVIDENCE: The home employs 14 staff. 10 carers, 1 manager, 1 chef, 1 laundry lady and one domestic staff. There were sixteen service users in residence on the day of this visit. The rotas evidenced that there are three care staff on duty throughout the whole day. There is two waking staff throughout the night. The manager is in attendance five days a week from 07:00 until early evening, there is a cook seven days a week, who does split shifts and returns in the late afternoon to prepare supper, a domestic cleaner four hours per day, seven days a week and a laundry person six days a week. Haye Corner Residential Care Home DS0000068989.V374729.R01.S.doc Version 5.2 Page 25 The staff practices were observed and staff were not rushing about and were observed to be giving time to service users and interacting with them in a relaxed familiar way. Those service users who were either in bed or had a high dependency were observed to look clean and comfortable in their beds. From observation of the daily routines and speaking to staff it would suggest that there were sufficient numbers of staff on duty to meet the service user’s needs. The home employs a mixed gender and a mix of staff from other cultural backgrounds. The manager told us that the service users have not voiced any objections to being cared for by the opposite gender but if they did, this would be documented and respected. Surveys returned to CSCI from the relatives say: ‘The staff are very attentive and the manager keeps a close eye on the residents’. ‘The service is stretched a little particularly at meal times’. ‘Good overall service’. ‘Mother is cared for very well’. The AQQA states that 80 staff have achieved their National Vocational Qualification level 2 and some staff are continuing to undertaken level 3. The NVQ assessor called at the home at the time of this visit to view a member of staff’s portfolio for NVQ level 3. A further two staff are working towards NVQ level 4. The AQAA states that the home has a robust recruitment process to assure that clients are in safe hands and are protected at all times. The home has policies in place for equal opportunities. The home employs a mixed gender staff group from various cultural backgrounds. A sample of three recruitment files were viewed for the most recently employed staff. All the necessary documentation and Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks were in place. Two written references were evidenced but for one carer there was not a reference from the manager of their previous employment but a reference from a trained nurse. This was discussed with the manager who said she does at times have problems in obtaining references from previous employers however many times she request these. The personnel files also evidenced the training certificates for the staff members and supervision notes, at which time training needs are discussed. The manager has an appraisal and supervision programme planned for the coming year and this is displayed on the staff notice board. The manager is committed to staff training and identifies different training providers to suit the staff training needs and that appertain to the client group they care for. The manager showed us the training matrix she has developed Haye Corner Residential Care Home DS0000068989.V374729.R01.S.doc Version 5.2 Page 26 for each member of staff in front of the training file that gives an analysis of what training that person has received, what training is required, and easily identifies when mandatory training is due. The manager told us she has arranged for practical training sessions for moving and handling and first aid as well as the theory training. The AQAA states that the manager’s intent for the coming year is to raise the employee’s skills and competences to improve the company’s performance through investing in valuable training and development. Newly employed staff undertake an induction programme based on the skills for care induction programme. If the staff member has been enrolled for the NVQ level 2 they undertake a shorter three day induction initially. For the staff members case tracked their files evidenced that they had completed the full induction programme. Staff surveys returned indicate that staff were happy with their recruitment and they feel well supported by the manager who they see for supervision meetings regularly and are being given training that helps them meet the needs of the service users. Haye Corner Residential Care Home DS0000068989.V374729.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): St 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A person who is competent and experienced to run the home and meet its stated aims and objectives is managing the home. The home has an effective quality monitoring and quality assurance system in place. Service user’s financial interests are safeguarded. The health and safety of service users and staff are promoted EVIDENCE: The manager was registered with the CSCI and has recently completed her registered manager’s award. Her assessor attended the home to collect her Haye Corner Residential Care Home DS0000068989.V374729.R01.S.doc Version 5.2 Page 28 portfolio for verification. The manager has worked some years with people with dementia and has a great deal of knowledge and experience. It was observed throughout this visit that the manager and staff have a good working relationship that is built on respect for each other. The manager demonstrated her knowledge of each of her service users needs and communicates regularly with the relatives that are involved with the home. We spoke to the professionals who visited the home at the time of this visit and they all spoke highly of the manager and said they communicate well with her and the home is responsive to any changed prescribed care. A survey returned by the district nurse said that the home has good working partnership with the primary health team and acknowledges that the home strive to deliver quality care to the service users. A comment from a member of staff said ‘the manager is fine and thought very highly of’. The manager has implemented a quality assurance system. This includes sending surveys to the service users, relatives, visiting professionals. The questionnaires have been analysed from each group and there were no issues identified as a result of this. We viewed a sample of questionnaire responses which were very positive in their remarks. Staff questionnaires returned did identified some issues and there were records of how these were addressed. There were also a number of ‘thank you’ cards from relatives from people who had been in the home for respite care. The manager holds staff and resident meetings and records of these are maintained and were seen by us. The manager audits other records and systems such as: care plans, medication audit two monthly, medication administration records (MAR) daily, accident recording, employment records and a health and safety audit. The manager also monitors the maintenance records to ensure that ongoing maintenance takes place. The manager meets weekly with providers to discuss how the service is progressing and any issues that may have arisen. The providers leave a regulation 26 visit reports monthly that were seen by us. The AQAA states that the financial interests of the service users are safeguarded. There are records to evidence this. The home manages the personal allowance for some of the service users. A sample of monies and records were checked. It was observed that all monies in and out were recorded with a running total maintained. Receipts were given each time a transaction was made. The monies held were checked against the Haye Corner Residential Care Home DS0000068989.V374729.R01.S.doc Version 5.2 Page 29 records for two residents and found to be correct. All monies are stored separately for each resident and kept in a secure environment. A risk assessment for the environment has been undertaken and this was viewed by us. The general maintenance and repairs for the home are undertaken by the proprietor’s son but large jobs are undertaken by a contractor. A sample of servicing certificates were viewed for equipment and systems and evidenced that these were current. The fire log was viewed and evidenced that fire alarms, emergency lighting, and fire fighting equipment are checked at appropriate intervals. Training records evidenced that mandatory health and safety training has been undertaken by all staff. The manager told us that all new members of staff have to undertake the moving and handling training before they are permitted to practice. Haye Corner Residential Care Home DS0000068989.V374729.R01.S.doc Version 5.2 Page 30 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 X X 3 X x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Haye Corner Residential Care Home DS0000068989.V374729.R01.S.doc Version 5.2 Page 31 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. Standard Regulation Requirement Timescale for action 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 OP15 Good Practice Recommendations It is strongly recommended that a heated trolley be purchased to ensure that service users’ meals are delivered to them at an appropriate temperature. Haye Corner Residential Care Home DS0000068989.V374729.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Haye Corner Residential Care Home DS0000068989.V374729.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. 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