Care Home: Hyne Town House

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What the care home does well People living at Hyne Town House have access to a range of health care services both at the home and in the community. People have access to NHS services and routine screening programmes. People are able to maintain links with their family, local community and friends. Visitors are welcome at the home at any time. Relevant checks are carried out before prospective staff start work at the home to show that they are suitable to work with vulnerable people. Staff have a comprehensive mandatory training programme to ensure they have relevant qualifications, knowledge and skills to carry out their job and they keep up to date with current practice. The premises indoors and outdoors are well maintained, with a programme of routine and ad hoc maintenance and repairs. The registered providers and manager ensure that the management of Hyne Town House creates an open, positive and inclusive atmosphere, and the home is run in the bestinterests of the people who reside there. Communication between the Care Quality Commission and the registered providers and manager continues to be good. Measures were put in place to address issues that were identified during our inspection as soon as possible following our visit. What the care home could do better: To ensure that people`s wellbeing is supported, the care staff need to develop how they communicate and interact with people so it is effective and follows the care plan. This will ensure that care is given in a consistent way and this will enable the people using this service to feel secure. To ensure that people are cared for in a flexible way changes to work practices and cultures should make certain that work practices fit around the people receiving care, rather than the other way around. People less able to express their views should be consulted about choices in such a way that they are able to make a choice. Although care plans are being improved, systems must be in place to ensure that all the staff understand and follow information and instructions about the home`s ethos of person-centred culture and attitude. Random inspection report Care homes for older people Name: Address: Hyne Town House Hyne Town House Strete Dartmouth Devon TQ6 0RU two star good service 22/01/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Megan Walker Date: 2 8 0 6 2 0 1 0 Information about the care home Name of care home: Address: Hyne Town House Hyne Town House Strete Dartmouth Devon TQ6 0RU 01803770011 01803770307 info@hynetownhouse.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Jean Gloria White Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Yvonne Margaret Mould,Mr Stephen Anthony Mould care home 33 Number of places (if applicable): Under 65 Over 65 33 33 33 dementia old age, not falling within any other category physical disability Conditions of registration: Date of last inspection Brief description of the care home 0 0 0 0 4 0 1 2 0 1 0 Hyne Town House is a privately owned care home registered to provide care for up to thirty-three people within the categories of Dementia - over 65 years of age (33), Old age, not falling within any other category (33), Physical disability over 65 years of age (33). It does not provide intermediate care and it is not registered to provide nursing Care Homes for Older People Page 2 of 10 Brief description of the care home care. Hyne Town house is a Georgian period-detached building with a purpose-built wing. It is situated in the small coastal village of Strete, approximately 15 minutes drive from the town of Dartmouth. It is on a bus route (Kingsbridge/Dartmouth), and local amenities including a post office/small shop are situated nearby in the village. Car parking is available within the grounds of the home or opposite in the village car park. The home provides accommodation for people over three floors, with a passenger lift to access the upper floors. Following an extensive refurbishment programme the home has been upgraded to a high standard. This includes a quiet lounge, assisted bathing facilities, a commercial kitchen, and a large garden room with patio doors allowing access to the garden and terraced areas. There are 27 single rooms and 3 double rooms, with the majority being en-suite and many with far reaching views of the surrounding countryside and out to sea. Care Homes for Older People Page 3 of 10 What we found: This was a random inspection undertaken by two Compliance Inspectors to check compliance with regulation. The last key inspection of Hyne Town House was on 22/01/2009 when it was rated GOOD. The fieldwork part of this inspection was unannounced and took place on Monday 28th June 2010 between 09:30 and 15:20. On our arrival we were met by one of the registered providers and the registered manager who, with the staff team on duty at that time, assisted us with all aspects of this inspection. Since the last key inspection there have been two random inspections, one of which was solely to look at medication; a fire safety inspection, and a visit by an Environmental Health Officer. We found that all the requirements and recommendations resulting from each of these visits have been met. We found that since the last inspection there has been significant improvement and changes to the way in which the care plans are being written. They have a picture profile of the person and are more person-centred. The information is descriptive. It tells the care staff how to enable and encourage people living in the home to make decisions with respect to their care and so far as it is possible, to ascertain and take into account their wishes and their feelings. A sample care plan we looked at had personalised risk assessments. There were clear rationales and instructions for staff about why and what they should do to ensure the safest outcome for the individual. The manager reported that the staff had found this new style more user-friendly. This is a large piece of work and we recognise that it will take several months for all the care plans to be updated and written in this way. We have discussed with the registered provider and manager about setting realistic timescales to achieve this piece of work. This will ensure that each care plan is able to reflect in detail how the persons care needs are to be met and their support follows current best practice. During the visit we spent a period of two hours sitting in a lounge area observing what it was like for the people living there. Specifically we looked at how well people were engaging with their environment, and how the staff interactions supported people with memory loss to understand and feel at ease in their surroundings. We found that some staff were able to communicate very effectively with people. These staff accentuated peoples identity. They followed through the instructions in the persons care plan about how communication was effective for them. One example was a persons care plan showed they benefit from regular reinforcement about relatives visiting. One member of staff did this very effectively. Some other staff were less successful. We found that some staff talked about people rather than engaging them in the conversation. We observed one person being given a number of choices about which drink they would like. This led to the person being unable to make a decision, so the staff member made a choice for the person. In this instance giving a smaller amount of choice might have been more successful. Another person had requested two glasses of drink. These were given to the person and they enjoyed sips from both flavours. Care Homes for Older People Page 4 of 10 We found that the noise levels in the lounge area were significant at times. People were seen to be watching the television only for a short period when a wildlife programme was on, otherwise were not involved. One of the people we were observing seemed to be looking around for something to do. We found that the persons care plan indicated they enjoy reading magazines and talking to people. We spoke to the manager about providing objects for stimulation to support people. On the day of our visit it was warm and sunny. During our tour of the premises we were shown two areas that have been created so people can sit outside and enjoy the seaviews. One of these is a sensory garden. They are both paved areas to reduce the risk of underfoot becoming slippery in wet weather. We found the care staff were prompting people to drink to make sure they were hydrated. The manager showed us the menu that had been changed to suit the warm weather. Residents Meetings are held every month, and the most recent one included a discussion about likes and dislikes of food, preferences regarding meals, and any changes people would like to see. From this meeting there are plans to introduce a choice of hot and cold foods with finger foods and a cooked meal in the evening. People can choose where they eat. In good weather meals can be taken outside in the garden. Tables with parasols are available for people to use on a raised paved area overlooking the sea and the garden. Breakfast is served until about 10:30. A light lunch is served between 12:30 and 13:00, and a larger, buffet style meal is served between 17:00 and 18:00. This gives people the opportunity to eat when they wish. There are mid-morning drinks and afternoon tea. Hot and cold drinks, cakes, biscuits and sandwiches are available throughout the day and night. The manager told us that there are no restrictions on meal times and there is no limit or restrictions on food and drinks. The homes policy is little and often. We found that the people we observed were, in general, having their needs met. Overall much of the communication and interaction we saw was either task based or based around information giving. On the day of our visit twenty people were residing at Hyne Town House. During the morning there were five care staff, a cook, a housekeeper (responsible for cleaning and laundry) and an administrator. The registered provider told us that in total thirty people are employed to work at the home, most of whom work full time. He told us there is always five care staff across the day covering from 08:00 until 14:00, and 14:00 until 20:00. Two night staff work from 20:00 until 08:00, and one care assistant works an extra hour to provide additional staff support until 21:00. We found that on the day of our visit the care staff were working either 08:00 to 20:00 or 08:00 to 21:00. We expressed concern about a shift being up to thirteen hours long. The registered provider told us that the care staff have requested to work these hours. He and the manager are also concerned about staff becoming overtired. They have therefore agreed with the care staff to have a three month trial of these long shifts. Staff are able to take three fifteen minute breaks (morning, lunch and afternoon) during their shift. We did not see evidence on staff files of a form for staff to sign stating they agree to work in excess of the European Working Time Directive of 48 hours including overtime in any seven day period. We were advised by the registered provider that staff are contracted to work a maximum of three twelve hour shifts per week, thereby working a maximum of thirty-six hours. The registered provider confirmed there was no need for staff to Care Homes for Older People Page 5 of 10 complete European Working Time Directive documentation. We asked the manager to monitor that long shifts do not have adverse outcomes for the people using this service because the care staff are tired. We found that all the staff team has completed the local authority E-learning course on Safeguarding of Vulnerable Adults (S.O.V.A.). This means they know the fundamentals of how to recognise different types of abuse of vulnerable people. About half of the staff team has attended the local authority Alerters training course and the remainder were due to attend the same course shortly after our visit. This means they can recognise abusive practice and know how to report it. This training also includes whistle blowing. The registered provider and manager are awaiting confirmation of dates for the local authority Managers S. O.V.A. training course. We discussed other training relating to safeguarding vulnerable adults, including the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS), and what it means for staff working with people in registered care services. This is legislation that came into force on 1st April 2009 and applies to people living in services registered under the Care Standards Act 2000, regardless of who funds their place. The manager showed us the training records and examples of staff Skills For Care workbooks about the M.C.A. and D.O.L.S. . We found that all the staff are working through these course books and they are learning about their responsibilities and duty of care under the MCA or DOLS. Since the last inspection there has been one safeguarding referral. The registered owners and manager worked collaboratively with all the services, teams and agencies, including CQC, involved in this safeguarding matter. They contributed to actions including sharing information and attending safeguarding meetings. They have shown us that they are able to respond appropriately, receive and act upon feedback from the safeguarding process. They have shown us that they are committed to protecting the welfare of the people who use this service. What the care home does well: People living at Hyne Town House have access to a range of health care services both at the home and in the community. People have access to NHS services and routine screening programmes. People are able to maintain links with their family, local community and friends. Visitors are welcome at the home at any time. Relevant checks are carried out before prospective staff start work at the home to show that they are suitable to work with vulnerable people. Staff have a comprehensive mandatory training programme to ensure they have relevant qualifications, knowledge and skills to carry out their job and they keep up to date with current practice. The premises indoors and outdoors are well maintained, with a programme of routine and ad hoc maintenance and repairs. The registered providers and manager ensure that the management of Hyne Town House creates an open, positive and inclusive atmosphere, and the home is run in the best Care Homes for Older People Page 6 of 10 interests of the people who reside there. Communication between the Care Quality Commission and the registered providers and manager continues to be good. Measures were put in place to address issues that were identified during our inspection as soon as possible following our visit. 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 set out on page 2. Care Homes for Older People Page 7 of 10 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 10 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 10 of 10 - 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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