Random inspection report

Transcription

1 Random inspection report Care homes for older people Name: Address: Yaxley House Residential Home Church Lane Yaxley Eye Suffolk IP23 8BU The quality rating for this care home is: two star good service The rating was made on: 03/06/2009 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: Date: Deborah Kerr

2 Information about the care home Name of care home: Address: Yaxley House Residential Home Church Lane Yaxley Eye Suffolk IP23 8BU Telephone number: Fax number: address: Provider web address: Name of registered provider(s): Type of registration: Providence Health Care Limited care home Number of places registered: 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 dementia 34 0 old age, not falling within any other category 0 34 Conditions of registration: The maximum number of service users who can be accommodated is 34 The registered person may provide the following categories of service only: Care Home only - Code PC 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 Dementia - Code DE Date of last inspection Brief description of the care home The current owner, Mr Govinden Vythelingum purchased the home in December A new manager, Mrs Wilson - Godber was appointed at the same time and was registered by the Commission for Social Care Inspection (CSCI). In August 2008 a major variation to the homes conditions of registration was approved by CSCI to Care Homes for Older People Page 2 of 13

3 Brief description of the care home provide service users whose primary care needs on admission to the home are old age not falling within any other category and dementia. The maximum number of service users who can be accommodated is 34. Providence Health Care have refurbished the home, dividing it into two units, the original part of the house Yaxley and a dementia unit called Peacehaven. The dementia unit provides accommodation for eighteen people, all rooms are on the ground floor, with en suite facilities. Peacehaven is built around a quadrangle garden facility where people can wander freely and safely. Yaxley has fourteen single bedrooms and one shared. Accommodation is on both the ground floor and the first floor. A shaft lift gives easy access to the upper floor for those unable to manage the stairs. The home is set in attractive gardens close to the church in the village of Yaxley. Ramps and handrails are provided at the front entrance. There is parking to the front of the house. Fees for this home range from 425 to per week. This was the information provided at the time of this key inspection. People considering using this service may wish to obtain more up to date information from the home. Care Homes for Older People Page 3 of 13

4 What we found: This random inspection took place on Monday 8th March 2010 to follow up on the requirements made at the previous random inspection, which took place on the 27th October 2009 and to assess the outcomes for people using the service. Both random inspections were carried out following a number of safeguard alerts raised about poor care, poor hygiene, poor care of laundry and peoples clothing, a lack of cleanliness of the home and a lack of fluids being provided do people in the service, raising concerns of hydration and continence management. We met with manager to discuss the aims of the inspection, which included undertaking a Short Observational Framework for Inspection (SOFI) observation in both units, Yaxley and Peacehaven. SOFI is a tool developed in conjunction with the University of Bradford, used to gain feedback from people, who due to their mental frailty may be unable to tell us information. Using the SOFI tool we advised the manager we would be looking at the attitude and quality of care provided by the staff, including how they interact, engage and communicate with people living in the home and how they promote and respect people's individuality and dignity. Three visitors and three residents, shared their views and experiences of the service with us. They told us, they felt there had been an improvement in the home recently, the home smelt better and there appeared to be more staff available, however they still felt that staffing levels are an issue, as they have observed residents' having to wait for assistance to access the lavatory. They told us, "the staff are lovely, they do really look after our relative, their room is always tidy, with no odours and the food is good". However, they commented, "there needs to be more activity, our relative loves singing and music, they also love the fetes and do's the home provides". One of the visitors told us, "my friend moved to Yaxley about eight months ago, I visit them regularly and have found that although the staff are very nice and mean well and meet my friends care needs, the support provided is very task based". They also commented, "there needs to be more engagement with residents', there does not appear to be enough staff specifically for engaging with residents and activities". The SOFI observation in Yaxley Lounge commenced at 10am. During this time the inspector was able to look, and record how residents spent their time, how it affected their mood and well being, and how well staff engaged/interacted with the residents. Four people were sitting in the lounge at the start of the observation and remained in the lounge all morning and had their lunch brought into them. We were told the residents' preferred to eat their meal in the lounge, one of the residents confirmed this. Two of the residents spent their time looking about out of the window, and speaking to staff when they appeared. The television was on the whole time, quite loud and people had to raise their voices to be heard and hear what staff were saying. A well known chat show was on the television, talking about sexual relationships. None of the residents in the lounge were watching the programme, however at 10.20am, a carer came in and turned the television over, commenting, "oh don't this get on your nerves", they did not ask if anyone was watching the programme or if there was anything in particular they would Care Homes for Older People Page 4 of 13

5 like to watch. At one of the individuals, quite unsteady on their feet, got up from their chair, stating they had cramp and started to walk towards the door, no staff were present and a visitor got up and gave them another residents walking frame to aid them, as they were concerned the individual would fall. The individual who the frame belonged to would not have been unable to reach their frame as this had been placed away from them, in the bay window. Mid morning people were brought a cup of coffee, they were not offered a choice of tea or coffee, biscuits were then handed around. Staff were observed picking biscuits out of the container and handing them to residents, however the biscuit container was offered to a visitor to choose a biscuit for themselves. Observation of staff showed there were moments of positive interaction, however these were not followed through to make the most of opportunities to engage with residents. A carer handed a resident a book about World War 2 and told the individual, "I will come back later to talk to you about it". They did not come back, during the observtaion. Another carer came in later and looked at the book and the pictures and engaged positively with the client for a few minutes talking about the book and its contents, and commented, "this must bring back memories", the resident responded well to this, sitting forward and interested, however the carer then walked away. This was a missed opportunity to engage meaningfully with this individual. Two other residents were provided with paper, pens, pencils and a colouring book. Neither of these residents engaged with the activity, unless a member of staff was in the room. One of the individuals fell asleep and was woken up on several occasions by staff to do some colouring. About an hour later, the individual did lean forward and look through the colouring book they had been given and appeared to be fully engaged in the book. A member of staff came over to sit with them asking them to say what certain objects were, there was a positive reaction from the individual and they clearly enjoyed the one to one attention and interaction they received. The other resident, having drawn a picture of a member of staff as requested, meticulously spent time folding up this piece of paper, there manner reflected that they were clearly bored, they got up twice leaving the room, returning the second time with a member of staff who told them, "this is your chair". The activity of drawing a picture did not respect the individual's experiences and age. Their care plan reflects they were always busy and was a keen DIY person, and that they like to feel useful, and likes fixing things. They were later seen laying the tables with cutlery and was clearly enjoying feeling useful. On two occasions staff walked through the room making no engagement at all with the people in the room. A visitor arrived mid morning to see one of the residents, who had been sitting quietly and dozing, when their visitor arrived they became a different person, animated, talking and shared doing a crossword with their friend. The SOFI in Peacehaven (Dementia unit) Lounge commenced 2.30pm. The number of people in the lounge varied throughout the afternoon, six people were present at the beginning, however there was up to eleven people in the lounge at different times. Three staff were allocated to this unit, one was present with the six people for the first Care Homes for Older People Page 5 of 13

6 half hour of the SOFI, there was very little engagement and interaction other than helping people to have a drink. Music was playing, however this was quite loud and people could not be heard, staff and residents needed to raise their voices to make them selves heard. At 3pm the two other staff arrived to help people with a cup of tea, again people were not offered a choice of tea or coffee and were again handed biscuits, rather than being able to make a choice themselves. For 10 minutes one resident, continually made reference to the tea trolley, "that's where the food is, on the trolley", however none of the staff paid any attention to this individual. We asked the individual, what they wanted and they told us "another biscuit". This and another cup of tea was provided when we told staff this is what the individual wanted. On occasions staff did show good interaction with people, one resident listening to the music became upset, one of the carers sat with them cuddling and holding their hand and talked with them, showing genuine affection, care and concern for the individual who quickly became less emotional and showed signs of happiness and well being. However, there there were lost opportunities, a member of staff sat between to residents, filling in a care plan, both residents were alert and would have benefited from some kind of interaction. Additionally, whilst two staff were assisting a client to their room, another member of staff came into the room to sit with the residents, there was minimal interaction, they sat completing paperwork. One of the members of staff on duty disappeared from the home for approximately an hour between 3.20 and 4.20pm for a personal engagement, leaving two staff to support up to eleven clients in the lounge. One very frail individual was observed sitting in an armchair, for the duration of the observation, they were either asleep or quietly listening to the music. None of the staff engaged with this individual, until 3.10pm, when a member of staff tried to help them with a cup of tea. They were unable to help the individual, due to their position, two staff repositioned the individual in the chair and tried again, but could not get them to drink. There was no further engagement with this individual until 4.10pm when two staff transferred the individual to their room, commenting, "XXX is tired today". Staff did not make any attempt to try again with the resident to see if they wanted their cup of tea, which had been placed in front of them at 3pm, this remained in front of them on the table. During the afternoon, people were observed listening to and enjoying the music, however there was very little interaction, a resident arrived accompanied by two relatives, who started to sing and clap along to the music, a number of the other residents' joined in, providing a different and more lively atmosphere in the room. Outcomes from the observation reflect that people living in the home are in the main awake, alert and in a positive state. There were some moments of positive interaction between residents and staff, however engagement with residents is mostly negative, treating residents in a patronising way, often talking down, in a childlike manner and handing out biscuits, rather than letting them choose, treating them differently to visitors, which does not promote peoples' self worth and dignity. A requirement was made following the previous random inspection for people living in the home to be consulted to establish their interests and arrangements for them to engage in meaningful activities. The activities co-ordinator has been working hard to improve the Care Homes for Older People Page 6 of 13

7 activities available, a weekly timetable has been established reflecting arranged activities, which have included manicures, cards and dominoes, indoor bowls, chair exercises, reminiscence sessions, looking at the papers and discussing current affairs. However more needs to be done to ensure residents not engaged in a scheduled activity are meaningfully occupied and stimulated. During the inspection residents were engaged in making Easter Bonnets for a Good Friday buffet, raffle and prize for the best hat. The registered provider confirmed that the activities co-ordinator has been booked on training to further their knowledge and creativity to support appropriate stimulation and activities for the people living in the home. We tracked three peoples' care plans, to clarify issues that arose from the SOFI observations. A review of all care plans has taken place, new documentation has been used, these are now clearer and show the assessed needs of each individual. Evidence was seen that these are being updated to reflect where peoples' needs have changed. Daily recording is being completed as standard practice, reflecting the daily care and support provided to each resident. However, staff need to make sure that they take note of information provided in the care plan and act accordingly. A visitor raised a couple of concerns about their friend, they were unable to find their reading glasses and their walking frame was found in their bedroom, when they should have this close by at all times to aid their mobility and reduce the risk of falls. This was confirmed in the individual's care plan. The visitor asked a carer where their friends glasses were, the carer said they did not know they wore glasses, however this is clearly stated in their care plan and a copy of the Suffolk County Council, Adult Placement review. Both confirm the individual needed glasses for reading. Improvements have been made to the record keeping in the home. Health charts are being completed and clearly reflect people are receiving proper health care. We visited an individual in Yaxley unit, whose care needs are being met on permanent bed rest, turn charts and fluid charts were being completed reflecting they were receiving adequate fluids care and attention throughout the day. The health charts were requested for two people on bed rest in the dementia unit. The manager advised these are kept in a folder by the seniors to stop these being removed by other residents from peoples rooms. The manager could not locate the folder and all staff were busy attending to residents needs, therefore these were not inspected on this occasion. We looked around the home to see if improvements had been to ensure the home is kept clean, hygienic, and free from offensive odours. There has been improvement in this area, however there is still a noticeable difference between the decor in Yaxley and Peacehaven. Although windows had been opened to let in fresh air, there was still traces of odours particularly upstairs in Yaxley. Opening the windows made the upstairs very cold. A number of residents had chosen to stay in their rooms, one resident was wearing two dressing gowns, but also told us this was because they were going outside for a cigarette. The manager was asked about the windows being open, they said this was only for a short time in the morning, however it was gone midday when we looked around the home. The door between Yaxley and the corridor to Peacehaven is a fire door. On arrival we pointed out to the manager that this door was wedged open. The manager removed the wedge, however when we returned later in the morning the door had been wedged open Care Homes for Older People Page 7 of 13

8 again, this time with a chair. Additionally, the fire door to the corridor from the lounge is missing part of the intumescent strip around the door and a piece at the top of the door is coming away. This was discussed with the manager and registered provider, that action needs to be taken to ensure fire doors adequately contain the spread of fire. Some armchairs have been replaced in Yaxley lounge, however the varnish has worn away on the remaining arm chairs with wooden arms and occasional tables. Additionally, the head rests and arm caps on arm chairs are looking stained and dirty. The radiator in the lounge has now been covered with a purpose built radiator cover, to protect people falling against the radiator and sustaining scolds and / or burns. Time was spent with the manager and registered provider discussing staffing levels in the home. We were informed that they are in the process of recruiting three more staff, which will increase the staffing ratio from five to six staff on the early and afternoon shifts, and from three to four at night. The home currently has five vacancies following a period of suspension of accreditation by Social Services. Accreditation has now been reinstated, however the provider confirmed they do not intend to fill these spaces until they have increased the staffing ratio. We discussed with the registered provider that once the service is back to full occupancy they will need to review staffing levels regularly to ensure they have sufficient staff available to meet the health, personal and social care needs of people living in the home. The home has two part time housekeepers, employed to work twenty five hours each a week each. The duty roster reflected that both housekeepers were 'off' on the same two days, Thursday and Friday of this week. The manager advised this was a mistake and would ensure that the housekeeping hours would be covered for these two days. They also confirmed they had also recruited a person full time to oversee the laundry and provide back up support for the domestic staff, however they had resigned this position the previous week. The manager is in the process of trying to recruit a new person to the post, in the mean time a carer has agreed to take on an extra two hours a day to look after the laundry. The manager provided us with an update on the training provided to staff. This showed there has been an improvement in the level of training. Thirteen staff have completed the Common Induction Standards, with plans in place for the remaining eleven to complete this training. The manager is in the process of completing a Social Services training course, Changing Cultures in Dementia Care. Four senior staff are also to commence this training. The training involves each candidate completing a project, which will make a positive change to the service. The registered provider confirmed they have arranged with an independent training company to visit the home, to provide dementia training to all of the staff and is awaiting confirmation of a date. Medication training has been arranged for the 10th March 2010 and Control Of Substances hazardous to Health (COSHH) training scheduled for the 11th March. Twenty staff have completed moving and handling training. Four seniors have enrolled a long distance medication course. The training matrix reflects that refreshers for health and safety, fire safety, food hygiene and safeguarding vulnerable adults are now due. The manager confirmed they know these need to done and is also arranging for all staff to complete first aid training. A behavioural chart is being completed for one individual where their behaviour can Care Homes for Older People Page 8 of 13

9 change to become verbally and physically aggressive. Ten incidents had been recorded where the individual had been aggressive towards staff and two incidents recorded regarding another service users. One of these was referred as a safeguarding incident and a subsequent referral made to the Community Psychiatric Nurse (CPN) and General practitioner (GP) to review their medication. The home has policies and procedures relating to management of violence and potential violence, restraint and aggression towards staff policy. The manager and registered provider agreed these need to be reviewed and updated as they made reference to restraint, which is not practiced within the home. Additionally, the manager agreed that staff have not received recent training on dealing with physical violence and verbal aggression and needs to arrange this. Improved processes are in place for the supervision of staff. A standardised agreement and structure has been implemented confirming the agreed frequency (bi monthly) sessions and an agenda. Evidence was seen that all staff have received a supervision session within the last two to three months. A review of the pre admission assessments at the previous random inspection identified that the information obtained did not go far enough to provide an accurate assessment of individuals' needs, which led to safeguarding alerts being made for lack of care and attention to their health, welfare and safety. As Yaxley House had their accreditation with Suffolk County Council SCC suspended in October 2009, the home has not been able to admit any new residents into the home. The manager provided a revised pre admission assessment, which has been developed to obtain all vital information to assess if the home is able to meet an individual's needs. These also include input from other professionals, family members and identify any special requirements. At the last inspection the registered provider and manager where required to ensure people living in the home receive a service, which meets their needs, and expectations and which meets the aims and objectives as set out in the statement of purpose. We attended a safeguarding strategy meeting in February 2010 to review how the service had met their action plan as agreed at the first strategy meeting in October We have also been kept informed of the homes progress by the Local Authority Outcomes and Quality Monitoring team of their visits to the service. Our findings at this inspection are that the home has made the required improvements. Seven requirements were made following the random inspection 27/10/2009. The registered provider and manager were able to provide information to reflect they have taken steps to address all of these requirements. However, these improvements need to be sustained and they need to demonstrate that they continue to make improvements to the service with out reliance on the input from the Outcomes and Quality Monitoring team. What the care home does well: Time was spent talking with three people using the service, they told us, "I am happy here, the staff are nice and do look after me, I get nice food and plenty of it". They told us "I spend their time watching television and staff spend time with me sometimes to talk about different topics". They showed us a page of pictures, incorporating fruit and a pram, which had used to promote conversation about different fruits, their childhood and their own children. Another individual spoken with confirmed they have settled well in the home, and that felt they were well cared for. They showed us they had had a manicure that morning and had their nails painted. They also commented, "I get good food and Care Homes for Older People Page 9 of 13

10 plenty of it". They were about to have their lunch and had chosen to eat in their room as they were expecting visitors, they had been provided with adapted cutlery to enable them to eat their meal, whilst maintaining their independence, self esteem and dignity. Staff were observed using the hoist well, and the correct sling and hoops as identified in the individuals care plan. They were supportive and explained to the resident each step of the transfer and covered them with a blanket to maintain their dignity during the transfer from arm chair to their wheel chair. What they could do better: One of the visitors told us, "I visit my friend regularly and have found that although the staff are very nice and mean well, there needs to be more engagement with residents, there does not appear to be enough staff specifically for engaging with residents and activities". Relatives also raised the issue about the laundry, everything is well marked, but they still find other peoples' clothes in the wrong rooms. A box of laundry observed in an individual's room was screwed up and did not appear to have been ironed very well. The SOFI observation identified that there is an ongoing staff inability to sustain improvements and to take on responsibility to ensure there is a consistent quality of care and attitude, which is vital to the continued improvement of the home. The culture and attitude of staff needs to improve, it is important for care staff to be involved in promoting the social care and daily activities for residents and be respectful of peoples' dignity. Although it is acknowledged the service has improved and that the manager and registered provider have completed the tasks required to retain accreditation and to meet the requirements made by us, at the last inspection. They now need to sustain these and continue to build on the improvements made. Further work needs to be undertaken to ensure odour throughout the home is controlled with out the need to keep windows open in cold weather. Additional training is required to ensure staff are up to date with current ways of working and to ensure they have the skills and understanding to treat people as valued individuals, recognising their age and life experiences, to enable them to live a meaningful and fulfilling life within the home and in the wider community. The registered provider agreed they need to undertake periodic reviews of staffing levels in the home to ensure there are sufficient staff available at all times to meet peoples' health, personal and social care needs. 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 10 of 13

11 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 11 of 13

12 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 12 of 13

13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act Copies of the National Minimum Standards Care Homes for Older People can be found at or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: Online ordering from the Stationery Office is also available: Helpline: Telephone: Web: 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 Care Homes for Older People Page 13 of 13