Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. The Hayes Culverhayes, Long Street, Sherborne, DT9 3ED Tel: 01935814043 Date of Inspection: 12 February 2014 Date of Publication: February 2014 We inspected the following standards as part of a routine inspection. This is what we found: Respecting and involving people who use services Care and welfare of people who use services Management of medicines Requirements relating to workers Assessing and monitoring the quality of service provision Inspection Report The Hayes February 2014 www.cqc.org.uk 1
Details about this location Registered Provider Registered Manager Overview of the service Type of service Regulated activity Dorset County Council Mrs. Ann Aylott The Hayes is registered to provide accommodation and personal care for up to 50 people. It is located in Sherborne in Dorset. Care home service without nursing Accommodation for persons who require nursing or personal care Inspection Report The Hayes February 2014 www.cqc.org.uk 2
Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 5 Our judgements for each standard inspected: Respecting and involving people who use services 6 Care and welfare of people who use services 8 Management of medicines 10 Requirements relating to workers 12 Assessing and monitoring the quality of service provision 13 About CQC Inspections 15 How we define our judgements 16 Glossary of terms we use in this report 18 Contact us 20 Inspection Report The Hayes February 2014 www.cqc.org.uk 3
Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 12 February 2014, observed how people were being cared for and talked with people who use the service. We talked with carers and / or family members and talked with staff. What people told us and what we found On the day of our visit there were 49 people living at The Hayes. Living accommodation was divided into five 'cottages', each with 10 single bedrooms, and lounge, dining and kitchen areas. There was also a large communal lounge that could accommodate greater numbers of people for social events. All of the people we spoke with told us how much they liked living at The Hayes. One person said, "It's absolutely marvellous. It's like living in a four star hotel." Another said, "I'm so glad I'm spending my last years here." Relatives that we talked with also spoke highly of the care shown to people. One said, "I can't praise them enough." We saw that people were treated in a kind and respectful way. They could choose how they spent their time. Their needs and preferences were clearly recorded in their care plans. Staff involved community health and social care staff to make sure that people's needs were met. We saw that new staff were recruited with all the checks needed to make sure they were suitable for the job. Staff told us that they enjoyed working at The Hayes. One said, "It's a lovely place to work." We looked at how The Hayes monitored quality and saw that there was a system of regular checks of all aspects of care. People who lived there, and relatives, were invited to make their views known in a variety of ways. You can see our judgements on the front page of this report. Inspection Report The Hayes February 2014 www.cqc.org.uk 4
More information about the provider Please see our website www.cqc.org.uk for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report The Hayes February 2014 www.cqc.org.uk 5
Our judgements for each standard inspected Respecting and involving people who use services People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run Our judgement The provider was meeting this standard. People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. Reasons for our judgement We looked at how people who lived at The Hayes were involved in their care, and supported to make decisions and choices. We also looked at whether privacy and dignity were respected. We did this by speaking with four people living there, as well as relatives and staff. We observed staff talking with people during the day, and saw lunch being served. We also looked at care plans. We saw that staff spoke with people in a kindly and respectful way. At lunchtime they gently encouraged people to eat, in ways that let them be as independent as possible. Some people had adapted cutlery to help them eat unaided. There was a choice of three main meals and people were able to help themselves to vegetables at the table. The people we talked with spoke positively about the choice and quality of food. One person described the food as "very, very good." Another said, "The food is first class. If you want something special, they'll get it." Staff told us that people living in the home were invited to help with menu planning during residents' meetings. We asked people about the choices they had in their daily lives. People told us they had as much choice as they wanted. Some people said they liked spending time quietly in their rooms, reading or doing craft activities. Other people told us about singing, exercise and days out. One person said, "I do whatever I like. The one thing I really like is that they respect your privacy." As we looked around the building we saw that each cottage had a 'wish' board that people could use if there was something they particularly wanted to do. One person told us about their wish. They said that they wanted to go to the sea "for a paddle." The staff arranged it for them, and they had enjoyed it very much. We asked people if they felt that their privacy and dignity were respected. They all said that they were very happy with how staff supported them. They described staff knocking on their door before entering, and speaking kindly to them. They said that new staff asked Inspection Report The Hayes February 2014 www.cqc.org.uk 6
them what they wanted to be called when they introduced themselves for the first time. We looked at five care plans to see whether people's choice and preferences were documented. We saw that they were described in detail for all aspects of their daily lives. Where possible, people had signed to say they agreed with the plan. There were risk assessments in place for people who might be in danger of harm. Each risk assessment included detailed notes of how to keep the person safe while helping them stay independent, and respecting their preferences. We also saw evidence that people and relatives were encouraged to influence how the service was run. This was done through regular quality surveys and resident/family meetings. People living at The Hayes, and relatives, told us about the meetings. We saw that the notes of the most recent residents' meeting were displayed on a noticeboard near the entrance. Inspection Report The Hayes February 2014 www.cqc.org.uk 7
Care and welfare of people who use services People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Reasons for our judgement We looked at how care was planned and delivered to meet people's individual needs and keep them safe. We looked at five care plans. We also spoke with people who lived at The Hayes, and relatives and staff. The care plans showed that each person's needs were assessed when they came to live at The Hayes. Care plans recorded all aspects of their care needs and preferences. They included the person's personal history, dietary, communication and mobility needs, and health profiles. They were reviewed on a regular basis, and whenever their medical or social situation changed. All of the plans we looked at contained a monthly review sheet. They were signed by the member of staff responsible for reviewing care, and in some instances by the person as well. There were also daily records that noted each person's well-being closely so that any periods of ill health could be detected quickly. Some of the plans we looked at contained assessments made by community healthcare professionals. For example, several people had been assessed for mobility aids by a community occupational therapist. This showed that people were being supported to stay independent and mobile. We spoke with a community healthcare professional who told us that they visited the home weekly to review people's needs. They said that staff always kept them informed about people's changing needs. The manager agreed that this was an arrangement that worked well. Most of the care plans we looked at contained information about people's end of life needs as well. The Hayes has Gold Standards Framework (GSF) accreditation. This is a nationally recognised award that shows that people nearing the end of life are being cared for to a very high standard. Some contained an 'advance care plan', which documented the person's wishes and preferences for end of life care. These were signed by the person and reviewed regularly. Where a person had not made a decision, or did not wish to discuss it, this was documented as well. We saw that each person had been assessed to reduce risks to their wellbeing, taking account of their capacity to make decisions. The manager told us that if a person's capacity to consent or make decisions was in doubt, they were assessed in ways that met Inspection Report The Hayes February 2014 www.cqc.org.uk 8
the requirements of the Mental Capacity Act. We saw some completed assessments, carried out by the person's GP, the manager and a senior carer. These assessments were signed by the person and reviewed six-monthly. We spoke with four people who lived at The Hayes, and four relatives. Some were not very familiar with their care plan. One person said, "I'm aware of it." Another person said they were "a bit vague about it," and that their relative knew all about it. Everyone we spoke with told us they were very satisfied the quality of care they were receiving. They felt that the staff knew their needs and met them well. One person said they were "very, very happy" living there. A relative who had experience of other care homes told us, "I'd recommend The Hayes to anybody." We also asked two members of staff about how they made sure they were caring for people in the best possible way. They told us they always asked the person first, if possible, and read the care plans to make themselves aware of any changes. Inspection Report The Hayes February 2014 www.cqc.org.uk 9
Management of medicines People should be given the medicines they need when they need them, and in a safe way Our judgement The provider was meeting this standard. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. Reasons for our judgement We looked at how medicines were managed within the home. We observed medicines being dispensed at lunchtime, inspected where they were kept, and looked at people's medication records. We also talked to the manager and two senior members of staff, and checked staff medication training records. We saw that medicines were kept securely in a locked cupboard and in trolleys within a locked room. Medicines that needed to be kept cool were stored in a fridge. There was a signed and dated daily record of the fridge temperature. Inside the medicines cupboard and trolleys, medicines were stored in a 'monitored dosing system' within blister packs. This system reduces the chance of someone being given the wrong dose of medicine. We also looked at how controlled drugs were used. These are drugs that are subject to strict controls, by law. They were kept in a locked cupboard within the main medicines cupboard. We looked at the controlled drugs log book and saw that two staff signed each time a person was given one of these medicines. The amount and type of controlled drugs and a record of those returned to the pharmacy was also recorded. These procedures met the requirements of how controlled drug must be stored and used. We looked at five people's medication profiles, kept within their care plans. These listed the medicines each person was taking. We compared the profiles with those recorded on the person's medicines administration record (MAR), to check that they matched. The medication profiles were marked to inform all staff that each person's MAR chart contained the accurate and most recently prescribed medicine. All of the MAR charts we saw were up-to-date and signed. At lunchtime medicines were dispensed from the secure trolleys. We observed a member of staff mark and sign the MAR chart to indicate that the dose had been given. MAR charts also recorded any allergies, to reduce the risk of mistakes being made. We looked at the medication staff training plan. This identified which grades of staff needed training, and at what level. For example, care assistants must be aware of the principles of good practice within the medicines policy. More senior care staff must have Inspection Report The Hayes February 2014 www.cqc.org.uk 10
full knowledge of the policy and all aspects of giving medicines safely. We checked what training staff had received and saw that it was appropriate to their grade. Training was upto-date. We also spoke with two members of senior staff about medicines. They told us what they did to make sure that people received their medicines safely. One of the senior care staff told us that medicines were reviewed regularly. There were annual pharmacy reviews as well as individual reviews whenever a person's medical needs changed. Annual reviews were attended by a community pharmacist, a senior member of the care staff and the staff member responsible for each cottage. There were also external pharmacy audits. We saw the results of an audit carried out in 2013. It included recommendations to check that medicines should by clearly marked with the date they must be discarded. The medicines we looked at all contained these dates. There was a medicines policy in place. The manager told us that it was in the process of being updated. Inspection Report The Hayes February 2014 www.cqc.org.uk 11
Requirements relating to workers People should be cared for by staff who are properly qualified and able to do their job Our judgement The provider was meeting this standard. People were cared for, or supported by, suitably qualified, skilled and experienced staff. Reasons for our judgement We looked at how the provider made sure that staff were recruited and trained to do their job effectively and safely. We spoke with people who lived in the home, and some relatives, as well as staff and the manager. We looked at the recruitment and supervision records of three members of staff, and at the induction programme. We asked the manager about how staff were recruited. They told us that Dorset County Council made all the necessary checks to ensure that staff were suitably qualified to work at The Hayes. These included professional references, health checks, police checks, and evidence of entitlement to work in the United Kingdom. These checks were made on agency staff as well as permanent staff. We looked at the files of three staff and saw that all this information had been received before they started work. The files also contained evidence of completed induction training, and supervision notes. These notes recorded regular supervision meetings between the new member of staff and a senior staff member. They provided a record of the person's progress through the induction programme, and any particular support needs. We spoke with two members of staff about working at The Hayes. They both told us that they had undertaken induction training before they were able to work unsupervised. This included training in manual handling, safeguarding adults and infection prevention and control. We asked staff about their knowledge of some of the induction training. Their responses provided further evidence that they knew how to care for people with dignity and respect, and how to keep them safe. One member of staff told us how they were being supported to gain further qualifications. Another said, "It's a lovely place to work." We asked four people living at The Hayes, and four relatives, if they thought the staff were fit and appropriately qualified to do their jobs. They all praised the staff for being caring and for knowing what needed to be done. One person told us, "It's absolutely marvellous: the caring is so good." Another said that the staff were "all so calm and professional." A relative said, "They are brilliant. I can't praise them enough." Inspection Report The Hayes February 2014 www.cqc.org.uk 12
Assessing and monitoring the quality of service provision The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was meeting this standard. The provider had an effective system to regularly assess and monitor the quality of service that people receive. Reasons for our judgement We looked at how the service monitored quality and safety. We spoke with the manager and looked at audit records and feedback from people who lived at The Hayes. We also looked at Dorset County Council's own quality audits. We asked people who lived at The Hayes, and relatives, if they were asked for their views on the quality of the service. The manager explained that Dorset County Council led a programme of regular audit, both monthly and quarterly. We looked at the quality assurance file, which contained reports and action plans for all recent audits. The council undertook regular performance checks on topics including safeguarding, privacy and dignity, and catering. We looked at some recent performance reports. Findings were based on information gathered in a number of different ways. These included talking with staff and people living at The Hayes, observing practice, and looking at care plans. The reports included recommendations for action and improvement. We looked at some other examples of recent quality monitoring. One was a catering report from 2013. It included checks of kitchen cleanliness, menus, flexibility and choice, and people's involvement in menu planning and food preparation. We saw that the report noted that there should be a sign to show the correct sink for washing dishes in the main kitchen. This was to maintain good levels of hygiene. We looked in the kitchen and saw that a sign was in place. We saw how staff monitored falls within the home, and what they did to prevent them. All falls were documented fully, and reviewed monthly and annually to look for trends. Repeated falling incidents were reviewed with suggestions of how to prevent them happening again. For example, one person was referred to hospital for a brace, and another needed a pressure mat by their bed so that staff knew when they were at risk of falling during the night. Dorset County Council undertook annual satisfaction surveys for people living at The Hayes. Relatives, staff and visiting professionals were also invited to complete the surveys. A recent report noted that social activities were to be extended in a response to Inspection Report The Hayes February 2014 www.cqc.org.uk 13
people's requests. There were other comments about menus and laundry facilities. The report showed that actions were taken to address these issues as well. The satisfaction survey showed high levels of satisfaction with topics including involvement in care, privacy and dignity. We spoke with four people who lived at The Hayes and four relatives. They all said that they felt they were involved in how the service was run. Some of them attended the regular residents' meetings, and had completed satisfaction questionnaires. None had ever needed to make a complaint, but knew how to do so. Relatives also said that they felt able to speak with the manager and senior staff if they had comments or suggestions. We saw that information on how to make suggestions or make a complaint was prominently displayed near the entrance. Copies of residents' meeting notes and satisfaction survey reports were available for anyone to read. Inspection Report The Hayes February 2014 www.cqc.org.uk 14
About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report The Hayes February 2014 www.cqc.org.uk 15
How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report The Hayes February 2014 www.cqc.org.uk 16
How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report The Hayes February 2014 www.cqc.org.uk 17
Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report The Hayes February 2014 www.cqc.org.uk 18
Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report The Hayes February 2014 www.cqc.org.uk 19
Contact us Phone: 03000 616161 Email: enquiries@cqc.org.uk Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: www.cqc.org.uk Copyright Copyright (2011) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Inspection Report The Hayes February 2014 www.cqc.org.uk 20