Hay House Nursing Home

We found the following examples of good practice:

The service had been facilitating outside visits and ensuring people had support to stay in touch with family and friends through technology and phone calls. They were now preparing to enable indoor visits by prior appointment using a large purpose made screen in the conservatory. They were planning cleaning schedules and a fogging machine between visits. Guidelines and procedures were being communicated to families to ensure positive, safe visiting.

People and staff have been regularly tested to ensure they have not contracted Covid-19. Strict measures were in place to ensure people and staff would be isolated immediately if they had any symptoms of the virus, or if they had tested positive. Contingency and admission plans were clear and included how to manage the two rooms shared by two people if necessary. People and staff had received their first Coronavirus vaccination.

People had coped well during the pandemic due to a dedicated staff group and a good range of activities to suit individual interests and engagement to keep people occupied. Birthdays had been celebrated and a new Smart TV was used for quizzes. An exercise instructor had run exercise classes for people from the decking. A volunteer had been recruited and included in the testing programme to enable additional support.

Most people were living with dementia and did not understand social distancing. Staff managed this well and ensured they and people regularly washed their hands. There was a clear admission policy including individual risk assessments to manage those living with dementia who were unable to fully isolate in their rooms on admission.

Safe procedures have been followed by staff to minimise the risk of transmitting Covid-19. They had good stocks of all personal protective equipment (PPE), including long sleeved gowns kept in a new PPE shed. There were supplies of PPE and clinical waste bags available around the home, which was monitored to ensure visible items were not a risk to people moving around the home with dementia. Staff were seen using appropriate PPE.

Staff had received training on donning and doffing and on the coronavirus pandemic from various sources including e-learning and from in-house training sessions. The registered manager knew who to contact for advice or in the case of a positive Covid result.

The home was clean and hygienic. Detailed cleaning schedules were in place for all areas of the home. All touch points were cleaned frequently including high touch points. Deep cleaning of all areas was carried out regularly. The home was well-ventilated and the premises were spacious to enable staff to support people to socially distance as much as possible. New key pads had been installed temporarily to manage zones. The large grounds would be used more as the weather improved.

The registered manager and providers acknowledged the staff team had been through a very difficult time and supporting staff to have regular time off and support and access to counselling if needed. Staff felt valued and appreciated and had received acknowledgment for their hard work.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

We carried out an unannounced inspection of Hay House Nursing Home on 19 February 2018. At the time of the inspection 32 people were living at Hay House Nursing Home.

There was a registered manager employed at the home who were clearly passionate about providing a high quality, individualised service. They had worked at the service for many years. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The provider, Chartbeech Ltd had recently been bought by new owners who owned another service in the South East.

At this inspection we found the service was meeting all regulatory requirements and we did not identify any concerns with the care provided to people living at the home. Most people were not able to comment directly on their experiences due to living with dementia. One relative said, "They’re amazing! Mum is seen as an individual and since she has been here we have seen her [personality] coming through again. They care deeply. She had the best care here.” Another relative told us, “They are brilliant. It’s such a nice home, relaxed. They know [person’s name]’s habits, people do their own thing.”

On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a friendly and respectful way. People were able to choose what they wanted to do and also enjoyed spending time with the staff who were visible and attentive. There was a lot of staff interaction and engagement with people. They looked comfortable and happy to spend time in the lounges, their rooms or the conservatory and diner.

People were encouraged and supported to maintain their independence. There was a sense of purpose as people engaged with staff, watched what was going on, played games and pottered around the home or watched television. The majority of people were living with dementia and were independently mobile or required some assistance from one care worker. Staff engaged with them in ways which reflected people's individual needs and understanding, ensuring people mobilised safely from a discreet distance or were engaged with sensory activities.

People were provided with good opportunities for activities, engagement and trips out. These were well thought out in an individual way. People could choose to take part if they wished and when some people preferred to stay in their rooms, staff checked them regularly spending one to one time with them.

People and relatives said the home was a safe place for them to live. One relative said, “It’s such a relief. I can have a break and not worry about coming in.” Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns. Staff were confident that any allegations made would be fully investigated to ensure people were protected. Any safeguarding concerns had been managed well with provider involvement and the service worked with the local authority safeguarding team.

Relatives said they would speak with staff if they had any concerns and issues would be addressed and people seemed happy to go over to staff and indicate if they needed any assistance. Staff were vigilant about protecting each person from possible negative interactions with other people living at the home, recognising frustrations and misunderstandings between people due to them living with dementia. They used chatting and distraction techniques as they knew people well, showing patience and understanding. Behaviours were monitored if necessary to keep people safe and appropriate referrals made to external health professionals.

People and relatives knew how to make a formal complaint if they needed to but felt that issues would usually be resolved informally. There had been few complaints. One relative had mentioned some windows needed cleaning and this was done immediately.

People were well cared for and relatives were involved in planning and reviewing their care as most people were not able to be involved due to living with dementia. Care plans showed that people were enabled to make smaller day to day choices such as what drink they would like or what clothes to choose. Where people had short term memory loss or anxiety staff were patient in repeating choices each time and explaining what was going on and listening to people's repeated stories.

There were regular reviews of people's health, and staff responded promptly to changes in need. For example, care records showed many examples of staff identifying changes in need and appropriate and timely referrals to health professionals. One person had been referred to the older persons mental health team and there was a GP round every week. People were assisted to attend appointments with appropriate health and social care professionals to ensure they received treatment and support for their specific needs.

Medicines were well managed and stored in line with national guidance.

Staff had good knowledge of people, including their needs and preferences. Care plans were individualised and comprehensive ensuring staff had up to date information in order to meet people's individual needs effectively. Handover and communication between staff shifts was good so there was consistent care. The service rarely used agency staff but were able to fill vacancies if they could not cover shifts within the staff team.

Staff were well trained and there were good opportunities for on-going training and obtaining additional qualifications. The staff team was very stable and many care staff had worked at the home for some years. A newer care worker told us, “I love it here. The manager is very nice too.”

People's privacy was respected. Staff ensured people kept in touch with family and friends, inviting friends and family to outings and events regularly. Four relatives told us they were always made welcome, updated on their loved ones care and were able to visit at any time.

The registered manager and showed great enthusiasm in wanting to provide the best level of care possible and valued their staff team. For example, they arranged their shift so they were available at early evening when people living with dementia could become more anxious. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people in individualised ways. We spoke to the registered manager about the accessible information standard. This ensures people’s communication needs are identified and met. Care plans provided good information and the registered manager already included the standard in their assessments, hospital passports and information sharing within the wider staff team.

People’s equality and diversity was respected and people were supported in the way they wanted to be. Care plans were person centred and held full details on how people’s needs were to be met, taking into account people preferences and wishes. For example, some people liked to live with strict routines to help them remain well and staff knew and respected those. Information included people’s previous history, including any cultural, religious and spiritual needs.

Meal times were a positive experience, with people being supported to eat a meal of their choice where they chose to eat it. Staff engaged in conversation with people and encouraged them throughout the meal, noting who liked to sit with whom. Nutritional assessments were in place and special dietary needs were catered for as well as specialist crockery and cutlery and finger foods to aid independence for people living with dementia.

There were effective quality assurance processes in place to monitor care and plan on-going improvements overseen by regular provider visits. There were systems in place to share information and seek people's views about the running of the home, including relatives and stakeholders. All responses were positive from the recent quality assurance questionnaire. People's views were acted upon where possible and practical, and included those living with dementia. Their views were valued and they were able to have meaningful input into the running of the home, such as activities they would like to do, which mattered to them.

A monthly newsletter and notice board kept people up to date and organised events such as BBQs and fetes encouraged families and children to attend. This showed that people and their families mattered to the staff, who also shared their lives, families and pets.

Further information is in the detailed findings below.

There were 33 people living at the home. We spoke with nine people living at Hay House. We also spent time with people in communal areas of the home so we could make a judgement about how well people were cared for as some people were not able to comment directly on their care. We spoke with seven visitors. We also spoke with three staff members and the manager. We looked at a selection of records; we focussed on how people's care, nutritional needs and medication were managed. We also looked at how staff were supported to carry out their role.

Staff offered people choice, and treated people with kindness and respect. Care and support was offered to people in a friendly, cheerful and professional manner. We saw people generally looked relaxed and at ease with staff. When people felt anxious, staff were quick to recognise the need to change their approach, such as sitting with them to reassure them. People's health and well-being was assessed, and care was provided in a way that suited people's individual needs. There was a range of meals and drinks to suit people's individual needs and tastes. Medication was well managed and administered in a person centred manner. Staff were provided with training to help them support people in an appropriate manner to help maintain their well-being.

One person said 'the team is really good, I feel well supported'. A relative said 'staff give time to all the residents' and another said 'staff are very good, well meaning, will do anything for you'. We found that people's needs were met and risks were well managed. On the day we visited we saw how much people enjoyed singing along during the musical entertainment. Staff engaged quietly and respectfully with people using helpful body language, for example crouching down to someone's level to speak to them and praising the achievements of others. When people were distressed or anxious, we saw staff immediately went to support them in calm and measured manner.

We found all six standards we inspected were fully compliant.