Inspection on 12/05/08 for Heatherbank

This is the latest available inspection report for this service, carried out on 12th May 2008.

CSCI found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Heatherbank 11/05/06

Heatherbank 28/11/05

Heatherbank 06/04/05

Heatherbank 09/12/04

Heatherbank 30/07/04

Similar services:

Spinney (The)

Queen Elizabeth House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Heatherbank 7-9 Cavendish Road Sutton Surrey SM2 5EY Lead Inspector Peter Stanley Unannounced Inspection 12th May 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heatherbank Address 7-9 Cavendish Road Sutton Surrey SM2 5EY Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8642 2930 020 8770 7278 hazel_hawkins@hotmail.com Mr Adrian Hawkins Mrs Hazel Hawkins Mrs Hazel Hawkins Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category 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: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 23 11th May 2007 Date of last inspection Brief Description of the Service: Heatherbank is a registered care home for 23 older people. It is situated near Sutton Town Centre and is owned by Mr and Mrs Hawkins. Accommodation for residents is available on the ground and first floors. There are 21 single and 2 double rooms. Two of the single rooms and one of the double rooms have en suite facilities. Some of the bedrooms are below ten square metres others are much larger. A stair lift is provided. Communal areas include a lounge and an adjoining dining room. There is also a kitchen and an adjoining room for the use of staff. There is a garden area to the rear, but this is not easily accessible for residents. Since 2007, the home has had a No Smoking policy. The home offers both long term and respite care. It does not have the facilities to offer intermediate care. Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was a key inspection of the home that was completed over one day. The home’s registered manager and provider, Mrs Hazel Hawkins, assisted with the inspection, with some assistance from the other registered provider, Mr Adrian Hawkins. The current number of residents totals 15. The home has had one new long-term admission over the last 12 months, and two short-term respite admissions. Staffing at the home presently consists of the person-in-charge and 2 staff at all times, including 2 waking staff for overnights. This will, however, need to be reviewed should the number of residents increase to previous higher levels. The inspector examined documentation including residents’ care plans, risk assessments, daily logs, medication records, staff, supervision and training records, policies and procedures, staff rotas and records relating to incidents, accidents and complaints. A recent admission to the home was case-tracked. The inspector carried out a full inspection of the premises and completed checks relating to health and safety. The inspector spoke to a large number of residents (including a recently admitted lady) during the course of this inspection, and with staff members on duty. In addition, questionnaires were received from 6 residents and 5 relatives. Views expressed by residents were generally favourable, with residents presenting as settled, and satisfied with the home and the care provided. Responses received from relatives also indicated broad satisfaction with the home and the support given to residents. The home does, however, need to develop its quality assurance processes so as to canvass the views of relatives and other stakeholders, as well as those of the home’s residents. The home has yet to prepare a proper Development Plan highlighting its’ survey findings and identifying those areas where improvements can be made. This must be prioritised for action during the forthcoming year 2008-09. Of 7 requirements issued at the previous inspection on 10.05.07, 3 requirements have been met, and 1 has been partly met. There are 3 requirements that remain to be met. Two of these relate to training. The inspector was concerned that statutory safeguarding adults’ training has not, as yet, been provided to all of the home’s staff. Following previous difficulties in having been able to obtain training dates from the local authority (LB Sutton), the registered manager was able to evidence that these have now Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 6 been obtained. From this inspection there are 3 new requirements, making 5 in total, and 3 recommendations. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 to 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are being provided with all the information they require to enable an informed choice as to where they would like to live.. The home is able to demonstrate that it is appropriately assessing the needs of prospective residents, and that the range of needs presented by residents is being appropriately met. Prospective residents, their relatives and friends, are able to visit to assess the suitability of the home. EVIDENCE: Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 9 The home has a comprehensive Statement of Purpose, and Service User Guide, a copy of which is issued to each service user. These documents have been reviewed and updated, in March 2008. While persons who have been admitted to the home are mostly funded by social services, the home has some privately funded residents. Prospective residents, their friends and relatives, are invited to visit the home and to meet residents and staff. The prospective resident and his/her relatives are fully involved in the process leading up to an admission, and are given the opportunity to fully assess the suitability of the home. The Registered Providers aim to ensure that any new admissions are compatible with existing residents. The home does not provide intermediate care. The Standex system of pre-assessment and care planning is used by the home. There has been one new admission for long-stay care within the last 12 months, and two short-term respite admissions. The home also provides respite care for short stays. The inspector examined files for these admissions and found that the necessary pre-admission information has been obtained and assessments completed. A three-way contract, involving the home, the referring agency, and the resident, is drawn up for new admissions involving social services. For private admissions, the home draws up its own statement of terms and conditions with the prospective resident. This is written in an appropriate and user-friendly format. The inspector examined the file for a recent admission and found the contract to be in place. This was signed by the resident, and stated the number of the room to be occupied. The inspector spoke to a large number of residents during the inspection, and received generally positive feedback regarding the care and support being provided. Views expressed indicated that residents perceive staff to be considerate, caring and kind, and that residents’ individual care needs are being met. The inspector met one resident from an ethnic minority group, who had been recently admitted to the home. She indicated that she had settled well and that her dietary and care needs were being well met. The inspector examined a random sample of assessments, care plans and minutes of reviews. These indicated that the home has the capacity to meet the assessed needs of residents who present varying degrees of cognitive and physical dependency. Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 to 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are having their health, personal and social care needs set out in an individual plan of care, and reviewed on a regular basis. The health care needs of residents are being fully met. Residents are being protected by the home’s medication policy, procedures and training. Residents feel that that they are being treated with respect and that their right to privacy is being maintained. EVIDENCE: Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 11 One resident has been admitted to the home within the last 12 months. It was evidenced that care plans have been drawn up and that these are being regularly reviewed. The inspector met the resident who indicated that she has settled well in the home and that her care needs are being met. Care plans are being compiled on the basis of the initial assessment prior to admission, on admission and during residency. These are being reviewed on a two-monthly basis, and detail the person’s individual needs and how the home aims to meet these. They also include a photograph of the individual resident. The inspector recommends that the home moves towards more regular review, and that care plans are reviewed on at least a monthly basis. This is in accordance with good practice, as detailed in standard 7.4. All medicines are being prescribed on an individual basis, and are being administered by trained staff. All staff have undertaken accredited medication training, a list of staff trained to administer medication being maintained. The inspector was advised that 3 staff are currently undertaking an optional course unit in medication awareness, as part of their NVQ studies. No residents are currently taking their own medication. The home has a medication policy in place, and uses the Monitored Discharge system for administering medication. The registered manager, Hazel Hawkins, who is a qualified nurse, advised that she regularly monitors medication recording to ensure accuracy. The home receives an annual inspection from its supplying pharmacy, this having most recently been completed in March 2008. All medications are kept within a locked cabinet in the staff area adjacent to the lounge. Any controlled drugs are stored in a separate and secure lockable safe. None are currently being prescribed. The home has a commitment to respecting the privacy of residents, this being stated in the Service User Guide. Whilst the home does not have a visitors’ room, the relative privacy of the dining area is usually available outside of mealtimes. Residents are also able to see visitors in their own rooms if they wish. All residents have a lockable space in their bedrooms for storing personal possessions and valuables. Personal care is given in residents’ own rooms. The inspector spoke with a wide cross-section of residents. Views expressed to the inspector indicate that residents feel that their privacy and dignity is being respected, and that they are being treated in a caring and respectful way. The inspector observed staff interacting well with residents, with care, kindness and consideration being shown. Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 to15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While efforts have been made to extend the range of opportunities for recreational and social activity, these are still fairly restricted. More could be done to promote residents’ participation in day-to-day activities. Residents are assisted to maintain contact with family and friends, and links with the local community are encouraged. Generally, residents are able to exercise some choice and control in their dayto-day routines, and to receive appropriate support from staff in helping to facilitate this. However, there has been a lack of collective consultation and information sharing with residents, with irregular residents’ meetings taking place. Residents receive a wholesome, appealing and nutritious diet in pleasant surroundings, and at times convenient to them. EVIDENCE: Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 13 The home has occasional organised activities. These include visits from a group of volunteers called ‘Non such Orbit’ who provide entertainment including singsongs and bingo sessions. There are occasional visits by paid musical entertainers, providing live entertainment, and fortnightly visits from a volunteer to engage residents in activities such as music and movement, and quizzes. The inspector was introduced to a church visitor who visits for up to an hour each week and spends time engaging with residents in conversation. In particular, she endeavours to spend time with those residents who do not receive any visits from friends or relatives. Other activities offered include reminiscence sessions, exercise sessions, and quizzes. There is a DVD player, with a selection of DVDs for showing to residents. A number of games and books are available, and a mobile library visits the home on a monthly basis. The home has made some efforts to involve additional volunteers but with limited success so far. The manager advised that a voluntary helper who attended for a few weeks did not prove to have the relevant communication skills and did not sustain her involvement. While staff try and involve residents in weekly activities and quizzes, it seems that only a relative few are wiling to participate. From previous inspections, residents have indicated that they would welcome more activities. Whilst there have been some attempts to remedy this, most residents were observed sitting in the lounge, with a few watching television, others asleep or unoccupied. Though an exercise session was scheduled, there was little sign of any activities taking place with residents. In this regard, there is room for further improvement and for more attention being given to meeting residents’ needs. The home has a pleasant garden at the rear that could provide a focus for the more physically mobile and motivated residents. The day of inspection was a pleasant sunny day, but there was no sign of any residents taking advantage of a change of scenery. There is, at present, partially restricted access from the lounge with some broken paving awaiting repair. The registered provider, Mr Hawkins stated that this has been shortly scheduled for repair. There is, however, little evidence of residents being offered the opportunity to go outside and enjoy sitting in the garden, either on this or on previous inspections. While there is a garden bench to sit on, there are no garden chairs or recliners in which to sit, or parasols for those who would prefer sitting in the shade. Whilst the explanation given is that residents show little or no interest in accessing the garden, there is, perhaps, insufficient encouragement to do so. To help encourage access, when the weather is nice, the purchase of some garden furniture could make a real difference. The inspector therefore Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 14 recommends that the registered providers improve access to the garden and give consideration to the purchase of some garden furniture. The home does not organise any outings itself but encourages relatives to visit and take residents out if they wish. There is access to a day centre in the community, which two residents attend, and residents are registered with Diala –Ride. Residents are encouraged to maintain contact with their friends and relatives and to develop links with the local community. The home has a hairdresser, who visits twice a week. Views expressed by residents indicate that visitors are made welcome at the home, and that they are encouraged to maintain their contact with friends and relatives wherever possible. A recently admitted resident said that her husband and children have bee able to visit her regularly at the home and that she has been able to sustain her contact with them. Visiting times are very flexible. The views expressed by residents indicate that residents feel able to exercise autonomy and choice in their day-to-day lives, with some residents exercising their wish to go out, and others, to spend time in their rooms. Feedback from questionnaires returned to the inspector, and from surveys completed by the home, indicate that residents are generally satisfied with the way that the home is being run. While there is evidence that residents are being individually consulted regarding their day-to-day lives, there has been a lack of collective consultation and information sharing with residents, with irregular residents’ meetings taking place. A requirement from the last inspection, for regular twomonthly meetings, has not yet been met. This must be addressed as a priority. The inspector addressed this issue with the manager, Mrs Hawkins, and recommends some delegation of responsibility for organising these meetings to a senior staff member. These meetings provide the opportunity for residents to be informed and consulted regarding issues that affect their day-to-day lives and must be held on at least a two-monthly basis. The inspector saw the kitchen area and inspected food storage arrangements. These were satisfactory. The registered provider, Mr Adrian Hawkins, is a qualified chef and has recently completed updated food hygiene training. Two other staff who work in the kitchen have also been booked on for this training. The menus, and inspection of the kitchen and food storage areas, evidenced a varied choice of food with fresh vegetables and fruit being made regularly available. Residents expressed a high level of satisfaction with the food that is offered, and the meals served at lunchtime were found to be both nutritious and appetising. Menus are provided over a four-week period, and include a wide-ranging choice of dishes. Individual tastes and dietary needs are being monitored and catered for. This includes a recently admitted lady from an ethnic minority, and two residents who are diabetic. Residents are able to Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 15 choose their meals the day before with a record of their choice being kept. The dining room has been recently re-carpeted and presents as a pleasant area in which to have meals. Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 to 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their relatives/friends are able to raise any concerns they may have, and to know that these will be taken seriously and addressed. Residents’ legal rights are being protected. Generally, residents are living in a safe environment, with appropriate adult protection policies and procedures being in place. However, for residents to be fully protected, all staff must complete statutory safeguarding adults training. EVIDENCE: The home has an appropriate complaints policy and procedure in place, a summary of which is included in the Service User Guide (Standard 16). A copy Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 17 of the complaints policy is kept in the entrance hall, together with a complaints record sheet. No complaints have been logged since the last inspection. The home aims to protect residents’ legal rights by involving family and friends in respect of their care plans, benefits and monies, and in discussing any issues at reviews. All residents are registered to vote, and are supported where necessary to vote, usually by postal vote, or by attending the polling station. The manager advised that 5 residents were assisted to exercise their right to vote in the recent local elections. Views expressed to the inspector indicates that residents feel safe and secure in this home, and that staff are generally perceived as being caring and considerate. No adult protection allegations or concerns have been recorded since the last inspection. The inspector checked a number of residents’ files and noted that care plans were being regularly reviewed, and that risk assessments were in place. Daily logs indicate that residents are being regularly monitored and that any concerns regarding residents’ health and welfare are being recorded, and actions noted. No adult protection concerns were identified. The home has an adult protection procedure. This outlines the home’s procedures in regard to any suspicion or allegation of abuse. The home also has a copy of the London Borough of Sutton adult protection policy and procedures. Staff at the home have previously received training from a qualified trainer in adult abuse. There are, however, a number of staff who are still awaiting places for the LB Sutton’s Vulnerable Adult training. 5 out of 14 staff have previously completed this training. Following a long delay in obtaining places, a list of dates have been received from LB Sutton for staff to attend this training in 2008. A requirement applies, this being outstanding from the previous inspection. Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 to 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are living in a safe, well-maintained environment, with access to safe, sufficient and comfortable facilities. Sufficient aids and adaptations are in place to safely meet the needs of residents. Residents’ rooms are safe, comfortable and pleasantly decorated, reflecting residents’ personal identities, and being suited to their individual needs. The home presents as clean, pleasant and hygienic. Staff training in infection control is, however, required, if standards are to be maintained. Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 19 EVIDENCE: The inspector completed an inspection of the premises. The home presents as being well maintained and decorated, and as providing a pleasant, safe and comfortable environment. A maintenance and development programme is in place, regarding the renewal of the fabric and decoration of the home. This includes ongoing redecoration and re-carpeting of residents’ bedrooms, and of the home’s communal areas. In 2007, the home was re-carpeted in the reception and communal areas and along the corridors, while in 2008 there has been re-carpeting of the main staircase and dining room. The home is basically well maintained, with an ongoing programme of external decoration to the front and back of the home having taken place over the last three to four years. There is, however, some external maintenance and repair work which needs to be completed. The inspector spoke with a number of residents and received feedback from questionnaires. Residents again indicated that they feel happy with their environment and with the individual and communal facilities provided. The communal areas in the home present as being adequately furnished and equipped, providing comfort and a homely atmosphere for the home’s residents. Furnishings and lighting are domestic in style. The home has sufficient bathroom and toilet facilities, which includes two Acer baths, one walk-in and one fixed bath. All of the home’s bathrooms have had a bath seat installed. All of the home’s toilets have raised seats and liquid soap dispensers. The first floor bathroom has been re-decorated (in 2007-08) and had new linoleum put down. The home presents as safe, with sufficient aids and adaptations in place. It was last risk assessed by an occupational therapist, in November 2004, and found to provide a sufficient range of equipment and adaptations appropriate to meeting the needs of the home’s physically frail and disabled residents. The home’s bath hoists, and the stair lift are being regularly serviced (see standard 38). There is a pleasant, but not easily accessible, garden at the rear of the property. The home’s proprietors, Mr and Mrs Hawkins, have previously advised that, due to budgetary constraints, there are no current plans to renovate and upgrade the garden area. It is, however, to be hoped that this may be achievable in the longer term for the benefit and enjoyment of the residents. Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 20 At the present time there are 15 residents, 2 of whom share a ground-floor double room. This is a long-standing arrangement, both residents having indicated that they are happy with this and for this to continue. The other residents each have their own room. The inspector met one resident in her room. She indicated that she was happy with her room and that it was meeting her needs. Other residents expressed similar views. The rooms seen by the inspector presented as being adequately furnished and pleasantly decorated, a number of rooms having been re-carpeted and redecorated over the last two to three years. All rooms have a lockable space. Residents’ rooms reflect their individual tastes and identities, and include personal photos and mementoes. Residents are able to bring personal possessions and items of furniture with them to the home. All rooms have appropriate door locks, which can be opened from the outside if necessary. Magnetic door guards (to enable self-closing) have been fitted to a number of bedroom doors where it is the resident’s wish to keep their door open. One bedroom (Room 22) has had a a magnetic door guard fitted, meeting a requirement from the last inspection. The inspector found the premises to be clean, hygienic and free from any offensive odours. From 1 July 2008, the home has adopted a no smoking policy, which has meant that smoking is no longer permitted in any of the communal areas. The home received an inspection from Environmental Health on 21/02/07, this being a 3-yearly inspection. The home has been trying to access on-site infection control training, this having proved difficult to access. 3 staff have completed external infection control training in May 2007, and 1 new staff member had completed training in this area in September 2007, prior to starting at the home. The inspector agreed to rephrase the requirement so as to enable other staff at the home to access training through the distance learning provided by NESCOT (North-East Surrey College of Technology). Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 to 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has the numbers and skill mix of staff sufficient to meet residents’ needs and ensure their safety. The staff complement will, however, need to be increased from 2 to 3 should the number of residents increase from the present level. Residents are being safeguarded by satisfactory recruitment policy and procedures. Criminal records checks being completed before the recruitment of any new staff. Generally, staff are being provided with the necessary induction and training with which to perform their work duties competently, and to safely meet the needs of residents. However, for residents to be fully protected, all staff must complete safeguarding adults and infection control training. EVIDENCE: Generally, the home was evidenced to have the numbers and skill mix of staff sufficient to safely meet the needs presented by the home’s residents. The inspector checked the staff rota. A minimum of two staff is presently being Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 22 provided at all times, day and night (both waking staff). There are currently a number of vacancies, the home being registered for 23 residents. The manager was advised that, should the number of residents increase to previous levels, then this would necessitate an increase in the staffing complement to 3 staff throughout the day. The Registered Manager, who is a trained nurse, and her husband also work within the home. They are supernumerary and their hours are detailed on the duty rota in response to a previous requirement. There are currently 12 care staff and a cleaner. Mr Hawkins, who is a trained chef, is in charge of the food preparation and cooking. Since the last key inspection, one new member of staff has been recruited. The inspector has examined the staff file and found that all the necessary recruitment and identity checks have been completed together with the necessary criminal records checks (CRB and POVA). An induction programme is in place for all new staff. There is ongoing training in health and safety, first aid, medication, manual handling and fire prevention. Most staff have completed training in dementia awareness. There is evidence on staff files of staff having relevant qualifications, and there is ongoing identification of training needs. The home currently has 3 care staff who have NVQ Level 3 and 7 staff with NVQ Level 2 or equivalent. Two other staff are due to register for studies leading to an NVQ2. This meets the target of at least 50 of care staff with an NVQ2. Since the last inspection, the registered manager, Hazel Hawkins, has developed a staff training programme. This details courses and training dates to be attended by staff throughout 2008. Courses include statutory safeguarding adults training (POVA), Food Hygiene, Safe Handling of Medication, Moving & Handling, and Dementia Awareness. There is also fire safety training provided internally by Mr Hawkins. A requirement, for all staff to access infection control training, remains to be met, together with a requirement for all staff to complete LB Sutton’s POVA training (for which dates have now been obtained). Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 to 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally, the home is being well managed, and in a way that demonstrates that it is being run in the best interests of residents. The management approach is evidenced to be open and enabling, and conducive to creating a positive and inclusive atmosphere in the home. With regular, one-to-one supervision now being provided, residents can be assured that staff will be appropriately supported in meeting their needs. Generally, the inspector is satisfied that the health, safety and welfare of residents and staff are being appropriately promoted and protected. However, paving in the area leading from the lounge to the garden needs to be repaired and made safe. Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 24 EVIDENCE: Mrs Hawkins is a trained nurse. Both she and Mr Hawkins have many years experience in working with this client group, and Mrs Hawkins has obtained the Registered Managers Award (in January 2007). From the evidence of this inspection, and the feedback received from both residents and staff, the home is generally being managed in a competent, caring and open way. From the views expressed (by residents and staff) to the inspector, and the feedback obtained from the CSCI residents and relatives survey returns, there is a large measure of satisfaction with the home and the way it is being run. Little or no critical comment was received, this being restricted to comments from two residents regarding their wish for more activities. Residents spoken to by the inspector expressed their satisfaction with the day-to-day management of the home and with the care being provided by staff. From the evidence available, the registered providers are viewed as being both competent and caring and to be providing a pleasant and homely environment in which to live. The inspector observed residents being treated with consideration and respect by the manager and care staff. The home has been developing its quality assurance processes with surveys for 2007-08 having been completed with residents, though none with relatives. Also, while questionnaires have been designed for visiting professionals, and other stakeholders, none had been completed for the year 2007-08. For quality assurance to be a more open and meaningful process, feedback needs to be obtained from as wide a spectrum as possible, and should always include the views of relatives and advocates. A requirement applies. While a summary of the responses obtained, together with an action plan, has been drawn up, a proper Development Plan has yet to be put in place. This is an unmet requirement from the previous inspection and needs to be prioritised. The Development Plan should collate all the feedback and information gathered from surveys and other sources, and identify those areas where the aims and objectives of the home are not being fully met, and the actions/plans proposed to address any deficiencies or improvements required. Copies of the Development Plan should be made available to residents and relatives, and a copy forwarded to the CSCI. The home has finally resolved the queries relating to its tax returns, thus enabling audited financial accounts to be completed for the tax years 2003-04, 2004-05 and 2005-06. The inspector was advised that accounts for the Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 25 financial year 2006-07 are currently being prepared. Whilst the home has yet to resolve its negotiation regarding the leasehold, the indication is that a satisfactory resolution can be achieved. From the evidence presented, including the preparation of a Business Plan for 2008-09, the home would appear to in a better position regarding its longer-term financial viability. Records required by regulation for the protection of residents, and for the effective and efficient running of the business, are generally being maintained to a satisfactory standard. A checklist of policies and procedures, which lists all policies and procedures, has been drawn up, with policies and procedures being reviewed and updated as required. A requirement remains to be met. A copy of the checklist should be included on each staff file. This needs to evidence that staff have read and understood each policy that has been developed and updated. The registered manager, Hazel Hawkins, is undertaking supervision, with some delegation of this task to a senior care worker. The inspector examined a sample of staff files, which included records of supervision sessions. These evidenced that staff have been continuing to receive supervision on a regular two-monthly basis, and that detailed records of supervision are being maintained. Given past concerns in this area, the inspector was pleased to see that this improvement has been sustained. The inspector examined certificates relating to health and safety. Up to date servicing certificates are in place for electrical wiring and installation (2/11/07), gas servicing (1/6/07), portable electrical appliances (10/5/08), fire safety (20/3/08), hoist maintenance (being serviced 6 monthly) and the testing of call systems (10/5/08), together with certificates for Legionella (15/5/07), which is again due, and environmental health (21/2/07), this being a 3-yearly inspection. The stannah stair lift was last serviced on 1/5/08, this being serviced on a 3-monthly basis. The Home’s Health and Safety Risk Assessments have been reviewed in 2007 (on 3/1/07 and 6/6/07), and are due again for review. The inspector was shown records evidencing that regular weekly hot water checks are being completed, together with daily fridge/freezer and oven temperature checks for the cooking of meat. There were also regular weekly checks being recorded for hot water temperatures (these being satisfactory, at 43C or below). Monthly checks are being recorded for the home’s emergency call systems and emergency lighting. The home’s fire alarms were evidenced to be receiving regular weekly checks. Following a recommendation from the last LPFA fire safety inspection, fire drills are now being held on a regular monthly basis, with drills rotating between each staff shift (morning, afternoon, evening and night time). The registered Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 26 provider, Mr Adrian Hawkins, provides fire safety training to staff. This includes familiarising staff with fire safety procedures and providing information relating to fire evacuation procedures. The Home’s Fire Risk assessment was last reviewed and updated on 14 May 2007 and is due again for annual review. The inspector inspected the premises, which generally presented as being well maintained and in a safe condition. There is, however, some external maintenance work (identified in a surveyor’s report), which needs to be carried out to the fabric of the building, and repair of paving in the paved area to the side of the area leading from the lounge to the garden. The registered provider, Mr Hawkins, assured the inspector that work was in hand to rectify this and to make it safe. Following an assurance that the residents are not presently accessing the garden area, the inspector decided against issuing a requirement. However, this work needs to be completed as a priority so as to facilitate safe access to the garden area for any resident who may wish to do so. No other specific concerns were identified. Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 3 X 3 2 3 Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP18 Regulation 18(1)(c) Requirement Adult protection. The registered providers must ensure that all care staff have accessed and completed Suttons Vulnerable Adult and Adult Protection training. The Registered Providers have had ongoing difficulties in obtaining dates for this training. Dates from May 2008 to March 2009 have now been obtained from LB Sutton. Requirement partly met, 5 out of 14 staff having previously completed this training in 200607, and 3 staff having completed this training in 2007-08. Extension of time-scale agreed. 2 OP26 13(4)(c), 13(6) 18(1)(a) & (c) Training in infection control must be provided for all staff. 3 staff accessed this training in May 2007. DS0000007168.V362828.R01.S.doc Version 5.2 Page 29 Timescale for action 31/03/09 30/09/08 Heatherbank Extension of time-scale agreed. 3 OP32 12(2) & (5) Residents’ meetings. Residents’ meetings must be held on at least a two-monthly basis. These meetings provide the opportunity for residents to be informed and consulted regarding issues that affect their day-to-day lives. Extension of time-scale agreed. See also Recommendation No 3. 4 OP33 24(1)(2) &(3) Quality assurance. A Development Plan must be put in place for 2008-09. The Development Plan should collate all the feedback and information gathered from surveys and other sources, and identify those areas where the aims and objectives of the home are not being fully met, and the actions/plans proposed to address any deficiencies or improvements required. A copy of the Development Plan should be made available to residents, their representatives and other interested parties, and a copy forwarded to the CSCI. 5 OP33 24(1)(2) &(3) Quality assurance For quality assurance to be a more open and meaningful process, views regarding the home must be obtained from as wide a spectrum of opinion as possible. This should always Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 30 30/09/08 31/03/09 31/03/09 include the views of residents’ relatives or representatives. 6 OP37 12(1)(a), 18(1)(a) A copy of the home’s policies and procedures checklist should be included in each staff file. This should evidence that staff have read and understood each policy developed and updated. Extension of time-scale agreed. 30/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP12 Good Practice Recommendations Residents’ care plans should be reviewed on at least a monthly basis (7.4). To enable and encourage residents to spend some leisure time in the garden, the inspector recommends that access to the garden is improved, and that some garden furniture is purchased. The inspector recommends some delegation of responsibility (to a senior staff member) for organising residents’ meetings so as to ensure that these take place on a regular basis. 3 OP14 Heatherbank DS0000007168.V362828.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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