Inspection on 01/06/10 for Heron Hill Care Home

This is the latest available inspection report for this service, carried out on 1st June 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heron Hill Care Home 23/07/09

Heron Hill Care Home 26/05/09

Heron Hill Care Home 02/06/08

Heron Hill Care Home 13/06/07

Heron Hill Care Home 07/03/07

Heron Hill Care Home 16/05/06

Heron Hill Care Home 14/11/05

Heron Hill Care Home 22/04/05

Heron Hill Care Home 15/12/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 03/09/2010.

Key inspection report Care homes for older people Name: Address: Heron Hill Care Home Esthwaite Avenue Kendal Cumbria LA9 7SE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Marian Whittam     Date: 0 1 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Heron Hill Care Home Esthwaite Avenue Kendal Cumbria LA9 7SE 01539738800 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): peterw@abbeyhealthcare.org.uk Abbey Healthcare (Huntingdon) Ltd Name of registered manager (if applicable) Mr Andrew Phillip Shewan Type of registration: Number of places registered: care home 86 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The home is registered for a maximum of 86 service users to include: up to 28 service users in the category of OP (old age not falling within any other category) up to 50 service users in the category of DE(E) (Dementia over 65 years of age) up to 4 service users in the category of DE (Dementia under 65 years of age) up to 4 service users in the category of PD (Adults with physical disabilities) Date of last inspection Brief description of the care home Heron Hill is a new purpose built home caring for up to 86 people with nursing needs and it opened to residents in October 2004. It is in a quiet residential area with access to the bus routes and the train station. The town centre of Kendal is about 2 miles Care Homes for Older People Page 4 of 32 Over 65 50 28 0 4 0 4 2 9 0 9 2 0 0 9 Brief description of the care home away. There is a car park at the front of the home. The home is on three floors and there is a passenger lift to all floors. All the bedrooms are single and have en suite bathrooms with showers. There are 2 communal bathrooms and toilets on each floor and separate communal lounges and dining rooms on each floor and an activities room on the first floor. The home has a statement of purpose and service user guide for prospective residents available on admission. A copy of the most recent inspection report is displayed on the notice board in the foyer of the home along with the results of the homes own satisfaction surveys and the complaints procedure. Information on the range of fees payable can be obtained from the manager and can include nursing contributions. There are additional charges to residents for hairdressing, private chiropody, papers and magazines and any personal toiletries. Additional charges for people living there who fund their own fees privately do not apply. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means that the people who use this service experience Good quality outcomes. This site visit, by two inspectors, to Heron Hill forms part of a key inspection. It took place on the 1.6.10. We (CQC, The Care Quality Commission) were in the home for five hours. The CQC pharmacy inspector also visited, as part of the inspection process, and looked at the handling of medicines by checking relevant documents, storage and meeting with the manager and other staff. We gathered information about the service in different ways: We sent an Annual Quality Assurance Assessment (AQAA) form to the home. The AQAA is a self assessment and a dataset that must be completed annually by all providers of registered services. It is one of the ways we gather information from the providers Care Homes for Older People Page 6 of 32 about their service and how they believe they are meeting outcomes for the people living there and using their service. The AQAA also gives us statistical information about the individual service and trends and patterns in social care. This was returned to us in good time and completed by the registered manager. We sent out surveys to the people who live at Heron Hill and the staff who work there to get their views on the service provided, the way the home is run for them and the staff experiences of working at the home. We looked at all the information we have about the service. We looked at any changes they have made and informed us of and how the registered persons have dealt with any complaints made to them or safeguarding vulnerable adults. We looked at what the manager has told us about things that happened in the service, these are called notifications and are a legal requirement. We looked at the previous key inspection and any calls or visits we have made to the home since their last inspection. We looked at any relevant information we had received from other agencies and organisations and any written comments people have made to us. We spent time talking to people who live there, and spent time with them to see what happens during their day and ask what they think about the way the home is run for them. We also spent time talking with staff who work there to get their opinions and views. During the day we spent time with people living at Heron Hill, in the lounges and also talking to them in private. We looked at care planning documents and assessments to make sure that people received the level of care they needed and expected. We made a tour of the premises to look at the environment people lived in, the standards of cleanliness and what facilities were available to them. We also looked at staff training and recruitment files and a sample of records and safety assessments required by regulation. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? Good maintenance and upkeep continues and internal redecoration and updating. There has been an increase in the number of domestic staff so the home is kept fresher and cleaner for the people living there. Having more cleaning staff means cleaning regimes can be kept up and allow for increased carpet cleaning. The environment is also now subject to audit to make sure standards are maintained. Care Homes for Older People Page 8 of 32 The service has maintained the improvements made to the way staff support people at mealtimes, including having more than one sitting for meals and having enough staff to try to make sure people can be supported individually to enjoy their meals. We saw that staff gave individual support and assistance to people at lunch time so they could enjoy their meal in an unhurried way. The manager has increased staff levels where a need had arisen to make sure there are sufficient staff available to escort people to outside appointments. Since the last visit the homes manager has been registered with CQC and staff we spoke with found him to be approachable and supportive. He has both general and mental health nursing qualifications and previous management experience. Staff commented on there now being a feeling of teamwork, good access to training and development and a better overall working atmosphere. We found that the manager and staff have continued to work at the areas of weakness with medication handling and continue to audit and monitor practices and improve records. Although there was an area of concern regarding medication the manager promptly began addressing this. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People thinking of coming to live at Heron Hill are provided with information about the home and they have their individual needs assessed . Evidence: The home has a statement of purpose and service user guide that is subject to review. The service also has a colour brochure with photographs of the inside and exterior of the home to give people an idea of the facilities and location. The information in the Statement of Purpose and the service guide can also be made available, if requested, in other formats to suit individual needs. There was a good level of information available for people and families to help them make a decision about using the service. There are information leaflets on the notice board and in the foyer including information on The Mental Capacity Act, peoples access to their records and helplines and support agencies. The notice board has information about what is going on in the home including the activities programme and religious services. Care Homes for Older People Page 11 of 32 Evidence: We looked at the pre admission assessments that had been done for people living in the home and at six peoples in detail.The assessments are to help make sure that the staff can be sure they will be able to fully meet peoples individual needs and expectations when they move in. Senior nursing staff had undertaken pre admission assessments in a persons home or other care setting. The assessments we saw covered the relevant areas of individual need and were in sufficient detail to identify what support and care a person would need on admission. We could see from peoples care plans that they had their admission assessments done promptly when they had come into the home and that these were being developed with people or their families where appropriate. We saw that where a care management plan had been done by social services a copy was obtained and information included in their assessments. This was also the case with information from hospital transfers and nursing and medical professionals, where involved in peoples care. People thinking of coming to live in the home, and their families, are welcome to visit the home beforehand and look around and speak with staff and other people living there. There is a trial period for people following their admission to the home that is followed by a review of care with the person and their representatives and support agencies to make sure the home is meeting their individual needs and expectations. We spoke with one person who had recently come in and they told us how the staff had helped them settle into the home as they had not wanted to come in at first. They told us how staff had spent time with them and finding out their interests, Coming in to have a chat, finding out about me and say hello, they even talk to me about football. They told us it is Going well, I didnt want to stop but I am glad I did. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Heron Hill have their health, personal and social care needs assessed and planned for. Medication handling and monitoring helps ensure peoples health and well being are promoted. Evidence: All the people living at Heron Hill have an individual plan of their care developed and this is generally well set out and easy to follow. We looked at care plans on all the three suites in the home and looked at six peoples in more detail. We could see that the information in the plans had been based upon the initial assessments made before and on admission and set out peoples health, nursing and personal care needs. Generally initial assessments on admission had been done within 24 hours of coming to live in the home. Relevant clinical assessments had been done for each individual including nutritional needs and risk, falls, mobility and moving and handling needs and skin care and tissue viability. Care plans and strategies for management were in place and generally up to date. We could see that care plans were being evaluated and changes made and all plans we saw were being reviewed on a monthly basis. There is also a system for monitoring falls and accessing support. Care Homes for Older People Page 13 of 32 Evidence: We could see from the care plan records that health care interventions and visits by professionals were being recorded and action taken when changes had occurred. The care plans we saw were person centered in style recording what people had said they wanted and included family history, social contacts, important life events, social links, pets, choices and decision making, health wishes, spiritual needs, hobbies and interests and personal aspirations. These provided a good picture of what mattered to people and what they wanted. During the visit we observed that staff interacted well with the people living there and supported them as they wanted and with activities and at meal times. We spoke with people living at Heron Hill to ask if they felt their individual needs were being met as they wanted and expected. One person told us Its not what I had imagined, the staff are very polite and there is nothing they wont do to help. Other comments by people living there and relatives included; Basic care and attention is good and they are quick to bring in the doctor when needed. The nurses are very versatile, and will find out anything, I am pleased I can have male or female carers, although I dont mind which. Give me information on Dads condition, which I never received in a previous residential home (Relative). As part of our visit we carried out a pharmacy inspection and checked the handling of medication on the MacKenzie and Nightingale Suites. We saw that nursing staff had continued to complete audits (written checks) to help ensure that medicines are safely handled and that should any shortfalls arise, they can be promptly identified and addressed. Most medicines were administered by qualified nursing staff, although people who wished to, and were able to, were supported to self-administer medication. We found that records of medicines handling were generally clearly completed helping to support and evidence the safe administration of medication. But, on the visit day we saw that not all the medicines administration records had been completed at the time of administration to each person. Care needs to be taken to ensure that the homes medicines policy is consistently followed, as completing the records at a later time can increase the risk of making mistakes. We looked at how information within peoples care plans supported the safe administration of medication. We found some good information about the use of when required medicines to help ensure consistency in their use, when needed. But, we found that Care Homes for Older People Page 14 of 32 Evidence: although care was taken to consider peoples medicines needs when away from the home, and that people were supported to self-administer medication, there was a lack of individual written information about how this was supported in practice. Similarly, we were told that to assist with swallowing some people needed to take their medicines with food but information about how this was carried out in practice was not recorded. This information could be usefully recorded to help ensure consistency in the handling and administration of medicines, so that peoples needs are best met. We saw that records of doctors advice and changes to peoples medication were clearly recorded helping to reduce the risk of mistakes. We found that all medicines including controlled drugs were safely stored helping to reduce the risk of mishandling or missuse. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Heron Hill have a choice of meals available to them and have the opportunity to take part in organised social activities or follow their own interests. Evidence: From our observations during the visit, from activities records and speaking to people living in the home we could see that there were opportunities available for people to take part in a programme of organised activities, religious services and social events. There was useful information in peoples care plans about what they enjoyed doing, what they were able to do and about what had meaning for them to take part in, such as trips out with family and friends, going to the pub, getting their hair done. We talked with one person who was partially sighted and they enjoyed their talking books and newspapers and that was made clear in their plan. Staff we saw chatting with people and assisting them at meals spoke in a calm and kindly manner. We observed staff assisting people to mobilise and from wheelchairs to easy chairs in the lounge using various types of moving and handling equipment. On most occasions staff chatted with them as they helped, explained to people what was happening and made sure their personal dignity was promoted by keeping their clothing straight and not exposing body areas. Care Homes for Older People Page 16 of 32 Evidence: We spent time with people living in the home and observing their activities and staff interaction on all the three units during the visit. The home now has five activities staff, working at different times from Monday to Friday to provide a range of things people could take part in if they want to. The in house programme included music and movement exercise sessions, reminiscence sessions, board games, soft ball games, art and crafts, quizzes, 1 to 1 sessions with hand massages and manicures, bingo, gardening, singing and music sessions. The programme offers people different activities morning and afternoon. We saw a film club screening, on a large projector screen, going on on Nightingale suite during the morning and singing and music on another suite. Some people, who enjoy gardening, have been planting seeds for the homes Summer Fete plant sale. There are many photographs around the home of people taking part in these different activities like the gardening and also birthday parties and trips out. The home has its own mini bus that is used for trips out and also provides transport for relatives living out of town so they can visit. The frequency of this transport has just been increased from two weekly to weekly. This is because the number of people living there from outside the town has increased and more relatives wish to visit. Overall our survey responses indicated people were satisfied with the activities on offer although some commented they would like more trips out. Some relatives indicated they would like more that was specifically for those with hearing and visual imparments. These are areas the manager can pursue with them at the residents meetings. There are also planned social events with outside entertainers and a popular musical entertainers. There was a multi denominational church service and communion taking place on the different units during the afternoon. We saw these had been advertised in advance so people were aware. It was clear from care plans that many people wanted to follow and maintain their religious beliefs and some were visited by their own priest or clergy. The home also has a hairdresser who visits weekly for those people who want this service. The home also provides an on line computer service for people to use and will set up email accounts for them if they want to use it to keep in touch, people could also bring in their own if they wanted. People told us their visitors and relatives were made welcome in the home and more than one said staff were friendly and welcoming, often with a cup of tea or coffee. Some people preferred not to take part in organised sessions and did not have to do so. The menus we saw and the food we saw being served to people at mealtimes was varied and nutritious and from what we could see and people told us was well presented and hot when served. The meals come from the kitchen area and are served by the staff. This was done in an unhurried and calm manner although many of Care Homes for Older People Page 17 of 32 Evidence: people did need encouragement or assistance with their meals. The service has made sustained improvements to the support of people at mealtimes, including having more than one sitting for meals and having sufficient staff available to try to make sure people can be supported individually to enjoy their meals. There is a four week rolling menu in place that is displayed on the notice board, which provides a good selection of healthy and nutritional meals. On the day of the visit people had a choice between chicken in white wine sauce or pork casserole and a selection of fresh vegetables, potatoes, broccoli and sweetcorn. Most people were having lunch in the dining room but some chose to eat in their bedrooms and a small number in the lounge, depending on where they felt most at ease. Individual nutritional assessments are completed and special dietary requirements were recorded. We could see that appropriate prescribed food supplements were in use for people with a poor diet or suited to their physical needs. For some people this includes finger foods that are easier for them to pick up and feed themselves. This means that people can be more independant and still do this for themselves. Survey responses indicated that generally people were satisfied with the food and snacks on offer to them. Their survey comments and those made to us during the visit included; The food is very good, excellent in fact and I am putting some weight back on now. The cakes are good but sometimes not enough at afternoon tea. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a clear complaints procedure available in the home and this and safeguarding procedures and practices help ensure that peoples rights are upheld and their welfare promoted. Evidence: The service has a complaints procedure, including the process stages and timescales for action. This is displayed throughout the home and is in the service guide with contact numbers for appropriate agencies for support and information. The procedure is available in different formats, such as large print versions, should it be needed or requested. There is also useful information available in the main foyer for people and their families on advocacy services, independent mental capacity advocates and funding care along with surveys asking for peoples general feedback on the service. There is also contact information should people want to contact CQC. There have been seventeen complaints logged over twelve months. The registered manager logs all complaints and comments made, written and verbal. We looked at the records kept of these, the correspondence and the investigations undertaken. These had been investigated and responded to by the manager or the organisations operations manager if that was more appropriate. We looked at the recording forms used for these complaints and the responses and actions being taken to address them. We saw the recording was detailed and, where needed, prompt action had been taken to protect peoples interests. The improvements we found in complaints investigation Care Homes for Older People Page 19 of 32 Evidence: at our last visit have been maintained. The manager reviewed the way complaints were handled when they came into post to see if there were more ways to improve the system. Concerns and complaints records indicated that complaints are being fully recorded and outcomes and actions clearly recorded. This helps to make sure they have been followed up and addressed fully. The manager has sent CQC copies of complaint investigations and responses where asked to do so and keeps us informed on matters affecting people living there and on staff disciplinary actions. The manager has acted quickly where disciplinary action has been needed with staff to safeguard peoples interests. Survey responses from people living in the home indicated some were still not sure how to make a formal complaint and the manager should look into why that is. People we talked to commented on how they felt about raising concerns and being listened to. These included, Any complaint I have they deal with, they dont make a fuss. The manager comes in and I can sit and talk about anything I want or dont like. A relative commented, The manager is very good and will always listen to you. There has been one investigation under safeguarding vulnerable adults procedures referred to social services by the registered manager to protect peoples welfare. This was investigated by social services and other appropriate agencies. There are clear adult protection procedures and guidelines in place to help protect the welfare of people living there and the local multi agency guidance is available for staff to refer to. The procedures are detailed and training records show that staff have been given training on safeguarding vulnerable adults and recognising what abuse may be. This should help staff be aware and act quickly should they suspect abuse. Staff we spoke to indicated that they had received this training and knew what the procedures were should a situation arise that needed referring to other agencies for someones protection. Staff survey responses also indicated they felt they knew what to do if someone has concerns about the home. The home has systems in place to help protect peoples rights including to enable them to vote. At the recent elections 50 of people on the nursing unit exercised their right to a postal vote. The home also had a visit from the standing MP during the run up to the general election. The home has whistle blowing procedures in place for staff to report concerns about Care Homes for Older People Page 20 of 32 Evidence: the practices of colleagues and managers. Staff we spoke with said that they found the manager to be supportive and approachable and There is a much better atmosphere in the home. They felt they would be supported should they need to raise any concerns over practice issues. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Heron Hill benefit from a comfortable and well maintained home with suitable facilities and adaptations to support them and promote their independence and choice. Evidence: We made a tour of the building and the areas used by people living there. We found that the home was being well maintained. Records are kept of any maintenance work needed and done. There is a programme of general maintenance and of testing of lighting, alarms and safety equipment and records are kept of this testing. The domestic supervisor does environmental checks to help make sure good hygiene and cleanliness are maintained and the home stays comfortable and homely for people living there. We saw there is a good standard of decoration, furnishing and lighting within the home. We found the home to be clean and tidy and there were no lingering odours evident. Survey responses from people living there indicated this was usually the case. We spoke to domestic staff who were working during the visit. They welcomed the increase in the cleaning staff levels and there were four working during our visit. Cleaning staff told us that there were now four cleaning staff each day. They felt this allowed them to make sure all rooms were attended to each day and made staff available for bigger tasks like shampooing the carpets. They told us that the increase Care Homes for Older People Page 22 of 32 Evidence: in domestic staff numbers had helped improve the cleaning service and We have worked hard to improve. New cleaning equipment had been purchased at our last visit to try to deal more effectively with the problem of carpet and upholstery cleaning. There are policies and procedures in place for infection control and the management of clinical waste. Training records indicated that staff have been given training on infection control. There are suitable sluice and disinfecting facilities on each of the 3 floors to promote good hygiene and these were clean, tidy and away from peoples rooms. There are also alco-gel dispensers on the ground floor and at the entrance for staff and visitors to use to help minimise cross infection risks generally. The laundry facilities are on the top floor of the home and well away from the areas used by the people living there. There are laundry staff to cover a 7 day period, although night staff will make sure any soiled bedding is laundered before they go off duty if needed. We received comments from people living there and their relatives about cleanliness and the laundry service. these included: I like the way they wash the clients clothes daily (Relative). They keep his room clean and tidy. I spend a lot of time in the home so notice. (Relative). The laundry - socks disappear! Even when named. (Relative) There are sufficient comfortable communal lounges in the home for people to relax in or to join in social group activities. The communal areas are well lit and warm and there is an area on the ground floor for people to use the homes computer if they want and a smoking room for those who want to smoke. There is also a separate hairdressing salon on the ground floor. Outside on the ground floor there are pleasant patios with appropriate seating areas for people to use to sit out in good weather. The manager is looking into ways to increase the outside space that residents can use as this is limited for those living on the first and second floors. All the bedrooms in the home are single occupancy and have en suite toilets, wash basins and showers for people. There are also separate toilets, shower rooms and bathrooms with assisted baths on all the floors. One person told us that I really like the en suite bathroom and the wet room and told us the manager said they could change the room around to suit themselves. The bedrooms we saw were comfortable and well furnished and decorated and all the bedrooms now have nursing beds. There is a range of equipment in the home, bathing Care Homes for Older People Page 23 of 32 Evidence: aids, nursing beds and moving and handling equipment to help people with mobility and independence. People we spoke with liked their bedrooms and many people on the dementia care suites had their own pictures or pictures of things that had meaning for them on their bedroom doors to help them recognise their own rooms and so make them better orientated. Care Homes for Older People Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient nursing and care staff on duty in the home to meet the personal and health care needs of the people living there. Evidence: We looked at the staff rotas and observed staff levels during the visit to assess if the staffing and skill mix on each of the suites was sufficient to meet the needs of the people living there. The rotas we looked at showed what staff were on duty, when and in what capacity. These and our general observations of staff levels and deployment during the visit indicated that there were sufficient staff on duty to provide general nursing and personal care for the people living there. On the specialist dementia suites Cavel and the smaller MacKenzie suite we noted that there is not always Registered Mental Nurses (RMN)on duty. We discussed this with the manager at our last visit. Currently staff on the demetia care suites are working on dementia study packs to help develop their knowledge and understanding to support the people living there. The manager is very aware of the need for this and wants to increase numbers of RMNs employed. It has proved difficult to recruit nurses with such qualifications so the manager intends to try to access training courses for general nurses to increase expertise in this area. We spoke with nursing and care staff working in different areas of the home during the visit. They commented on there being a feeling of teamwork and lately a better working atmosphere and told us they Care Homes for Older People Page 25 of 32 Evidence: received supervision and training to do their jobs. They also told us that staffing levels are better and there is lots of training going on. The individual staff training records, the annual training plan showed that they had been given induction training and that this had covered moving and handling, fire training, communication, food hygiene and abuse awareness. Records also showed that training was being made available in advanced care planning, deprivation of liberty, dementia awareness and first aid and resuscitation. A high percentage of care staff do have NVQ level 2 in care, or at in the process of doing the course, and many have this at level 3 as well. Overseas staff are given additional support with a literacy and numeracy induction as well if required. We looked at a sample of recruitment records for some of the new staff. The homes recruitment procedure was being followed and staff had all necessary security checks done and references taken up before they started work to help make sure they were suitable to work with vulnerable people. The manager has done checks on this to make sure all is in place to protect the welfare of people living there. Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The interests and welfare of the people living at Heron Hill are being promoted by the management systems and procedures in place. Evidence: Heron Hill has a registered manager in post, Mr Andrew Shewan, who is suitably qualified and experienced for this role and holds both general and mental health nursing qualifications. Mr Shewan has previously been a registered manager. There are quality monitoring systems in place within the service and the providers require a monthly quality report on any accidents or incidents reported in the home and reported to us (CQC). Audits are carried out on care plans, the cleanliness, medication and accidents. Policies and procedures are subject to review and the procedure files are available for staff to refer to on all the units. Satisfaction surveys are available within the home for people living there to use as well as those for relatives, visitors and visiting professionals so they can give feedback on the service. There are also residents and relatives meetings and records are kept of these and the Care Homes for Older People Page 27 of 32 Evidence: topics discussed. We looked at the regular monthly visit reports by the Regional Manager required by the regulations and as part of the service providers monitoring of standards in the home. The service has achieved accreditation with ISO 9000. This is the accepted standard for monitoring an organisations quality monitoring systems and procedures. Records and personal information about people living in the home are being kept securely. We looked at the procedures and records for monies kept for people living there and spoke with the administrator on the handling of personal finances. Each entry for peoples money is checked in and out by 2 members of staff. The money is held in individual packets with individual record sheets and receipts for each person. These records had been audited periodically. We found from training records and speaking to staff that they have received mandatory training on safe moving and handling, infection control, food hygiene, first aid and fire safety. Staff we spoke with told us that they had been given supervision. Each nurse acts as primary nurse responsible for a set number of care plans and they receive supervision from the manager, the deputy manager supervises carers which the nurses said they felt was better. Staff interviewed stated, things are much improved with the new manager, they told us they now get the equipment we request, feel they are better supported and that residents care has improved. They also told us staffing levels are better and that more carers were doing NVQ qualifications. People living there and relatives commented on the running of the home: Its a well run home, I see him (manager) often to talk to. (Resident) The manager is very good, he listens to you. (Relative) Records indicate that fire safety equipment and moving and handling equipment is serviced under annual contracts and records for lift and hoist servicing were up to date. There was a fire risk assessment completed this year and fire alarms and detectors and emergency lights are regularly tested. We looked at a sample of records of accidents and incidents affecting people living in the home. The manager kept records of accidents and incidents in the home and information on this was passed to the provider for quality monitoring. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Where people choose to self-administer medication, or where medicines are supplied for administration when away from the home, there needs to be written supporting information To help ensure peoples medicines needs are met in the safest and best way. 16/07/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 Care needs to be taken to ensure that the homes medicines policy is consistently followed and that all the medicines administration records are completed at the time of administration to each person as completing the records at a later time can increase the risk of making mistakes. We recommend that a record is kept of any special support needed when taking medication to help ensure consistent approach. The manager should look into why some people were still not sure how to make a formal complaint and how this can Page 30 of 32 2 9 3 16 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations be improved. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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