Inspection on 28/02/06 for Halcyon House

This inspection was carried out on 28th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Halcyon House 16/05/06

Halcyon House 17/02/05

Halcyon House 13/07/04

Halcyon House 09/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Halcyon House 55 Cable Street Formby Merseyside L37 3LU Lead Inspector Debbie Corcoran Unannounced Inspection 28th February 2006 11:00 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 Halcyon House DS0000017280.V286487.R01.S.doc Version 5.1 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. Halcyon House DS0000017280.V286487.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Halcyon House Address 55 Cable Street Formby Merseyside L37 3LU 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) 01704 833350 halcyonhouse@btopenworld.com Abbeyfield North Mersey Society Limited Mrs Anne Garmona Terry Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Halcyon House DS0000017280.V286487.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 31 OP. Maximum no. registered 31, of which up to a maximum of 31 PC (personal care) and up to a maximum of 15 N (nursing) - this to be increased to 16 places to accommodate a named service user and only until such times as the named service user continues to reside at the home The service should have a suitably qualified and experienced manager who has been approved by the CSCI 21st September 2005 3. Date of last inspection Brief Description of the Service: Halcyon House is registered to provide residential care and nursing care for up to 31 older people. The home was first opened in 1992. The home is owned and managed by Abbeyfield North Mersey Society Ltd. This is a charitable organisation. The home is located in a residential area in Formby and is close to local shops and transport links. The home is a single storey building that has a large garden and patio area in the centre. All bedrooms are single rooms and have en-suites. There are adjoining rooms available for married couples or for those who wish to share. There is a large lounge and dining room and the garden area is overlooked by a sun lounge. Other facilities include a small chapel and library. There is a large car park at the front of the home. . Halcyon House DS0000017280.V286487.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second unannounced inspection at the home in this inspection year. The inspection took place over a period of 6 hours and throughout the day the inspector met with 3 residents on an individual basis, spoke with 3 residents on a group basis and met the vast majority of residents at some point throughout the day. The inspector also spoke with two members of care staff on a one to one basis, the chef, 2 administrators and the registered manager. A tour of the premises was carried out and a sample of resident’s rooms were viewed. Records were examined and these included four of the resident’s care plans, medication records, staff files, staff training, health and safety records, What the service does well: The residents were very positive about all aspects of the home. Resident’s comments included staff are “excellent”, “it couldn’t be better” and “it’s a home from home”. Each of the residents has a care plan which gives a good level of information on how to meet the person’s needs and how to maintain the person’s independence, dignity and respect. Good efforts are made to ensure that the residents are included in good level of activities within the home and there are occasional trips out organised for small groups of residents. Activities are well advertised and residents are involved in planning the activities. Residents meetings take place regularly and residents are also given further opportunities to comment on the home through questionnaires. The catering arrangements are well organised and residents were clearly more than satisfied with the quality of food and meals provided. The chef has information on the dietary needs of all of the residents and of their likes and dislikes of food. The home is very well presented both inside and out and is comfortable, spacious and welcoming. Aids and adaptations are in place to promote the independence of residents and ensure staff carry out safe practices when assisting residents with moving and transferring. Resident’s bedrooms are very nicely presented and furnished with many of their personal belongings. Staff were seen to interact with the service users with courtesy, respect and warmth. Staff responded quickly when calls for assistance were made from the residents. Staff are being provided with some good training opportunities and further training in planned for the near future. A high percentage of staff are qualified to a National Vocational Qualification (N.V.Q) level 2 in care. Halcyon House DS0000017280.V286487.R01.S.doc Version 5.1 Page 6 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. Halcyon House DS0000017280.V286487.R01.S.doc Version 5.1 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 Halcyon House DS0000017280.V286487.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 Each of the residents has an assessment of needs carried out by a senior member of staff at the home. Care management assessments are not being attained from referring agencies. The home provides long term care only. EVIDENCE: The inspector examined the files for three of the most recently admitted residents. An assessment of needs is in place for each of the residents. These assessments have been completed by a senior member of staff at the home. The inspector recommends that a more detailed assessment is carried out using a more comprehensive assessment form. In addition to the assessment ‘pen pictures’ (which is a brief outline of the person and their background) are provided by members of resident’s family along with information on the resident’s social, cultural, ethnic and spiritual needs. This is a good area of practice which informs the home of who the resident is as a person and not just what their needs are. A medical report is also provided by the resident’s G.P prior to the resident moving in to the home. Halcyon House DS0000017280.V286487.R01.S.doc Version 5.1 Page 9 Further assessments for issues such as moving and handling and nutritional risk assessments are carried out when the resident moves in to the home and these are reviewed monthly. A tick list assessment is in place as a means to review resident’s assessment. Again, this could be improved upon with the introduction of a more comprehensive assessment tool. There was no evidence that the home is attaining Care Management assessments for residents who are referred through Social Services Departments. The manager should aim to attain these when appropriate. Standard 6 is a key standard to be assessed however the home provides long term care only and does not provide intermediate care. Some of the residents have lived at the home for a number of years and there is a waiting list of people wanting to move into the home. Halcyon House DS0000017280.V286487.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Each of the residents has care plan which is sufficiently detailed and clearly reflects the residents needs. Care plans are reviewed regularly. Residents are well supported to remain healthy and staff refer for medical assistance appropriately. New procedures have been adopted in storage, administration and recording of medication. EVIDENCE: Each of the residents has a care plan. The care plans of four of the residents were examined in some detail. The manager has introduced new care plans since the last inspection. The new plans are very easy to read and follow. The care plans provide information on meeting the residents needs in areas such as; maintaining a safe environment, communication, personal care, food and nutrition, mobilising, social needs and sleeping. The care plans examined had been signed by a relative of the resident and they had been reviewed monthly since being produced. Members of the staff team reported that they read the residents care plans and are encouraged to contribute to the information in them. The detail in some of the care plans shows that a lot of thought has gone into them. For example on describing how to meet a person’s communication needs one of the care plans Halcyon House DS0000017280.V286487.R01.S.doc Version 5.1 Page 11 gave a clear explanation as to what the difficulties were, why the person was having difficulties with their communication and outlined clearly what staff need to do to communicate effectively with the person. Care plans also indicated that the residents are encouraged to maintain their independence as much as possible. The care plans are very personalised and in some cases describe the detailed needs and wishes of the resident. The way in which care plans are written also indicate that the residents are treated with dignity and respect for example in maintaining their personal care. The care plans detail how a resident likes to be supported so as to maintain their independence and dignity. The care plans should always include information on how to meet a residents needs when the resident has been assessed as at risk. For example, if a resident is determined to be at risk of developing a pressure area then details of what action staff need to take to prevent this should be clearly recorded in the resident’s care plan. There were examples where this information had been recorded but there were a couple of examples where this information was either not recorded particularly clearly and in another part of the resident’s file or it was not recorded at all. Residents records show that they are well supported in remaining healthy. Residents are weighed and have their blood pressure checked regularly and this is recorded. Residents who may have difficulties with their diet or weight loss are referred for specialist support. Residents are supported to see a GP or nurse when appropriate and feedback from residents was that staff are very good at responding to their health care needs. Some of the care staff have been provided with training for supporting residents who have significant personal / health care needs. At the previous inspection there were a number of areas of concern as to the storage, recording and administration of medication. Medication was therefore assessed on this inspection. The home has taken action to address most of the issues raised following the last inspection. The manager was advised that a further inspection by a Pharmacy Inspector would take place in the forthcoming future. Medication is now only administered by qualified nurses. Some members of care staff used to be designated to administer medication to residents who did not require nursing care but this practice has now stopped and nursing staff administer medication directly to the resident. This was confirmed during discussions with two members of care staff. Medication storage was checked and found to be appropriate for the sample of medications checked. Medication for two of the residents was checked against medication administration records and the medication was found to be appropriately recorded. A number of medication administration records had gaps where signatures should be. If for some reason a resident has not had their medication then the person administering the medication should use the appropriate codes to explain why this is the case and they should not just leave the space blank. There was an example where a dosage of medication had been changed by the prescriber however the medication administration Halcyon House DS0000017280.V286487.R01.S.doc Version 5.1 Page 12 record had not been signed and dated by two members of staff. Fridge temperatures for the fridge in which medication is stored are now recorded daily. The medication file now has a photograph to identify each of the residents. Controlled drugs (which are very strong medications which require special recording by law) are recorded and checked regularly. Halcyon House DS0000017280.V286487.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14, 15 Residents are well supported to be involved in indoor and occasional outdoor activities. Residents are encouraged to maintain their independence and exercise choice. Residents are provided with a choice of good quality food and the catering arrangements and kitchen are well organised. EVIDENCE: The residents are encouraged and supported to continue with interests and activities which they enjoyed before moving to the home. Residents and their family members are requested to provide the home with information on their background and interests and their social, cultural and religious needs. Residents gave good feedback on the activities at the home and forthcoming activities are well advertised. Recent activities have included bingo, board games and a horse racing night. A small group of residents informed the inspector that there was a trip to a garden centre and lunch scheduled for the next day. A hairdresser was visiting the home at the time of the inspection and many of the residents were having their hair styled. The residents gave very good feedback on the quality and quantity of meals and food provided. Residents are given the opportunity to give written feedback on their meals as a comments book is kept at the entrance of the dinning room. The manager was able to give an example of how this has Halcyon House DS0000017280.V286487.R01.S.doc Version 5.1 Page 14 influenced the meals offered. Entries in this book referred to the food as “very good”. Some of the residents comments on food were quite detailed and it was good to see that residents felt empowered enough to detail their views. Residents are given a choice of two meals and there are additional options if required. A catering contractor is used to provide the catering . The chef was spoken with and asked how he is made aware of the needs of the residents. He was able to show the inspector a card for each of the residents which identifies if they have any special dietary needs or any likes or dislikes. Residents are encouraged to make choices about the running of the home and their care. Examples of this can been seen in how residents are consulted at the home. Residents have the opportunity to attend a residents meeting on a regular basis and are given the opportunity to complete surveys to give feedback on the home. Many of the residents are well able to express their needs and preferences and contribute to changes at the home. All residents are given their post directly, residents are encouraged to manage their own medication when possible and to manage their own money when possible. Halcyon House DS0000017280.V286487.R01.S.doc Version 5.1 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed on this occasion. EVIDENCE: Whilst these standards were not assessed it is noteworthy that staff were scheduled to undertake training in the protection of vulnerable adults commencing the day after the inspection and there were information leaflets on adult protection as provided by Sefton Social Services placed strategically around the home. Halcyon House DS0000017280.V286487.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 23, 24, 25, 26 Residents live in a home which is well presented, well maintained, safe and comfortable. Bedrooms are nicely decorated and personalised with the resident’s own belongings. The home is presented as clean and hygienic and staff have been provided with training in health and safety. EVIDENCE: The home is purpose built and all accommodation is provided at ground level. It is fully accessible to people who are physically disabled and is fitted with aids and adaptations. The environment is very well presented and maintained. At the centre of the home there is a patio / garden area which is a very nice and secure setting. The decoration and furnishings across the home are of a very good standard. Residents have full use of all communal areas which consists of a large dinning room, a sun lounge and four smaller lounges located around the building. It was noted that many of the residents were spending time on their own in their bedroom. Whilst residents choice to do this is rightly respected the manager should discuss the use of communal areas with the residents as there may be Halcyon House DS0000017280.V286487.R01.S.doc Version 5.1 Page 17 reasons why the communal areas are not being used. One of the residents felt that the sun lounge is a thoroughfare and not best suited as a lounge and felt that one of the smaller lounges was more like a ‘staff station’. Each of the residents has their own bedroom with en suite facilities. In addition to this there are numerous bath, shower and toilet facilities around the home. Residents bedrooms are decorated and furnished to a very good standard and residents are clearly encouraged to bring their own possessions in to the home and personalise their rooms. All bedrooms doors are lockable and each room has some facility for storing items securely. The home was presented as clean and hygienic throughout. There were two domestic staff on duty at the time of the inspection. The home uses a firm of contractors for domestic staff. Policies, procedures and practices for infection control are in place. During discussions with members of staff they confirmed that they have the necessary equipment to prevent the spread of infection. Halcyon House DS0000017280.V286487.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 30 Staff numbers were appropriate and service user’s needs were being met effectively and promptly. Residents are supported by staff who are qualified and currently having good training opportunities. EVIDENCE: During the inspection there were five care staff on duty, the manager, an assistant matron, and two qualified nurses. The home is running on a full staff team and the manager reported that there have been no new appointments of care staff since the last inspection. The manager provided information of training for all staff. Since the previous inspection all staff have been provided with training in health and safety. All staff have up to date moving and handling and fire safety training. Further training for the whole team has been booked in infection control, first aid and food hygiene, these will run from March to July. The manager is also planning for staff to be provided with training on dementia care. Carers have been provided with information on dementia care in the meantime whilst the manager is resourcing an appropriate course. Training records also showed that some staff have been provided with training in topics such as palliative care, hand and foot massage and visual disability awareness. The manager reported that 85 of care staff have attained a National Vocational Qualification (N.V.Q) level 2 in care and that it is intended that approximately 50 of care staff will commence N.V.Q level 3 in the near future. Halcyon House DS0000017280.V286487.R01.S.doc Version 5.1 Page 19 The residents gave very good feedback about care and nursing staff and described staff as “brilliant”, “first class” and “excellent”. Residents made similar comments about all staff including domestic staff, caterers and the manager. Staff were observed to be warm and friendly with the residents throughout the inspection. Two members of care staff were interviewed. Both described the home as supportive of them as employees. They also described good team work and a good team spirit. Halcyon House DS0000017280.V286487.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35, 38 Residents are encouraged to maintain their independence and manage their own money. When residents are supported with managing money this support is appropriate and monies are recorded and accounted for. Policies, practices and procedures are in place to safeguard the health, welfare and safety of service users and staff. EVIDENCE: Residents manage their own money when appropriate. Where a resident needs support with managing their money then a record of all money they give in and take out is kept and receipts are kept for purchases whenever possible. Residents or their relatives sign their money in and out. All money is maintained securely. It was reported that the treasurer of the board of directors does spot checks on residents finance records. Health and safety policies, procedures and practices are in place to safeguard the well being of residents, staff and visitors. Health and safety records were Halcyon House DS0000017280.V286487.R01.S.doc Version 5.1 Page 21 checked. These showed that fire safety and water safety checks are in place and up to date and a current gas safety certificate and a current electricity safety certificate were available. Hoisting equipment has been serviced. Halcyon House DS0000017280.V286487.R01.S.doc Version 5.1 Page 22 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 x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 3 x 3 3 4 3 3 3 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x 3 x x 3 Halcyon House DS0000017280.V286487.R01.S.doc Version 5.1 Page 23 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 OP7 Regulation 15 Requirement The registered person must ensure that residents care plans include information on all relevant aspects of their care. The registered person must ensure that medication administration records are maintained accurately at all times. The registered person must ensure that if a dosage of medication is changed by the prescriber then the medication administration record is signed and dated by two members of staff if this is hand written. Timescale for action 28/04/06 2. OP9 13 (2) 28/03/06 Halcyon House DS0000017280.V286487.R01.S.doc Version 5.1 Page 24 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. Refer to Standard OP3 Good Practice Recommendations For residents referred by Care Managers the registered person should ensure that Care Management assessments and care plans are attained prior to a resident moving to the home. The registered person should introduce a new assessment format to ensure that comprehensive assessments of the residents needs are carried out. 2. OP3 Halcyon House DS0000017280.V286487.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Halcyon House DS0000017280.V286487.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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