CARE HOME ADULTS 18-65
Healy House (Burnley) 11 Ormerod Road Burnley Lancashire BB11 2RU Lead Inspector
Mr Jeff Pearson Unannounced Inspection 24th November 2005 09:30 Healy House (Burnley) DS0000009528.V257954.R01.S.doc Version 5.0 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 Healy House (Burnley) DS0000009528.V257954.R01.S.doc Version 5.0 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 Adults 18-65. 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. Healy House (Burnley) DS0000009528.V257954.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Healy House (Burnley) Address 11 Ormerod Road Burnley Lancashire BB11 2RU 01282 838845 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) Mrs Bridget Mary Healy Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places Healy House (Burnley) DS0000009528.V257954.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 4th May 2005 Brief Description of the Service: Healy House is part of Healy Care Dispersed Home Scheme, which is in Burnley and consists of three terraced properties. The properties are situated on the same road, in what is primarily a residential area. The home is close to shops and local resources. The accommodation available is homely and mostly domestic in style. There is a dining kitchen with separate dinning area and a lounge. There is one shared and three single bedrooms. There is a large yard to the rear of the home. Staff are on duty to provide support 24 hours per day. Transport is available to enable service users to visit relatives, take short trips, including outings within the local area and further a field. Healy House (Burnley) DS0000009528.V257954.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took 7 hours and was carried out over one day by one inspector. There were 4 service users accommodated. The files/records of 3 service users were examined as part of ‘case tracking’, this being a method of focusing upon a representative group of residents. The records of the most recently recruited staff were looked at. During the inspection, service users, the house manager and staff were spoken with. A tour of the premises was carried out. Some policies and procedures were looked at. What the service does well: What has improved since the last inspection?
The people living in Healy House were being involved with the producing of a new guide to the home. A better way of making sure peoples’ support needs are kept an eye on had been put in place. More thought had been given to people taking risks and how staff should respond to these situations. Risks in the home had also been given attention, to keep things as safe as possible for people living in the home users and staff. One persons’ bedroom had been decorated and new furniture provided. “It’s much better now, I really like it,” he said. A new ‘people carrier’ type car had been obtained to provide transport for service users. Staffing arrangements had improved to provide for support in the evenings and weekends. Healy House (Burnley) DS0000009528.V257954.R01.S.doc Version 5.0 Page 6 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. Healy House (Burnley) DS0000009528.V257954.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Healy House (Burnley) DS0000009528.V257954.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 5 Healy Houses’ guide and statement of purpose were still being updated, therefore current and future service users did not have up to date and accurate information, but some progress had been made. Service users initial assessment details were not available, therefore, it was not clear if their needs had been fully assessed or that they could be met at the home. No progress had been made in introducing updated contracts of residence, therefore, terms and conditions were still lacking in clarifying rights and providing safeguards. EVIDENCE: The manager explained that the service user guide was being reviewed with the involvement of everyone in the home. Records of house meetings showed peoples’ input on what should be included and a ‘draft’ guide was seen. This had much relevant information. The manager did not have a copy of the homes’ assessment format. There were no assessment details available on current service users accommodated. There had not been any new or recent admissions into the home. The manager said service users had not been provided with revised contracts, there were n revised contracts available. Healy House (Burnley) DS0000009528.V257954.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Service users had individual written Plans, which responded to their support needs and outlined goals and activities. Systems were in place to enable service users to make decisions and choices, as individuals and as a group. Assessing and managing responsible risk taking was effective in helping to ensure a reasonable balance is achieved between personal safety, independence, choice and rights. EVIDENCE: The individual Plans examined as part of case tracking, were sensitively written and included details of each persons support needs and goals, the action to be taken and by whom. Care notes provided a good reflection of each person’s daily living and specifically responded to identified needs/goals. Service users spoken with were aware of their individual Plans; they said they signed in agreement with them. Healy House (Burnley) DS0000009528.V257954.R01.S.doc Version 5.0 Page 10 The care planning process showed service users were being supported to make choices and decisions in their daily lives. Service users said house meetings were held each week, for group discussions information sharing, they felt involved with day-to-day matters in their home. Any restrictions on choices, in the persons’ best interest had been agreed and recorded in their Plan. The risk assessments seen were much improved. A new risk assessment format had been introduced, key risk factors had been highlighted and graded, possible outcomes had been considered. Risk management strategies were recorded, dated and were being reviewed. Risk assessments had been completed on service users’ having access to hot water in their bedrooms. Healy House (Burnley) DS0000009528.V257954.R01.S.doc Version 5.0 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15, 16, 17 Service users were being offered opportunities to engage in a range of activities, they were supported to use community resources. Arrangements were in place to enable service users to maintain links with families and friends. Independence was being promoted and rights were being respected, some rules had been agreed to clarify any limitations and responsibilities. The catering arrangements were sufficient in providing for the residents tastes, choices, diet and skill development. EVIDENCE: During the inspection service users went out into the local community. Individual Plans showed planned activities and outings. Service users spoke of the various activities, both in and out of the home, including Greenspace, day centres, pubs, shops, church, sports/fitness centres, shopping, games and
Healy House (Burnley) DS0000009528.V257954.R01.S.doc Version 5.0 Page 12 cooking. Two service users said they had enjoyed a holiday abroad. Good records were being kept of service users achieving activities and having one to one support. Some progress had been made with staffing arrangements, to provide more cover for weekends and evenings. Service users spoken with explained they were keeping in touch with members of their families and friends, by telephone, visits, or short breaks away. Risk assessments showed improvements had been made in responding to complex relationships, other agencies continued to be involved. Independence living skills were being encouraged, service users kept their rooms tidy and did their own laundry, they had freedom of movement in the home. One service user said the house rules had been discussed at a recent meeting. Mealtimes were flexible, depending what was happening in the home. Service users made drinks and snacks for themselves and said they could get involved with shopping, cooking and baking. Healthy eating was being encouraged. Records showed the meals being served. The weeks menu was being discussed in house meetings. Healy House (Burnley) DS0000009528.V257954.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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, 20 Arrangements were in place to monitor the service users’ general health and wellbeing and to access appropriate health care services. Some progress had been made with medication management, but policies and staff training still needed attention to promote best practice and reduce risks to service users. EVIDENCE: Service users spoken with confirmed they had received attention from health care professionals including GPs, Community Psychiatric Nurses, Consultants and Dentists. Service users were receiving annual health care checks. Health care matters were reflected within individual Plans. Records showed general health was being monitored and support was being provided for appointments. Medication storage was secure and tidy. Appropriate records were being kept of medication administration. Risk assessments had been completed for service users having involvement with their medication. The house manager explained the medication policies and procedures were still being reviewed, hand written amendments were seen. Only the house manager had undertaken accredited medication management training. There were no suitable storage facilities should service users be prescribed controlled drugs.
Healy House (Burnley) DS0000009528.V257954.R01.S.doc Version 5.0 Page 14 Healy House (Burnley) DS0000009528.V257954.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Some progress had been made in producing an appropriate complaints procedure. To ensure service users have correct contact information further details were needed. No progress had been made in updating the protection and abuse policies and procedures; this may result in abuse matters not being properly dealt with. EVIDENCE: An overview of the complaints process had been placed in each service users bedroom. The full complaints procedure was in the service user guide; this included most details but needed to include the contact details of the Commission, which were elsewhere in the guide. Systems were in place to record and follow up complaints. Service users said most issues were raised and discussed, in the weekly house meetings. The protection/abuse policies and referral procedures were still in the process of being revised and updated. The staff whistle blowing policy was also being updated. Some staff had received guidance on abuse and protection as part of NVQ training, or the initial induction training programme. Healy House (Burnley) DS0000009528.V257954.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 30 Limited progress had been made in improving the standard of décor and furnishings, with no evidence of future planning. Therefore the home did not provide a safe, pleasant and homely environment for the service users. EVIDENCE: The outward appearance of the home was poor; the windows of the home were in a poor state and the property looked unkempt and uninviting. In the lounge part of the ceiling over the bay window had fallen down. The ceiling and walls were still covered in ‘office style’ panels; there was fluorescent strip lighting. The carpets in communal areas looked shabby. The sofa in the lounge was in appalling condition, the fabric was torn and the cushions were misshaped. One service users’ bedroom had been redecorated and new furniture provided. The service user had been involved with choosing the furnishings and carpet. A lockable drawer/cupboard had not been provided and another key was needed for the door. Risk assessments on the use of hot water were seen, water temperatures were being checked and ‘warning hot water’ signs were in place. There was only one toilet in the upstairs bathroom. There was no evidence to indicate plans were being made to up-grade the home.
Healy House (Burnley) DS0000009528.V257954.R01.S.doc Version 5.0 Page 17 The home was clean and free from unpleasant odours, the laundry area was still in need of attention the walls/were not easily cleanable and there was no sink. Despite the lack of progress in improving the facilities, it was apparent the house manager and staff were doing there best to provide a pleasant environment for the service users. Healy House (Burnley) DS0000009528.V257954.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34, 35 Staff training and development was ongoing, this needed to continue to ensure all staff are appropriately trained. Staffing arrangements were sufficient in providing support for the service users. Staff recruitment practices suggested full attention was not being given to protecting the service users. EVIDENCE: Staff on duty interacted well with the service users, they appeared well motivated and were enthusiastic about their work. Service users spoken with expressed an appreciation of the staff team. There had again been some changes in staff. The required numbers of staff were on duty. Staff rotas and records of hours worked, indicated that appropriate staffing levels were being kept with additional staff also being on duty for activities, outings and one to one support. The rota was being devised in response to service users living patterns.
Healy House (Burnley) DS0000009528.V257954.R01.S.doc Version 5.0 Page 19 Service users said they had been involved with the recruiting of new staff. The records of the most recently appointed staff were found to have some details missing, including a full employment history and a written reference from the last care setting. The application form did not indicate the relationship of referees to the applicant. Not all staff had been provided with contracts of employment. Records were seen of the induction training programme for new staff. One support worker had completed NVQ level 2 and was undertaking NVQ level 3; all others had commenced NVQ level 2. The house manger had completed NVQ level 4 and the Registered Managers Award. Training in safe working practices was ongoing. Healy House (Burnley) DS0000009528.V257954.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 The management practices and leadership approach were satisfactory, but no progress had been made in ensuring there is a registered manager to take responsibility for the day-to-day running of the home. Some quality assurance processes were in place, but improvements were needed to show the home was being properly reviewed and developed. Some arrangements had been made to maintain health and safety; further safeguards were needed to promote the well being of residents and staff. EVIDENCE: The registered provider Mary Healy was not managing the home; the Commission had not received an application for a registered manager at Healy House. The house manager was enthusiastic and expressed commitment in providing a good service for the people living at Healy House, but had limited autonomy to effectively manage the home. The house manager said a survey had recently been given to service users and staff and a questionnaire was being devised for others such as Community
Healy House (Burnley) DS0000009528.V257954.R01.S.doc Version 5.0 Page 21 Psychiatric Nurses. There was no development plan available. The home had attained Investors in People accreditation. The house manager had completed a number of risk assessments around the home, which showed attention was being given to health and safety matters. The ceiling in the lounge needed attention to reduce the possibility of falling debris. Suitable thermostats still had not been fitted to the bath and shower. Records showed that fire drills and fire equipment tests were being carried out. Most of the staff had completed First Aid and Food Hygiene training and Infection Control training was being considered. Three staff had attended Health and Safety training. Healy House (Burnley) DS0000009528.V257954.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 1 X X 2 Standard No 22 23 Score 2 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 X 2 2 X X 2 LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X 3 2 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Healy House (Burnley) Score N/A 3 2 X Standard No 37 38 39 40 41 42 43 Score 2 X 2 X X 2 X DS0000009528.V257954.R01.S.doc Version 5.0 Page 23 YES Are there any outstanding requirements from the last inspection? 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 YA1 Regulation 4,5,6 Requirement The statement of purpose and service user guide must include clear factual information about the services and facilities provided. A copy of the revised service user guide must be given to each service user (Timescale of 08/07/05 not met) Records of service users initial assessment must be kept available in the home. Prospective service users must be informed in writing, following assessment that the home can meet their needs. All staff responsible for dealing with medication must receive accredited medicines management training (Timescale of 05/08/05 not met) Medication management policies and procedures must be in accordance with current recgnised guidelines and legislation (Timescale of 08/07/05 not met) The complaints procedure must include the contact details for the Commission. Each service users must be provided a with a
DS0000009528.V257954.R01.S.doc Timescale for action 31/03/06 2 YA2 14,17 03/02/06 3 YA20 13,18 31/03/06 4 YA20 13 31/03/06 5 YA22 22 03/02/06 Healy House (Burnley) Version 5.0 Page 24 6 YA23 13 7 8 9 10 11 12 YA24 YA24YA42 YA24 YA24 YA27 YA30 16,23 16,23 16,23 16,23 23 16,23 13 YA34 17,19 14 YA37 8 15 YA42 13 copy of the complaints procedure (Timescale of 03/06/05 not fully met) The protection and abuse policies and procedures must be ammended to include apprporite details for responding to suspicion, allegation or evidence of abuse or neglect (Timescale of 08/07/05 not met) The windows of the home must be repaired/replaced. The ceiling in the lounge must be made safe. The home must be refurbished to a satisfactory standard. (Timecsale of 25/11/05 not met) The sofa in the residents lounge must be replaced. A toilet must be provided on the ground floor (Timescale of 25/11/05 not met) The laundry floor must be made impermeable, the walls washable and a wash basin provided (Timescale of 01/03/05 not met) The recruitment process must include the obtaining of full employment histories and satisfactory written refernces. A suitable manager must apply for registration with the Commission (Timescale of 10/06/05 not met) A suitable thermostat which provides water at a safe temperature must be fitted to the bath and shower (Timescale of 01/03/05 not met) 31/03/06 30/06/06 16/12/05 30/04/06 25/12/05 30/04/06 30/04/06 30/11/05 10/02/06 03/02/06 Healy House (Burnley) DS0000009528.V257954.R01.S.doc Version 5.0 Page 25 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 YA5 Good Practice Recommendations Service user contracts should be developed to ensure they meet the details specified in Standard 5 of the National Minimum Standards for Younger Adults. Suitable storage facilities should be available should a service users be prescribed controlled drugs. The outward appearance of the home should be improved. The ceiling in the lounge should be finished off a soon as possible. All service users need to be provided with a lockable drawer/cupboard. Service users’ bedrooms should include the minimum furnishings as outlined in standard 26 of The National Minimum Standards for Younger Adults, unless otherwise agreed. All staff should be provided with up to date contracts of employment. The programme of staff training and development needs to continue, to ensure staff are able to respond to the service users needs. The quality assurance system needs to ensure all relevant people are consulted and that a development/action plan is produced. 2 YA20 3 4 5 YA24 YA24 YA26 6 7 8 YA34 YA42 YA39 Healy House (Burnley) DS0000009528.V257954.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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