CARE HOME ADULTS 18-65
Healy House 11 Omerod Road Burnley Lancs BB11 2RU Lead Inspector
Jeff Pearson Unannounced 4 May 2005 9.30 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 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 Stationary 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 F57 F07 S9528 Healy Hs V224951 4.5.05 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Healy House Address 11 Ormerod Road Burnley Lancs BB11 2RU 01282 838845 Telephone number Fax number Email 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 MD Category(ies) of Mental Disorder registration, with number of places Healy House F57 F07 S9528 Healy Hs V224951 4.5.05 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14 December 2005 Brief Description of the Service: Healy House is part of Healy Care Dispersed Home Scheme which in Burnley consists of three terraced properties. The properties are situated on the same road, in what is primarily a residential area. The home is in close proximity to a number of resources and community facilities within the local area. The accommodation available is homely and generally domestic in style, and provides communal living for people with mental ill health. There is a dining kitchen with separate dinining area and a lounge. there are 1 double and 3 single bedrooms. There is are large yard to the rear of the home. Staff are on duty to provide support 24 hours per day. A member of staff with an RMN (Registered Mental Nurse) qualifiction works in the home approximately 2 days per week. Transport is available to enable service users to visit relatives, take short trips, including outings within the local community and beyond. Healy House F57 F07 S9528 Healy Hs V224951 4.5.05 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 7 hours. There were 5 service users accommodated. During the inspection 4 service users, the deputy manager and manager were spoken with. The files of 5 service users were examined along with various other records. Documents, including policies and procedures, were looked at. A tour of the premises was carried out. What the service does well: What has improved since the last inspection?
The new house manager had made positive changes for the benefit of the people living in the home and for staff. A deputy manager had been recruited, to help the house manager keep home running smoothly. Healy House F57 F07 S9528 Healy Hs V224951 4.5.05 Stage 4.doc Version 1.30 Page 6 Individual Plans had been developed to include much more detail, these had been agreed with each person. People were getting better support with recognising their needs and setting goals, two said they felt better in themselves. Some decorating had been carried out in the hallway, which made the home look brighter. Some staff had received relevant training. What they could do better:
There were lots of matters needing attention; it was of concern that most were remaining from previous inspections. The guide to the home needed to be improved, so people are clear what services and facilities are available. To protect peoples’ rights, the contracts of residence should be further developed to specify more clearly terms, conditions and rules. More attention must be given to people taking risks and how staff should respond to these situations. All staff who deal with medication needed training, medication guidelines needed updating and accurate medication records must be kept. People living in Healy House must have a clear complaints procedure, which includes contact details for the Commission. Guidelines for protecting people from abuse needed updating, to make sure staff do the right things. The home needed improving inside and outside, to provide a more comfortable, appealing and homely place for the people living there. Bedrooms needed more things like furnishings, unless people agreed they didn’t want or need them. Another toilet was needed on the ground floor, as there was only one in the bathroom. To reduce the spread of germs, the laundry walls must be easy to clean, the floor must not be absorbent and people must be able to wash their hands. Staff training needed to continue in first aid, health and safety, food hygiene, mental ill health and NVQ training (National Vocational Qualifications) Staffing arrangements needed to be more flexible, so people get support as and when they need it. More staff were needed for one to one support. A manager for the home needed to register with the Commission. People living in Healy House, their relatives and others must be formally asked if things are allright , to make sure the home is being run in their best interests. To protect people from possible scalding, a device must be fit to the bath and shower to control the water temperature. To make sure everything in the Healy House is as safe as possible, all areas and routines must be carefully considered, to reduce the risk of harm to people living there, staff and visitors.
Healy House F57 F07 S9528 Healy Hs V224951 4.5.05 Stage 4.doc Version 1.30 Page 7 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 F57 F07 S9528 Healy Hs V224951 4.5.05 Stage 4.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection Healy House F57 F07 S9528 Healy Hs V224951 4.5.05 Stage 4.doc Version 1.30 Page 9 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 standard(s) 1,3,5, The homes statement of purpose and service user guide were still inadequate and did not provide accurate and sufficient information to enable current and prospective service users to be clear about the services and facilities provided. The service users contracts and terms and conditions were insufficient in agreeing the specifics of occupancy and safeguarding rights. The lack of progress in addressing previous requirements, suggested the home was unable to appropriately meet service users needs and aspirations. EVIDENCE: A statement of purpose and service user guide were available, but they had not been updated to include appropriate specific information. Service users spoken with were not aware of the service user guide. A copy of the last inspection report was available. Several requirements and recommendations from the previous inspection were found to be outstanding. Service users had contracts/terms and conditions of residence in their files; these had not been revised and updated to include further good practice safeguards. Healy House F57 F07 S9528 Healy Hs V224951 4.5.05 Stage 4.doc Version 1.30 Page 10 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 standard(s) 6,8,9 Improvements in the content of individual Plans had resulted in a more effective response to individual service users support needs. Systems were in place to enable service users to make decisions about their lives. Assessing responsible risk taking needed further attention, to ensure a reasonable balance is achieved between independence, choice, rights and personal safety. EVIDENCE: Individual Plans included more specific details of service users support needs, goal planning and action to be taken by staff. Reviews had been carried out. Service users had been involved with defining their Plans; they had signed in agreement with them and were aware of their contents. Service users were seen being consulted and involved in day-to-day matters, they said that house meetings were still being held weekly. The house manager said one service user had agreed to be involved with staff recruitment. Promoting independence was reflected in Individual Plans and observed in practice.
Healy House F57 F07 S9528 Healy Hs V224951 4.5.05 Stage 4.doc Version 1.30 Page 11 Some risk assessments had been completed, others needed updating or defining in response to individual circumstances. Risk assessments had not been completed on service users having access to hot water in their rooms. Healy House F57 F07 S9528 Healy Hs V224951 4.5.05 Stage 4.doc Version 1.30 Page 12 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 standard(s) 13,14,15, Service users were being offered opportunities to engage in a range of activities and were supported to use community facilities. No progress had been made in addressing staffing arrangements; as a result service users support was constrained. Arrangements were in place to enable service users to maintain links with families and friends. The management of complex relationships needed improvement to safeguard service users from abuse or exploitation. EVIDENCE: On the day of the inspection all the service users were using local community facilities. Individual activity plans were seen indicating proposed activities. Service users spoke of the various activities, both in and out of the home, including pubs, shops, sports centres, caring for pets, cooking and baking. One person was considering a college course. A holiday abroad was being planned for, one service user explained how they had researched this and decided on the destination. A relative visited the home and was made welcome. Service users said they were keeping in touch with families, via ongoing visiting or short breaks away.
Healy House F57 F07 S9528 Healy Hs V224951 4.5.05 Stage 4.doc Version 1.30 Page 13 Service users files indicated complex relationships/behaviours were being responded to with the involvement of other agencies. Staff considered the insufficient staffing levels restricted support, in helping service users form appropriate relationships. Staff rotas and discussion with staff, indicated no progress had been made in improving staffing arrangements to offer greater flexibility of support. Healy House F57 F07 S9528 Healy Hs V224951 4.5.05 Stage 4.doc Version 1.30 Page 14 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 standard(s) 18,19,20 Support with personal care was provided sensitively in a way which promoted service users privacy, dignity and independence. Service users health care needs had been identified and were being addressed. Policies and practices for managing medication were insufficient and potentially placed service users at risk. EVIDENCE: Individual Plans identified any assistance service users needed with personal care, staff said current service users needed minimal assistance, either prompting or encouraging. Service users said they chose their own clothes; one was planning for a change of hairstyle. Staff were observed to treat service users in a respectful and sensitive manner. Records indicated service users were having access to medical professionals, including psychiatric consultants; arrangements had been made for routine health checks. The medication management policies and procedures did not reflect current guidance, but were in the process of being reviewed and updated. Not all staff responsible for managing medication had received accredited training. Most medication records were accurate; some had not been completed appropriately. Risk assessments had been carried out for service users managing their own medication.
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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 standard(s) 22,23 No progress had been made in providing service users with an appropriate complaints procedure, therefore their rights to have their views acted upon were not clear. There had been limited progress in amending the protection of vulnerable adults policies and procedures to ensure a proper response to any suspicion or allegation of abuse, this might place service users at risk. EVIDENCE: Some service users said they could raise any issues at the weekly house meetings, or speak with a member of staff or the registered provider if they had concerns. None of the service users spoken with were aware of a written complaints procedure, or that they could refer complaints to the Commission. A copy of the complaints procedure was unable to be located. A policy on managing complaints was available. The protection/abuse policies and referral procedures had not been revised and updated, but were seen to have hand written proposals for change. Some staff had received guidance on abuse and protection as part of NVQ training, or the induction training programme. Healy House F57 F07 S9528 Healy Hs V224951 4.5.05 Stage 4.doc Version 1.30 Page 17 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 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. The outstanding matters mean that the home does not provide a safe, comfortable and homely environment for the service users. EVIDENCE: Healy House F57 F07 S9528 Healy Hs V224951 4.5.05 Stage 4.doc Version 1.30 Page 18 The outward appearance of the home was unkempt, windows to the front of the building looked to be in a poor state of repair. The ceiling and walls in the lounge were covered in ‘office style’ panels; there was fluorescent strip lighting. The carpets in the lounge, hallway and stairs looked shabby. Some decorating in the hallway had been done, but had not been completed. The kitchen and bathroom were decorated and maintained to a good standard. The service users were generally happy with their bedrooms, but one said a new mattress was needed. No lockable facilities had been provided for service users. There were no records to show service users had been asked what furnishings they needed in their rooms. There was only one toilet in the bathroom upstairs, with no toilet near the ground floor bedroom. The home was generally clean and free from unpleasant odours. The laundry walls and floor were not easily cleanable and there was no sink for washing hands. The registered provider must supply the Commission with an action plan indicating how the required timescales to meet the requirements relating to these environmental matters will be met within 2 weeks of receiving the report. Healy House F57 F07 S9528 Healy Hs V224951 4.5.05 Stage 4.doc Version 1.30 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,35 No progress had been made in ensuring there are a sufficient number of suitable staff to provide a flexible responsive service. The staffing levels were insufficient in providing service users with adequate one to one support. Training to ensure staff are competent to do their work was ongoing, but more was needed. EVIDENCE: There had been a number of changes in the staff team, which had affected stability, but service users spoken with expressed an appreciation of the current staff. Positive and respectful interactions were observed. The minimum required staffing levels were in place; the staff rota indicated the staffing levels were being kept up. An additional staff member was on duty twice per week. There was one member of staff on duty from 5pm onwards, which limited evening activities for service users. Staff considered there was insufficient opportunity to provide effective one to one support for service users. Staff recruitment was ongoing. One member of staff was undertaking NVQ (National Vocational Qualifications) level 2 in care; the deputy manager was to commence NVQ level 3. In house training on ‘challenging behaviour’ was being arranged. The house manager was attending in house training on mental health issues.
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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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,42 Although the management practices and leadership approach, had improved the support and service for the people living in the home, a registered manager was needed. Some arrangements had been made to maintain health and safety; further safeguards were needed to promote the well being of residents and staff. The residents and others were not being formally consulted about the quality of the service, so had limited opportunity to influence developments in the home. EVIDENCE: There had been a change of house manager since the last inspection and several positive changes in management systems had been introduced. The atmosphere in the home was relaxed and welcoming. Positive interactions were observed between the service users, staff and manager. Service users said they were happy with the current management arrangements. Mary Healy
Healy House F57 F07 S9528 Healy Hs V224951 4.5.05 Stage 4.doc Version 1.30 Page 22 the Registered Provider was not managing the home on a day-to-day basis; therefore a Registered Manager was needed. Risk assessments had not been completed for all safe working practices in the home. There were no formal quality assurance/consultation systems being carried out. Staff had received ‘in house’ fire safety training; a fire drill was carried out at the time of the inspection. Not all staff had received training in first aid, basic food hygiene or infection control. Hot water temperatures had not been risk assessed and were not regulated to the bath/shower. Healy House F57 F07 S9528 Healy Hs V224951 4.5.05 Stage 4.doc Version 1.30 Page 23 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 x 2 x 2 Standard No 22 23
ENVIRONMENT Score 1 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 x 3 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x 2 2 x x 2 Standard No 11 12 13 14 15 16 17 x x 3 2 2 x x Standard No 31 32 33 34 35 36 Score x 2 2 x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Healy House Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 3 2 x x 2 x F57 F07 S9528 Healy Hs V224951 4.5.05 Stage 4.doc Version 1.30 Page 24 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 1 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 service user guide must be given to each service user. (Timescale of 25/2/05 not met) Progress must be made in addressing requirements and recommendations, to ensure the service users needs and aspirations are safely and appropriately met. Risk assessments/management strategies must be completed, on service users engaging in activities which may affect their health or well being.(Timescale of 28/1/05 not met) Staffing arrangements must be flexible and responsive to meet service users needs All staff responsible for dealing with medication must receive accredited medicines management training (Timescale of 1/3/05 not met) Medication management policies and procedures must be in accordance with current Timescale for action 8/7/05 2. 3 12,13,16, 18,23 8/7/05 3. 9 13 3/6/05 4. 5. 14,15, 20 16,18 13,18, 8/7/05 5/8/05 6. 20 13 8/7/05 Healy House F57 F07 S9528 Healy Hs V224951 4.5.05 Stage 4.doc Version 1.30 Page 25 7. 8. 20 22 13,17, 22 9. 23 13 10. 24 16,23, 11. 26 12,16,23 12. 13. 27 30 23 16,23 14. 32,35,42 18 15. 33 18 16. 37 8 recgnised guidelines and legislation. Accurate records must be kept of medication given to service users. Service users must be provided with a clear complaints procedure, outlining the steps to be take should they wish to make a complaint. The procedure must include the contact details of the Commission (Timescale of 28/1/05 not met) The protection and abuse policies and procedures must be amended to include appropriate details for responding to suspicion, allegation or evidence of abuse or neglect. The home must be refurbished to a satisfactory standard(Timescale of 1/3/05 not met). Service users bedrooms must include the minimum furnishings as outlined in standard 26, of the National Minimum Standards, unless otherwise agreed. A toilet must be provided on the ground floor The laundry floor must be made impermeable, the walls washable and a wash basin provided. (Timescale of 1/3/05 not met) All staff must receive training appropriate to the work they perform.(Timescale of 1/3/05 not fully met)l Sufficient numbers of staff who are trained and competent to meet the needs of the service users, must be on duty at all times. A manager must apply for registration with the Commission.) (Timescale of 4/5/05 3/6/05 8/7/05 25/11/05 8/7/05 25/11/05 25/11/05 5/8/05 10/6/05 10/6/05 Healy House F57 F07 S9528 Healy Hs V224951 4.5.05 Stage 4.doc Version 1.30 Page 26 1/3/05 not met) 17. 39 24 A formal system for reviewing and improving, the quality of care provided at the home must be implemented. A suitable thermostat which provides water at a safe temperature must be fitted to the bath and shower. Timescale of 1/3/05 not met) Risk assessements for safe working practices must be completed. 5/8/05 18. 42 13 8/7/05 19. 42 13 8/7/05 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 5 Good Practice Recommendations Service user contracts should be developed to ensure that they meet the details specified in Standard 5 of the National Minimum Standards for Care Homes for Younger Adults. The complaints procedure should advise service users that they may refer a complaint to the Commission for Social Care Inspection at any stage, should they wish to do so. The complaints procedure should reassure service users and/or their representatives they will not be victimised for making a complaint. Ation should be taken to ensure the homes policies and procedures in respect of physical intervention/restraint, are in accordance with Department of Health guidance. 2. 22 3. 23 Healy House F57 F07 S9528 Healy Hs V224951 4.5.05 Stage 4.doc Version 1.30 Page 27 Commission for Social Care Inspection Unit 4 Petre Road Clayton-le-Moors Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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