Inspection on 25/09/07 for Heanton Nursing Home

This inspection was carried out on 25th September 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Heanton Nursing Home 04/09/08

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Heanton Nursing Home Heanton Punchardon Barnstaple North Devon EX31 4DJ Lead Inspector Adele Adams Unannounced Inspection 10:00 25th September and 3 October 2007 rd 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 Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heanton Nursing Home Address Heanton Punchardon Barnstaple North Devon EX31 4DJ 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) 01271 813744 PSP Healthcare Ltd Vacancy Care Home 64 Category(ies) of Dementia - over 65 years of age (64), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (64) Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection Newly registered Brief Description of the Service: Heanton Nursing Home is a service that is provided in a large Victorian house situated in the small village of Heanton Punchardon, close to Braunton and Barnstaple in North Devon. The service changed ownership in February 2007 and is now owned by PSP Healthcare Limited. The house is set in well-maintained grounds, which includes to the front a sensory garden and extensive views over the Taw Estuary and Bideford Bay. There is ample parking space and disabled access is available at the side of the house. Heanton church is within walking / wheelchair distance and there is a post office and general store close by in the village. The house has been adapted for use as a care home with nursing. The registration categories allow for a maximum of 64 service users to live in the home, the present categories to provide care for those with a mental disorder and dementia. The service mainly provides specialist care to older people who have dementia. There are three separate areas within the home that cater for different levels of health care need. These are known as, Williamson, Tarka and Chichester. These are arranged over the ground and first floors and are accessed by two shaft lifts. The home has two activities co-ordinators who help service users to pursue activities and interests. There is ample communal space and areas in which service users can wander freely. The fees are generally reviewed once a year in April and are agreed before admission; additional charges are made for personal items such as toiletries, magazines, newspapers, chiropody and hairdressing. Copies of previous inspection reports are available within the home. Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection has introduced “Key Standards “ to be inspected over each inspection year. Therefore, unless it is felt necessary by the inspector, some standards may not be inspected. This inspection was unannounced and took place over two days starting at 10:00 and ending at 17:15 on the first day and staring at 9:15 and ending at 12:15 on the second day. This was the service’s first inspection under the new ownership of PSP Healthcare Ltd. The purpose of this inspection was to inspect the key standards this included looking at: information; health and social care; leisure activities, complaints and protection; environment; recruitment; management and health & safety. To do this, we looked around the home and also read records, policies and procedures. Time was also spent observing people that use the service. We also spoke to five staff, during the inspection. Surveys were sent to people using the service, health and social care professionals and comments from those received are included in the report. One health care professional responded, two care staff responded and, two relatives there were no responses on this occasion from people using the service. There were some visitors to the home during the inspection and we were able to speak with one of them. Information was also received before the inspection from the service as requested by the Commission for Social Care Inspection. This was in the form of an Annual Quality Assurance Assessment that provided us with important information that supported this inspection. All of the above information has contributed to the inspection findings included in this report. Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? This does not apply on this occasion, as this inspection was the service’s first under the new ownership of PSP Healthcare Ltd. Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 7 What they could do better: This inspection found that some medication practices in the home had to be improved. Some of the practices needed to be improved immediately and so we gave the service immediate requirements, these are given to make sure that swift and immediate action is taken. The details of these are included below. The service was asked to check all medication records to see that all people using the service (or if unable to a recognised person or persons acting on their behalf) have given their permission to be given their medication. The service was asked to check all medication records to see that if there are special instructions recorded about how to help a person take their medicine to prevent a person missing out on essential treatment, that this is written following up to date recognised guidelines. The service was asked to make sure that where permission is not recorded – that the consent for the administration of medication for each person receiving care must be obtained and held on record. The service was asked to carry out a full review of their medication policy and procedure in line with the Care Standards Act and Care Homes Regulations, the National Minimum Standards for Care Homes, the Nursing and Midwifery guidelines in relation to the administration and the covert administration of medicines and the Royal Pharmaceutical Society of Great Britain guidelines and the Mental Capacity Act. This is to make sure that the service policy follows up to date, recognised and appropriate guidelines. The service was asked to identify staff medication training needs and the arrangements made to meet those training needs. It must be noted that the service did respond both swiftly and professionally to these to ensure the well being of the people using their service. In addition, medication received into the home on behalf of people using the service must be clearly and appropriately recorded. This is to make sure that people receive the correct prescribed medication and that clear audit trails are in place. The service on taking over the home identified that staff recruitment records needed improvement – this is commendable – however this has taken rather a long time to complete and should now be addressed as a priority. This is to make sure that all staff records hold the correct information about staff so that the service can be confident that the staff in their employment pose no risk to the vulnerable people using their service. Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 9 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 Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The service’s performance was assessed against Key standard 3. Standard 6 does not apply. Quality in this outcome area is good. People who may use the service at Heanton Nursing home have undergone a thorough assessment process to determine whether their needs can be met by the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provided a completed AQAA (Annual Quality Assurance Assessment), which described how the service selects people through assessing their individual needs. Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 11 The Statement of Purpose was read and advises people that a pre admission assessment will be undertaken by a qualified nurse to assist the service in identifying whether they can meet the persons care needs. On this occasion people using the service were unable to tell us about their own pre admission assessment experience. In addition, we read five people’s records and these showed the large amount of good quality information that is gathered during the assessment process that enables the service to make their decision about whether or not they can meet a person’s needs. This information is gathered form various sources and includes information from relatives, care managers, mental health and health professionals and frequently includes a multi agency assessment. This information confirmed what had been stated in the AQAA. Although Standard 1 was not fully inspected on this occasion, the Statement of Purpose / Service Users guide was referred to. Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. The service’s performance was assessed against Key standards 7, 8, 9, and 10. The health and personal care that people receive at Heanton Nursing Home is based on each person’s individual needs. The principles of respect, dignity and privacy are put into practice. Some current medication practices place people at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provided a completed AQAA (Annual Quality Assurance Assessment), which described how having a settled staff team helps in caring for the people living at Heanton Nursing home. We read five people’s records and these showed that there has been a major overhaul of people’s individual care records. (We were advised that the company that now owns this service has the same approach to care records in all of their homes). Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 13 This change has had positive results and the records are very well organised, easy to follow and information can be found and tracked more easily. There was a general discussion with four nursing staff about the new style care records and it was generally felt that the new style records are more professional. The records hold a great deal of important information about each individual and clearly show each person’s health and social care details. The personal information includes a personal profile, which provides staff with a good understanding of the individual’s life experience that staff find can be really beneficial when working with people with dementia and mental health problems. There are good multi disciplinary records, which clearly show the involvement of other health professionals in people’s care, for example the involvement of a visiting psychiatrist, the involvement of a General Practitioner and visits form other health care professionals such as a physiotherapist and optician. We saw that when a person cannot be involved in the writing of the care record themselves that their person’s representative is involved in this on their behalf. Areas that had been identified by us for improvement were brought to the four nursing staff’s attention. This included the lack of some necessary entries in care records about the use of bed rails /cot sides. For example when such decisions are made the involvement of an advocate and other health professionals must be evident, Staff agreed with this and gave assurances that this will be addressed. During the inspection staff were observed acting in a respectful manner to people using the service at all times. People using the service were not able to say that the care they receive is that which has been recorded in their care plans. However, the relative that was spoken with together with the observations we made during the inspection and the survey responses we received show that it is. The medication arrangements at the home were inspected. Staff confirmed and we observed that trained nurses give the medicines to people. Medicines that are given to people are prescribed on a Medication Administration Record (MAR) and a nurse signs this when the medicine has been given. Medication is stored suitably and securely and in line with the recognised appropriate guidelines. We found that there were some gaps in the recording of medicines given to people, which made it unclear whether a person had or had not received their Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 14 medicine. This was pointed out to the Registered Manager as an area needing improvement. In addition, we read some instructions that directed that in some cases medicines were to be crushed and then placed in jam (this information was stored with the people’s concerned MAR sheets) in order to make sure people took their medicine. This type of action should only take place after strict guidelines are followed appropriately. For example only after following a formal shared decision making process which involves people such as a doctor, a nurse, a care manager, a pharmacist and a relative or advocate acting in the best interest of the person concerned – the decision is then clearly recorded. This finding was brought to the attention of the Registered Manager and an immediate requirement was issued, as there was no evidence of such a decision-making process taking place and no documented reference to these actions in any care records. The medication policy for the home was read and was found to consist of several fragmented policies, some of which were out of date and had not been reviewed. This was brought to the attention of the Registered Manager. It must be recognised that during the remaining inspection period the Registered Manager obtained up to date and appropriate medication guidance and gave assurances that action would be taken promptly to address the other medication findings. The newly registered manager explained that the service’s policies were currently being reviewed – the company human resource officer who was present later in the inspection also confirmed this. Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. The service’s performance was assessed against Key standards 12, 13,14 and 15. People who use the services at Heanton Nursing home are enabled where possible to make safe choices about their life style, and are supported to have their social, cultural and religious needs met. People’s nutritional needs are well provided for. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provided a completed AQAA (Annual Quality Assurance Assessment), which told us that there are two activities coordinators that provide a varied programme of activities and that over the last twelve months this is an area that has been continually reviewed and that new equipment has been purchased. The service told us that they gather feedback about how well they perform through our inspection reports, and feedback from people that use the service, their relatives and staff. Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 16 We read five people’s care records these contained details of people’s social care needs, their likes and dislikes, their interests and their contact with friends and family; for example it was noted that one person tends to isolate themselves, another record noted that someone does not take the lead in making social contact but does enjoy company, care records contain an activities assessment form which details each person’s interests and hobbies and evidence of the activities people have taken part in. An activities record showed us that people had taken part in a wide range of events including; arts and crafts, reminiscence therapy, music, charades, bingo, the hairdresser and states if people have decided not to take part and why – showing that people’s right to choose is recognised and respected. We saw visitors at the home with people that use the service; one of the visitors was able to spend time talking with us and was very positive about the care that is provided. The five care records that we read contained information about people’s dietary needs and noted if people needed a special diet or help with eating their meal. For example we saw that some people need a diabetic diet and others have allergies such as an allergy to cheese and some need to have their meals pureed and others like to have ‘ finger food’ – all of these needs are catered for. We spent time talking with the chef and found the kitchen to be in good order, the menu continues to provide a varied well balanced choice of meals and is a four weekly menu and the produce is seasonal, fresh meat, fruit, vegetables and milk are delivered daily and bread is delivered three times a week. The chef told us about how individual needs are catered for in the kitchen. Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The service’s performance was assessed against Key standards 16 and 18. A complaints procedure is in place, and people using the service are protected from abuse, and have their rights protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provided a completed AQAA (Annual Quality Assurance Assessment), which told us that there have been no complaints in the past twelve months and that they communicate well with people that use the service and their advocates. We read the complaints process and saw that it is also on display in the entrance and in the office area on the ground floor. The procedure contains nearly all of the necessary information and the manager was advised that the timescale within which a complaint will be dealt with should also be included in the procedure. The three staff that we spoke with knew of the services complaints procedure and what action to take if a complaint was made. The surveys we received showed that staff and relatives are aware of what action to take if they wish to complain and that they have confidence in the service. Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 18 We saw information about protecting vulnerable adults displayed clearly in the home. The staff we spoke with confirmed that they had received training in this area and were clear about their responsibilities. The registered manager told us that in house training had been provided for staff and that the service had put forward a member of staff for training in this area so that they could do their own training in house – the manager advised that unfortunately this had been postponed and that the service is currently waiting for a new date to be confirmed by the agency providing ‘ train the trainer training. The surveys we received and discussion with a relative confirmed that relatives have confidence in the service. Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The service’s performance was assessed against Key standards 19 and 26. Heanton Nursing home provides a comfortable, clean and safe environment suitable to the needs of those who reside there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provided a completed AQAA (Annual Quality Assurance Assessment). This told us that the location and cleanliness of the home is a positive aspect of the environment and that the service receives feedback about the environment from social services, relatives and the quality assurance survey and that over the next twelve months ongoing maintenance and refurbishment will continue. Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 20 We took a tour of the home, which confirmed the previous inspection findings, we saw that the ‘ Dolphin room’ has recently been redecorated and is much brighter, it was good to see that more people seem to be using this room. We saw a number of specialist disabled bathing facilities provided in large bathrooms including a Hi-Low bath and two Parker baths. There were also suitable toilet facilities within a reasonable distance from communal and sleeping facilities. The home has disinfecting sluices on each floor in its own rooms with wash hand basins available for staff to use. The home has been further adapted to meet the needs of the service users with the installation of two 8 man shaft lifts, hand rails where they are needed such as in toilet facilities and corridors, low surface temperature radiators, nurse call system to all areas, mobile and bath hoists and storage space for such things as wheel chairs. All windows are double-glazed and are at a height that enables a good view from a seated position either in a chair or on the bed. Bedrooms are of good size with a number of doubles rooms available for choice to be met. Service users only share double rooms after agreement with the appropriate people and this is recorded in the service users files. There is privacy screening in all double bedrooms. Rooms are suitably decorated and furnished and all have a nurse call system, wash hand basin with push taps in a vanity unit. It was confirmed that fresh towels and face cloths continue to be provided daily. The home still has its own large laundry that operates seven days a week with full time staff working in it. The floors and walls provide suitable surfaces for cleaning and will not be permeable to water. The equipment includes three commercial sized dryers, 2 commercial washers with sluicing cycles and one without a sluicing cycle. There is also a commercial ironing machine. A suitable hand basin together with liquid soap and paper towels is provided. A member of staff described how soiled and infected linen is handled and confirmed they had received infection control training. Protective equipment such as aprons and gloves is provided for use. Each person using the service has his or her own laundry basket and clothing is name tagged. The home was clean and odour free during the inspection. The registered manager told us that the mountainous programme is to be planned annually. There are two people employed to cover five days a week to Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 21 undertake general maintenance of the home and one person carrying out general maintenance was seen by us during the tour of the home. Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The service’s performance was assessed against Key standards 27, 28, 29 and 30. The home usually has satisfactory numbers of suitably qualified and skilled staff on duty to meet the needs of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provided a completed AQAA (Annual Quality Assurance Assessment), which told us that the service has an experienced stable staff team that communicates well and that the staffing levels are correct. The service says that they get feedback that staffing is managed well from surveys, staff meetings and staff supervision. The service tells us that they have increased staff supervision and there is a set supervision programme in place and that they plan to recruit two more care staff. We read staff rotas, staff records, and spoke with three nursing staff, a care worker and the Registered Manager and read staff surveys. Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 23 A staff survey informed us that there are not always four care staff covering and that this is the minimum number needed – this was also confirmed by another member of staff spoken with during the inspection. The staffing rotas indicated that there are adequate numbers of staff rostered to work, however further reading of the staffing rotas showed that due to staff illness and difficulty obtaining a qualified nurse, that on one previous occasion there was only one qualified nurse supported by carers to care for fifty one people using the service. The Registered Manager had also worked as a carer when a carer was ill – on this occasion this meant for a period of three hours there were 3 care staff and one trained nurse on duty. During this inspection we found that there were adequate numbers of staff on duty. The Registered Manager advised us that two care staff have been recruited by Head Office to provide cover when it is needed. Discussion with the staff and reading of training records showed us that staff do have access to training and do undergo an induction period when they join the service. Examples of training attended include, food hygiene training, moving and handling, the protection of vulnerable adults, health and safety and fire training. Nursing staff told us that they keep up to date professionally through reading of professional journals, by attending training, through regular supervision and by attending meetings with specialist nurses. Staff identified that more dementia training would be beneficial. We also read staff recruitment records. We were told that when the home was purchased staff recruitment files were checked to make sure that the correct information was held for all staff employed by the service and a record was made of any additional information that was to be obtained. We were shown a spreadsheet that contained this information. We were informed that the person who had been doing this was now on long term leave and that another person had since been brought in to complete the task. We found that some staff records contained all necessary information in line with the service’s recruitment policy and others did not – which as stated above was indicated on the service’s spreadsheet following their own audit on purchase of the service. We also found that some staff did not have contracts of employment and we were advised by the services Human Resources Manager and the Registered Manager of the service that all staff were being issued with new company contracts of employment. We also discussed the finding that one employee that has minimal contact with people using the service has had a POVA First check undertaken but had no Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 24 references held on file and no CRB check – we were informed that the CRB check was being undertaken and that character references would be sought. We informed the Registered Manager that whilst it is evident that the issue of staff records is being addressed in line with company policy, it is essential that this be addressed with more urgency, as it is six months since the home had been purchased and this information is essential and plays an important part in protecting vulnerable people that use the service. We were given assurances that the updating of staff recruitment records in line with company policy would be addressed as a matter of priority. Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The service’s performance was assessed against Key standards 31, 33, 35 and 38. The home being managed by a Registered Manager, people’s views are taken into consideration and health and safety issues are taken seriously. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provided a completed AQAA (Annual Quality Assurance Assessment). The management and administration section of this form told us that the service keeps excellent records, has ‘full occupancy’ and that they receive feedback from visitors and staff. The service told us when maintenance of equipment had taken place and what policies are in place, these were last reviewed in 2006. Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 26 The service told us that it has to get used to the new systems and paperwork that have been introduced since being under new ownership, and that they have had no complaints in the past twelve months and that they are introducing new systems. The manager of the service is registered with the Commission for Social Care Inspection, has an NVQ Level 4 and the Registered Managers Award and is a qualified nurse. The staff we spoke with were complimentary about her management style and abilities. The staff were clear about how the home is run and managed and the changes that have taken place since she has been manager of the home. The atmosphere was friendly, relaxed, organised and professional throughout the inspection. We found that there is a planned approach to Quality assurance, the company undertakes an annual quality assurance survey and staff surveys were done in February 2007, a copy of the staff questionnaire was seen by us. The last surveys were previously carried out in October 2006. The Registered Manager told us that the company’s service managers meet to discuss quality Assurance and that she was attending a meeting later in the week. Three staff and the registered manager told us that there is no involvement with people’s finances- except when items such as small personal items are bought for a person and then there is a process in place which is followed – evidence of this was seen when people’s individual records were read. We read records that show that a fire drill took place in June 2007 and that the Fire Risk Assessment was reviewed in February 2007; fire training was last undertaken in May 2007. The service’s Fire maintenance and safety certificate was issued in June 2007. The service has indemnity insurance and this expires in January 2008. We read the service accident book – on our advice the position of this was changed to a more secure location during the inspection as it contains personal information about people that use the service and staff. We saw that equipment such as hoists are serviced and the next service is due in November 2007. When visiting the service’s kitchen a fridge – (fridge 2) was not working. This resulted in other fridges in the home being overloaded – we were told that this fridge had been breaking down recently and had been reported and was again awaiting repair. This was discussed with the Registered Manager as it is important for a home to have appropriate cold storage facilities available at all times. Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NA 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 OP9 Regulation 13(2) Requirement When medication is received into the home on behalf of people using the service it must be given safely, following current recognised guidelines. This is to make sure that people do not receive medication covertly. An Immediate Requirement was issued. When medication is received into the home on behalf of people using the service it must be given safely with a person’s consent. This is to make sure that people do not receive medication covertly and that every person’s consent is recorded in respect of their agreeing to be given medication. An Immediate Requirement was issued. Robust arrangements for the 26/09/07 recording, handling, safekeeping, safe administration and disposal DS0000068924.V338538.R01.S.doc Version 5.2 Page 29 Timescale for action 26/09/07 2. OP9 13(2) 26/09/07 3. OP9 13(2) Heanton Nursing Home of medicines received into the care home must be in place and monitored. This is to make sure that Heanton Nursing home’s medication policy and procedure are in line with the Care Standards Act and Care Homes Regulations, the National Minimum Standards for Care Homes, the Nursing and Midwifery guidelines in relation to the administration and the covert administration of medicines and the Royal Pharmaceutical Society of Great Britain guidelines and the Mental Capacity Act. This is to make sure that if there are certain circumstances when ‘covert’ administration needs to be considered to prevent a person missing out on essential treatment, a clear policy is in place, which is specific to the individual and in line with all recognised current practice guidelines. An Immediate Requirement was issued. When medication is received into the home on behalf of people using the service it must be clearly and appropriately recorded, kept securely, given safely and disposed of correctly. This means that there should be a full review of staff skills and knowledge in relation to all aspects of dealing with people’s medication. This will identify staff medication training needs, gaps in staff knowledge and identify the arrangements Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 30 4. OP9 13(2) 26/09/07 needed to meet identified training needs. This is to ensure that the service’s medication practices are sound. An Immediate Requirement was issued. When medication is received into the home on behalf of people using the service it must be clearly and appropriately recorded. 5. OP9 13(2) 15/12/07 6. OP29 4 (c) Schedule 2 (5) This is to make sure that the risk of error is minimised and there is a clear audit trail in place. Staff employed by the service 15/12/07 must have all necessary documentation kept on file. This is to make sure that the service is confidant that all the necessary steps have been taken with the people in their employment to protect vulnerable people using the service. 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 OP38 Good Practice Recommendations Appropriate facilities for the cold storage of food should be available at all times to ensure that food does not become contaminated. Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Heanton Nursing Home DS0000068924.V338538.R01.S.doc Version 5.2 Page 32 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!