Inspection on 04/09/08 for Heanton Nursing Home

This inspection was carried out on 4th September 2008.

CSCI found this care home to be providing an Adequate service.

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 25/09/07

Extracts from inspection reports are licensed from CQC, this page was updated on 26/11/2008.

CARE HOMES FOR OLDER PEOPLE Heanton Nursing Home Heanton Punchardon Barnstaple North Devon EX31 4DJ Lead Inspector Jo Walsh Unannounced Inspection 09:30 4 & 9 September 2008 th th 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.V367964.R02.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.V367964.R02.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 0870 286 9463 manager@heantonnh.org.uk www.psphealthcare.com PSP Healthcare Ltd Mrs Sarah Jane Coull 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.V367964.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 03/10/07 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.V367964.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key inspection took place over two days during September and included the regional pharmacist advisor inspecting medication practices during one of the days. To help us understand how the home runs we spoke to people who live at Heanton and also to seven visiting relatives. We also observed care practice throughout different periods of the day, but particularly at lunchtimes. Time was also spent talking to staff members and looking at some key documents including plans of care, assessments completed in respect of individuals needs, staff recruitment records, medication records and staff training. Surveys were sent to a sample of people who live at the home, staff and to local general practitioners. Their views are included throughout the report and have helped to inform the inspection process. Prior to the inspection the home were asked to complete an Annual Quality Assurance Assessment (AQAA), which provides us with information about how the home maintains a safe environment, what staff training has been implemented and how they monitor their quality of care and support. The registered manager for Heanton is off on long-term sick leave. The registered provider has implemented interim management arrangements and this involves the registered manager from another service within the PSP group providing management support to the home. What the service does well: People who live at Heanton and/or their relatives said • I am treated really well, staff look after me. • I chose this home for my relative because it was recommended by our GP, and they do a really good job looking after people • We have been very happy with the care xx gets. Heanton provides people with a safe relatively well maintained and homely environment. The home has been adapted to meet the needs of people who are frail elderly and who have dementia. There is a keypad system on doors to ensure individuals who are at risk of wandering off, are kept safe. Comments from relatives varied but the majority of those spoken to said that Heanton provided a good environment. One person said ‘’ Staff make strenuous efforts Heanton Nursing Home DS0000068924.V367964.R02.S.doc Version 5.2 Page 6 to keep the home clean and well aired. It is not easy to cope with incontinent residents and despite their best efforts there are at times, particularly after ’accidents’ when there are odours.’’ Plans of care show how individuals’ personal and health care needs are assessed and planned for, and overall people’s needs are well met. The home provides a good choice and range of meals that ensures individual preferences and special dietary requirements are catered for. One relative commented ‘’ the food always smells and looks superb, xx has a good appetite and eats really well here.’’ There are two activity coordinators who work hard to ensure that there is a range of stimulating activities for people to enjoy. One relative said ‘’ the activities coordinators are brilliant, they do a really good job of keeping people involved and occupied.’’ The home has robust recruitment practices that ensure people are protected and systems are in place to train and support staff to do their job safely and competently. Good systems are in place to ensure the views of the people who live at the home are listened to and acted upon to review and improve the quality of care and support. What has improved since the last inspection? What they could do better: Medication guidance and recording needs to be made more robust to protect people and ensure a consistent approach. Arrangements must be made to ensure that clear guidance is available to direct how decisions are to be made for the administration of medicines prescribed to be administered “when required”. Also there must be a clear record of how the decision to administer Heanton Nursing Home DS0000068924.V367964.R02.S.doc Version 5.2 Page 7 has been made. The home should develop audit systems to monitor errors on records and the actions taken, otherwise repeated mistakes and errors may go unchecked. The kitchen was not as clean as it should have been on the second day of the inspection. The record of cleaning had not been completed for the previous few days and there was no evidence of systematic deep cleaning having taken place or being planned. This was discussed as part of the feedback to the manager overseeing Heanton, who agreed to look at getting a deep clean organised as a priority and to ensure this is an ongoing process. We did receive some negative comments via surveys and face-to-face interviews with visiting relatives, that the cleanliness of the home had ‘’gone downhill.’’ However overall relatives said they were happy with the environment. One relative did raise the fact that some doors in the downstairs unit on the small lounge and at the end of the corridor had double handles which, if not held open by the door guards would be impossible for people with dementia or frailness to open. This was highlighted to the manager overseeing the home, and she agreed to arrange to have these removed ASAP. Although staffing levels are sufficient to meet the basic needs of the people who currently live at Heanton, this should be kept under review, to ensure care and support can be delivered in a timely fashion throughout the day. Lunchtimes on both days were observed in both units. In Chichester most individuals eat together in the main dinning area, which appeared cramped for the number of people in there. Staff were extremely busy trying to ensure that those who needed support to eat their meals were given enough time and support. One person did not get their meal until everyone else had finished. Some individuals would have benefited from closer supervision and support. Two people fell asleep during their meal for example and were only encouraged to finish their meal once staff had assisted someone else to eat. Another person poured their drink all over their meal and did not then eat much of the meal. The pudding was served some 10 minutes after most people had completed their main course. This is a long wait for people with dementia and two wandered off and had to be brought back into the dinning area. Staff provide support in a kind and respectful way, but were clearly rushed to ensure everyone’s needs could be met. Staff did report that normally they have some assistance from the activity coordinators who were busy that day getting ready for a planned 60th wedding anniversary and birthday party for people who live at the home. Two relatives have made their concerns known to CSCI in respect of staffing levels at the home. One said that in the Chichester Unit some individuals need 1:1 supervision because they ‘’presented as a risk to other residents.’’ This was not directly observed during the inspection, but these concerns were passed to the manager. Another relative said that there appeared to be a lack of supervision and not enough staff on duty in the downstairs at teatime/bedtime. They highlighted the fact that if there were only four carers on duty and they were putting people to bed, that those people left in the lounges could be without supervision for up to 20 minutes. This is because they layout of the Heanton Nursing Home DS0000068924.V367964.R02.S.doc Version 5.2 Page 8 unit downstairs means that the communal lounges and dinning areas are separate from the bedrooms. The design layout of the home does impact on the availability of staff at key times such as assisting people getting up and going to bed. The management team need look at issues raised re bullying amongst some staff, and ensuring that staff feel able and comfortable to use the whistle blowing policy and discuss any areas of concern within supervision. 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.V367964.R02.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.V367964.R02.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Potential new people benefit from a good admission and assessment process, which ensures that the home can meet their needs. EVIDENCE: Pre admission assessment information for three people was looked at during this inspection. Details include what needs the individual has in terms of personal and health care and includes and identified risks. There is also a copy of the local authority assessment and care plan, which helps inform the home’s own assessment. One of the nurses on duty confirmed that either the manager or a trained nurse visits the potential new person either in hospital or their home and discusses identified needs with the individual if possible and their carers and family members. This helps them to put together an initial plan of care to show how the person’s personal and health care needs will be met. Heanton Nursing Home DS0000068924.V367964.R02.S.doc Version 5.2 Page 11 The AQAA states ‘’ We ask the resident (if possible) and /or a family member to come and visit the home to see the environment and discuss the care needs of the resident and how they can be met. With the aim of providing a high level of reassurance and support, a member of staff will dedicate a significant amount of time to spend with the family on their visit to the home.’’ The home also aims to get family members to complete a ‘’Residents profiling booklet’’, which asks for information about the individual at various stages of their lives. This information can then be used by the home to assess and plan for social needs where possible. Profiles also allow staff to have a ‘glimpse’ of the individual as a person rather than just their needs and tasks they need to complete. One carer said ‘’ I love knowing about the persons history, it helps to get a better picture of them.’’ Heanton Nursing Home DS0000068924.V367964.R02.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): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although individuals’ personal and health care needs are reasonably well met, improvements are needed to ensure the medication system and recording is more robust EVIDENCE: A sample of four plans of care were looked at and discussed with some staff. Plans are well organised and in the main give clear information to staff about how individuals personal and health care needs should be met. Where risks are identified, risk assessments have been put in place and are reviewed regularly as part of the care planning process. Visiting health care professionals who have been completing reviews on individuals have commented that the homes plans of care are very detailed and provide really good information about the needs of people. Plans of care include a range of assessments that include moving and handling, Nutritional risk assessment, falls risk, urinary continence assessment, pressure ulcer risk assessment and oral hygiene. These assessments together with long term goal plans give a very good picture of how individuals nursing and Heanton Nursing Home DS0000068924.V367964.R02.S.doc Version 5.2 Page 13 personal care needs should be met. One plan of care looked at showed that pressure areas had developed and that specialist input via the tissue viability clinical nurse specialist had been sought. Another plan identified via nursing notes and daily records that one individual’s mental health state had deteriorated and both the GP and psychiatrist had been asked to assess the individual. The commission received a regulation 37 notice from the home in respect of a death of one individual. This was followed up during this inspection as the person had died in hospital following a septic foot. The visiting chiropodist was able to confirm that the individual had appeared to respond to antibiotics and that the wound to their foot was healing but that when he debrided it, he could see that there was still infection. The chiropodist stated that the staff had done everything in their power to ensure the individual had good care for this wound, and that following the discovery of an underlining infection, further medical attention was sought. The home have now also begun to look at how they can improve the plans of care by making them more person centred. They aim to achieve this by including a section on the individuals’ personal and preferred routines. This has been implemented as a result of advice given during another inspection in the sister home to this one. This shows that the provider is listening to and acting on advice to improve services within the group of homes owned by the company. Areas where plans need to improve are where PRN medication has been prescribed. Relatives were overall very positive about the care and support individuals receive comments included • Couldn’t ask for better • We have been impressed with the care given • The staff do a very difficult job well One relative said that care had declined and gave the example of an electrical shaver being used for a number of people, without it being cleaned in between uses. This was discussed with the unit sister/nurse and manager who said that people had their own individual shavers, and these were evident in bedrooms and in bathroom areas. Another relative said that during busy times such as assisting people to bed, people left in the communal areas could be left unsupervised for long periods. One person said that the needs of people coming to the home appeared to be more complex and challenging and this concerned them as there have been occasions when one individual has been challenging to other people living in the home, e.g. trying to sit on them or lift them out of their chair, and that staff have not been present or available to supervise. These issues were raised with the manager who said that there are Heanton Nursing Home DS0000068924.V367964.R02.S.doc Version 5.2 Page 14 some individuals who they are currently trying to have reassessed in light of their complex needs in a bid to get increased funding so that they can provided some additional support for those individuals. None of these particular issues were witnessed during the inspection, but other busy periods such as lunchtime were observed and similar conclusions found, i.e. during busy periods four care staff per unit is barely adequate to meet needs in a timely fashion. One survey returned by a staff member states that ‘’Currently there seems to be a problem with staffing. Usually 4 carers would be on shift, but currently there are often only 3 (that is per unit) which is very hard work for little reward.’’ These comments were discussed with the manager who said that they have now taken on more staff and that it would be exceptional for there to only be three carers on shift per unit. There are however some night shifts where there is only one nurse on shift with carers, to cover the whole home. The overseeing manager explained that this was due to some long term sickness issues, that their aim would be to have two trained nurses on at all times. The continuing health care team have raised some concern about the lack of trained nurses in mental health, most nurses are currently general trained nurses, although some have many years experience in working with older people with dementia and mental health issues. The local GP also raised a concern about staffing stating ‘’ Due to the once a week GP visit being discontinued we are now more reliant on the experienced nursing staff to feed back concerns and medical issues to us. The concern recently has been the loss of long standing experienced staff members which ultimately causes variable quality of feedback to ourselves.’’ Staff spoken to in one of the units had differing opinions about the way individuals incontinence should be managed; in order to ensure pressure areas did not develop. Clinical decisions need to be based on best practice with the advice of any specialist in put. In this instance the continence advisor should be consulted. Although care in respect of continence appeared to be consistent, the staff team were clearly not all in agreement with decisions made, and this could effect the way care is delivered. During the inspection we found that many people were prescribed medicines to be administered “when required”. On discussion with the people administering the medicines they were able to tell us how they would make the decision to administer. However we could find neither clear guidance to indicate how these decisions were to be made nor any records of how the decision to administer had been made. This may mean that people would not always receive their medicines consistently. We also found for one person that there is an agreement in place that medicines can be administered covertly. Whilst this decision is well documented part of the risk assessment states that the risk is only identified as occurring “sometimes”. However “sometimes” is not defined anywhere within the plan of care. Again this may mean that people do not get consistent care. Heanton Nursing Home DS0000068924.V367964.R02.S.doc Version 5.2 Page 15 We found that whilst the home has a system in place for the audit and monitoring the expiry dates of medicines and dressings, we found an error regarding the recording of administration of a controlled drug had been picked up by the nurse in charge, but there was no clear audit process to show how this would be followed up. This means that people administering medicines could make repeated errors without this being identified. We found that some people had medicines that were prescribed to be administered at infrequent intervals and that the home had a clear record when these medicines were next due to be administered. The home has provided secure storage for all medicines including those requiring refrigeration. However some medicines that do not require refrigeration during use were not stored appropriately. Also whilst the current temperature of the fridge is recorded no record is maintained of the temperature range meaning that medicines may have been stored inappropriately. Heanton Nursing Home DS0000068924.V367964.R02.S.doc Version 5.2 Page 16 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): 12-14 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who live at Heanton have a range of activities that suits their needs and are supported to exercise choice and control over their lives. EVIDENCE: The home currently has two activity coordinators who work hard to ensure that a variety of activities and events are available for people to participate in. On the first day of this inspection they organised a 60th wedding anniversary and a birthday. This included snacks, celebration cake and an entertainer providing music and singing, which people appeared to really enjoy. Staff said that over the weekend they had put on an Olympics day, where staff and visitors/family members took part in races and a special tea. The AQAA states ‘’We now provide a range of stimulating activities for all residents based on information gained from their life history profile and from their strengths assessments. There are regular entertainers (weekly live music etc) brought into the home and the reaction and participation of the residents is very evident. Our visiting physiotherapist (weekly) also provides a vital form of stimulation for many of our residents. Our dedicated activities assistants use imaginative techniques to stimulate residents in different ways. These activities range from basic things like reading the newspaper through to external visits Heanton Nursing Home DS0000068924.V367964.R02.S.doc Version 5.2 Page 17 to the seaside or shopping trips into town. We also involve residents and supporters in planning their activities and consult on opportunities to improve. Our specialist sensory equipment provides many of our residents with much needed relief. Our local clergy help us to maintain individual spiritual needs in a very effective manner.’’ All visiting relatives spoken to and those who completed surveys spoke very highly about the activities, one commented ‘’the activity ladies are wonderful, they do a brilliant job.’’ Another relative said ‘’ whenever we visit there is usually something being organised to keep people entertained, my xx does not really take part but it is nice to see people being encouraged to join in singing and that.’’ The activity coordinators said that they try to offer a range of things and were in the process of looking at the Pool assessment tool to help them assess individual abilities and engagement levels so that they can gear activities to suit individual needs. Visiting families said that they were always made welcome, that they can visit at any time. One commented ‘’ they even pick me up from the bus, because I could not make the walk up the hill to the home, you couldn’t ask for better.’’ Visitors were encouraged to take part in the celebrations on the day of the inspection, were offered drinks and refreshments. Plans of care seen clearly identified individuals dietary needs, and the chief confirmed that they are aware of individuals likes, dislikes, special requirements and whether food needs to be served in a particular way, chopped or minced for example. The menus showed that a good range and choice of meals are offered each day to people. Although meal times were hectic at times the food served was well presented and served hot. Those people who had to wait for assistance had their meal kept warm. The home have identified in their AQAA that they want to develop their menus over the next 12 months, with more choice and the use of photographic aids. Heanton Nursing Home DS0000068924.V367964.R02.S.doc Version 5.2 Page 18 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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals’ views and concerns are listened to and acted upon EVIDENCE: The home has a stated complaints procedure as well as more informal ways of seeking the views of the people who live at the home. Quality assurance surveys are used and the results of these are collated and posted around the home. Relatives spoken to said that they would be able to make their concerns known to staff and were confident on the whole that they would be dealt with. One person did say that they have tried to make their concerns known but said the ‘’owner was not interested, and there is no head of care you can talk to at present.’’ They did not wish us to discuss their specific issues as they wished to remain anonymous. We were therefore unable to verify what response the home or providers gave. The home do keep a log of all complaints made with what actions and outcomes have been used to resolve matters. The complaints log is looked at monthly by the responsible individual for the company to ensure that the home are following up on any issues. The AQAA states that the home has a whistle blowing policy and encourages an ‘’Open door’’ policy for all staff and visitors. Some staff clearly do not believe this to be the case. Two who completed surveys said they did not wish Heanton Nursing Home DS0000068924.V367964.R02.S.doc Version 5.2 Page 19 to give their names due to fear of bullying. This has been fed back to the provider and acting manager. Heanton has been subject to a safeguarding investigation, which is still being looked at by the Police. The alert came from the hospital, when someone was admitted from Heanton in a state of dehydration and renal problems. Staff have fully cooperated in the investigation, and are now awaiting the outcome of this investigation. Staff spoken to knew what abuse was and who they should report any concerns to. Training in the protection of vulnerable adults is an ongoing process and staff have either had this training or are booked to complete it. Heanton Nursing Home DS0000068924.V367964.R02.S.doc Version 5.2 Page 20 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): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Heanton are able to enjoy a safe, comfortable and relatively clean environment. EVIDENCE: During this inspection a tour was made of all communal areas, the kitchen, laundry and three of the bedrooms. Overall the home was clean and relatively odour free. There were a few areas where odour could be detected, but these were in specific areas and not throughout the whole home. One staff member said that although they normally have two cleaners every day, they have been short staffed so ‘’standards may have slipped a little.’’ One relative commented ‘’ Staff make strenuous efforts to keep the home clean and well aired. It is not easy to cope with incontinent residents and despite their best efforts there are at times, particularly after ’accidents’ when there are odours.’’ Bedrooms seen were personalised with photos and people can bring small items of furniture if they wish. All the bedrooms on the ground floor are Heanton Nursing Home DS0000068924.V367964.R02.S.doc Version 5.2 Page 21 situated away from the living areas. Corridor doors have keypads fitted so access to bedrooms could be limited if the individual is unable to use the keypad or know the number. Staff spoken to said that generally only people who were unwell spent time in their rooms, most were encouraged to spend time in the communal areas. Some guidance and thought needs to be given to how they can facilitate freedom of movement to individuals bedrooms, as this could be viewed as a deprivation of liberty and new legislation will come into effect from April 2009, which will look at these issues. Heanton has been significantly adapted to meet the needs of frail elderly and for people with dementia related issues, including adapted bathrooms, level access or ramps to ensure easy access to areas both inside and outside. The AQAA gave us details of how equipment and the environment is maintained, and staff said they had training on infection control. The kitchen was not as clean as it should have been on the second day of the inspection. The record of cleaning had not been completed for the previous few days and there was no evidence of systematic deep cleaning having taken place or being planned. This was discussed as part of the feedback to the manager overseeing Heanton, who agreed to look at getting a deep clean organised as a priority and to ensure this is an ongoing process. One relative did raise the fact that some doors in the downstairs unit on the small lounge and at the end of the corridor had double handles which, if not held open by the door guards would be impossible for people with dementia or frailness to open. This was highlighted to the manager overseeing the home, and she agreed to arrange to have these removed ASAP. The Health and Safety Executive recently inspected Heanton and issued an improvement notice in respect of fitting more secure window restrictors where risk assessments have identified significant risks. The registered provider says this has now been done. The laundry area looked well organised and good infection control policies are in place to ensure that a ‘no touch’ technique is used for soiled linen. Heanton Nursing Home DS0000068924.V367964.R02.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): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff group are experienced, but require further training and support to ensure the needs of the people who live at the home are well met. EVIDENCE: Although staffing levels are sufficient to meet the basic needs of the people who currently live at Heanton, this should be kept under review, to ensure care and support can be delivered in a timely fashion throughout the day. Lunchtimes on both days were observed in both units. In Chichester most individuals eat together in the main dinning area, which appeared cramped for the number of people in there. Staff were extremely busy trying to ensure that those who needed support to eat their meals were given enough time and support. One person did not get their meal until everyone else had finished. Some individuals would have benefited from closer supervision and support. Two people fell asleep during their meal for example and were only encouraged to finish their meal once staff had assisted someone else to eat. Another person poured their drink all over their meal and did not then eat much of the meal. The pudding was served some 10 minutes after most people had completed their main course. This is a long wait for people with dementia and two wandered off and had to be brought back into the dinning area. Staff provide support in a kind and respectful way, but were clearly rushed to ensure everyone’s needs could be met. Staff did report that normally they have some assistance from the activity coordinators who were busy that day getting ready Heanton Nursing Home DS0000068924.V367964.R02.S.doc Version 5.2 Page 23 for a planned 60th wedding anniversary and birthday party for people who live at the home. Two relatives have made their concerns known to CSCI in respect of staffing levels at the home. One said that in the Chichester Unit some individuals need 1:1 supervision because they ‘’presented as a risk to other residents.’’ This was not directly observed during the inspection, but these concerns were passed to the manager. Another relative said that there appeared to be a lack of supervision and not enough staff on duty in the downstairs at teatime/bedtime. They highlighted the fact that if there were only four carers on duty and they were putting people to bed, that those people left in the lounges could be without supervision for up to 20 minutes. This is because they layout of the unit downstairs means that the communal lounges and dinning areas are separate from the bedrooms. The design layout of the home does impact on the availability of staff at key times such as assisting people getting up and going to bed. One survey returned by a staff member states that ‘’Currently there seems to be a problem with staffing. Usually 4 carers would be on shift, but currently there are often only 3 (that is per unit) which is very hard work for little reward.’’ These comments were discussed with the manager who said that they have now taken on more staff and that it would be exceptional for there to only be three carers on shift per unit. The continuing health care team have raised some concern about the lack of trained nurses in mental health, most nurses are currently general trained nurses, although some have many years experience in working with older people with dementia and mental health issues. Staff spoken to said that they had not had updated training in dementia, mental health or breakaway techniques for people with challenging behaviour. This training needs to be implemented to ensure staff have the right skills and knowledge to work with people who live at Heanton. The Health and Safety Executive also highlighted this lack of training as being a potential health and safety issue. In one of the units staff said there was an element of bullying between staff, and this was also highlighted via an anonymous staff survey. These issues have been fed back to the registered provider and acting manager, to look at as a divided staff team could impact on the quality of support and care delivered. Staff files seen show that there are good clear recruitment practices, which ensure that only people who have been checked as suitable to work with vulnerable people are employed. Heanton Nursing Home DS0000068924.V367964.R02.S.doc Version 5.2 Page 24 Heanton Nursing Home DS0000068924.V367964.R02.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): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management arrangements have been put in place to ensure the home is run in the best interests of the people who live there. EVIDENCE: The registered manager is currently off on long-term sickness. The registered providers have implemented an interim management arrangement, involving daily in put from a registered manager from another home owned by the same company. This together with extended administration hours and supernumery hours for the deputy matrons of both homes to enable them to take on some management tasks are working as a stopgap. Staff spoken to said they felt that the acting manager was approachable and their views were being listened to. Some staff have highlighted that there have been aspects of bullying and mistrust between the team and this needs to be addressed. Heanton Nursing Home DS0000068924.V367964.R02.S.doc Version 5.2 Page 26 The home have systems in place for ensuring the views of the people who live at the home, and their relatives/representatives are used to review the quality of care and support provided. Surveys are used and the results of these are collated and posted around the home. The PSP health care group holds all individuals’ finances centrally. The monies are held in a separate account from the business and they keep audit trails to ensure that people are protected. As a limited company all accounts are audited independently. We did not directly audit any financial records on this occasion. All new staff completes an induction programme that looks at all the key safe working practices. The Health and Safety Executive inspector has expressed some concerns about, who in the home has overall responsibility for health and safety issues; particularly in light of the fact the home does not have a full time manager present. This is being followed up with their operations manager. The home gave good information in their annual self-assessment, to show how they maintain a safe environment. They health and safety issues are addressed via training for staff and regular checks and audits on equipment and facilities. Heanton Nursing Home DS0000068924.V367964.R02.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 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Heanton Nursing Home DS0000068924.V367964.R02.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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 Arrangements must be made to ensure that clear guidance is available to direct how decisions are to be made for the administration of medicines prescribed to be administered “when required”. Also there must be a clear record of how the decision to administer has been made. All parts of the home must be kept clean, this relates to the kitchen and ensuring that there are systems in place to keep it clean. Staffing levels must be kept under review to ensure there are sufficient qualified and experienced staff on duty at all times to meet the needs of the people who live at the home. Timescale for action 04/12/08 2 OP26 13(3) 04/12/08 3 OP27 18 04/12/08 Heanton Nursing Home DS0000068924.V367964.R02.S.doc Version 5.2 Page 29 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 2 Refer to Standard OP27 OP36 Good Practice Recommendations Staff should have up to date training on caring for people with dementia and dealing with aggression Staff need to be able to discuss issues effecting their work, such as bullying and be able to use the whistle blowing policy with confidence. Heanton Nursing Home DS0000068924.V367964.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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.V367964.R02.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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