CARE HOMES FOR OLDER PEOPLE
Heath Bank Nursing Home Linden Road Halifax West Yorkshire HX3 0BS Lead Inspector
Lynda Jones Unannounced 17 August 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Heath Bank Nursing Home J52J01_s40605_heath bank_v244953_170805.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Heath Bank Address Linden Brook Halifax HX3 0BS Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01422 352299 01422 365557 Philip Bennett (Heath Bank New Co) Ltd Mr John Wright Care Home 41 Category(ies) of 41 x Old Age (over 65 years) registration, with number of places Heath Bank Nursing Home J52J01_s40605_heath bank_v244953_170805.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: The conditions of residence are listed on the registration certificate displayed at the home. Date of last inspection 21/1/2005 Brief Description of the Service: Heath Bank Care Home offers 24 hour nursing care to 41 residents. The registration also includes the provision to offer nursing care for two named persons under the age of 65 years. The home is in a quiet residential area of Halifax and is approximately 10 to 15 minutes walking distance from the town centre. The home offers single and double bedrooms, a number of rooms have en suite facilities. There are two lounges, a dining area and a number of quiet seating areas. There is a separate smoking area. At the time of this inspection a new extension to the home was under construction. This will provide additional en suite bedrooms and a conservatory. Heath Bank Nursing Home J52J01_s40605_heath bank_v244953_170805.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 6.45 hours, this was the inspectors first visit to the home. Six residents and three of their visitors were spoken to during the course of the day and they, along with six members of the staff team provided the information for this report. There was a brief opportunity to talk to the group operational manager who visited the home during the inspection and the project manager for the extension to the home gave an update on progress. Not all parts of the house were inspected. The communal areas and those parts of the building bordering on the extension were inspected. What the service does well: What has improved since the last inspection? What they could do better:
Consultation with residents and relatives needs to continue. People said they had begun to be asked for their opinion on the service but they didn’t know for example, when the building work would finally be completed and they didn’t know what the extension would be used for. The lengthy building process has
Heath Bank Nursing Home J52J01_s40605_heath bank_v244953_170805.doc Version 1.40 Page 6 taken its toll on some people, the feeling was that most individuals would be “glad when its finished.” None of the relatives knew about the care planning process or about “key workers” and no one could recall being involved in a review. Similarly, none of the residents knew about their care plans. Having said that, no one felt that they were denied information rather, they were not familiar with nor encouraged to be active in the process. Some people felt that there should be more organised activities taking place, this will hopefully be remedied soon by the appointment of an activities organiser. The ventilation in the residents smoking area should be improved and the staff smoking area should be relocated. The manager said there are plans to do this as improvements to the building continue. As part of the improvements, more storage space for wheelchairs would be useful. 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. Heath Bank Nursing Home J52J01_s40605_heath bank_v244953_170805.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Heath Bank Nursing Home J52J01_s40605_heath bank_v244953_170805.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these areas were assessed on this inspection. EVIDENCE: Heath Bank Nursing Home J52J01_s40605_heath bank_v244953_170805.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 10 People are treated with respect and personal care is delivered discreetly, in private. Residents and relatives need to be more involved in the care planning process. EVIDENCE: Residents said the staff were courteous and respectful to them. Some residents commented on how they saw the staff interacting with people who were unable to say how they were feeling. The consensus was that the staff were sensitive and patient. Individuals said the staff were helpful when responding to requests for assistance. Comments included “the staff are marvellous” “they do a first class job” and “I would rather be at home but I’ve had no complaints since living here.” Residents said they thought the staff listened to them and tried to provide support in a way that suited each person. From observation it seemed that the staff delivered personal care discreetly. Residents and visiting relatives confirmed that this was usually the case. Relatives said that judging by appearances, people always seemed to be well cared for. They said they called at different times of the day and always found
Heath Bank Nursing Home J52J01_s40605_heath bank_v244953_170805.doc Version 1.40 Page 10 people was well dressed. Residents said their clothes were laundered and looked after, they had their hair done regularly and they made their own arrangements with staff about bathing. Although care plans were not examined in detail on this inspection, residents and relatives were asked what they knew about the care planning process at Heath Bank. People were asked whether they had been consulted and involved in constructing and reviewing the plans. Unfortunately, there was no evidence of involvement. People assumed there must be a plan that staff worked to but no one could recall talking to staff about the content. On a positive note, this has been recognised by the management team and there is commitment to addressing this by encouraging wider participation in the process. This will be revisited on the next inspection. Heath Bank Nursing Home J52J01_s40605_heath bank_v244953_170805.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13, 15. Contact with family and friends is welcome and positively encouraged. The menu is varied and people are offered a choice on a daily basis. EVIDENCE: Visitors to the home are welcome at any time. Those relatives who called on the day of the inspection said that they were always well received and they found the staff pleasant and approachable. There is not a lot of space in the lounge areas for people to receive their guests. Visitors said that if a few of their family members visit together they usually use the dining area to meet in. Bedrooms can also be used if people wish to see their guests in private. Activities were not considered on this inspection, however two relatives did say that they rarely saw any activities taking place when they visited. When this was raised with the manager in the feedback session at the end of the inspection he indicated that an activities organiser had been appointed and was due to take up employment in September. There are plans to consult extensively on the type of activities that people would like to take part in. There is one cook in post at present, who works three weekdays each week. Arrangements are underway to recruit a second cook to cover weekends.
Heath Bank Nursing Home J52J01_s40605_heath bank_v244953_170805.doc Version 1.40 Page 12 These hours are currently covered by agency catering staff or by care staff working extra hours to cover catering duties. This arrangement is not always satisfactory according to residents and staff. There is a 4 week rolling menu which is operated company wide. Staff say the menu is not totally fixed and there is room for some flexibility. Residents are consulted on a daily basis about what they would like from the lunch and tea time menus. The cook reports that an alternative can be made available should anyone make a request. Residents confirmed that birthdays are always celebrated and the cook said she would like to introduce theme days to celebrate particular events and to introduce new food experiences. Special diets can be catered for. Residents and staff said the produce that is used is of good quality. Generally, everyone was happy with the standard of the meals, people felt that there was plenty of variety on offer and the meals were well presented. One person said the food could be a little boring but was unable to qualify this further. The cook said she knew about individual likes and dislikes by asking residents and relatives at admission. These are not recorded anywhere it seems. When agency staff are on duty it appears that they rely on the knowledge of staff and catering assistants. Given the shortage of another permanent cook it may be useful to introduce some method of stock control in the kitchen. Heath Bank Nursing Home J52J01_s40605_heath bank_v244953_170805.doc Version 1.40 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Staff are aware of their responsibility to make sure that people are protected from abuse. Recruitment procedures need to be strengthened. EVIDENCE: From speaking to staff it is evident that they are familiar with adult protection procedures and they are aware of what they must to do if they have any concerns about any aspect of care practice within the home. There is evidence that information about adult protection is included in the induction programme for all new staff. The management team give this area high priority. In view of this it was disappointing to discover that two staff had recently started work at the home before all of the necessary checks had been carried out to complete the recruitment process (see standard 29 of this report). Relatives said they wouldn’t hesitate to speak to the managers if they had any concerns. Heath Bank Nursing Home J52J01_s40605_heath bank_v244953_170805.doc Version 1.40 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,25,26. Although efforts have been made to minimise disruption, residents satisfaction with the environment has been overshadowed recently by the building work that is taking place. EVIDENCE: The theme of the day was the new extension to the home as this was the factor that was raised most. Residents, relatives and staff commented on the length of time the building work had been going on (it was started in Jan 05) and on the noise and dust that they have endured. Residents and their visitors said the domestic team had worked hard to maintain standards in the building. The team clearly deserve credit for their commitment and effort. Many people commented on the fact that the home is always free from any odours. Residents in the part of the home adjoining the extension have experienced most disruption from the building work, the noise and dust was reported to have been particularly wearing in this area.
Heath Bank Nursing Home J52J01_s40605_heath bank_v244953_170805.doc Version 1.40 Page 15 It is essential that staff continue to be vigilant about health and safety issues until work is completed. Particular attention must be paid to ensuring that there are no obstructions on the corridors and that fire safety measures are strictly observed. The manager reported that he had tried to keep people informed about the plans for the extension and the timescales for completion of work, although he has not long been in post. However, relatives and residents seemed unclear about the proposals and appeared resigned to this continuing for some time. If anything positive can be gained from the disruption, it is that some residents said they had gained some interest from watching the construction develop and from the many additional people that they saw working on the site over the months. Heath Bank Nursing Home J52J01_s40605_heath bank_v244953_170805.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29 Recruitment procedures need to be improved to ensure that residents are adequately protected from abuse. EVIDENCE: Staff files were examined in respect of two staff who were recently recruited. Both members of staff had started work at the home before all checks had been carried out. One person started work before the check with the Criminal Records Bureau (CRB) was received, another started without a CRB and Protection of Vulnerable Adult register (POVA) check. This was discussed with the manager at the time of the inspection. Heath Bank Nursing Home J52J01_s40605_heath bank_v244953_170805.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 & 33. The new management team are experienced in working with older people. Consultation with residents has begun about the future development of the service. EVIDENCE: The manager took up post at Heath Bank in May 2005. He is a qualified nurse and has considerable management experience. He has gained the Registered Managers Award and is well qualified for the role at Heath Bank. He was recently registered by CSCI as the manager of Heath Bank. Relatives and residents alike commented on the recent succession of managers that had worked at the home. There was overwhelming support for the current management team. People expressed a very positive outlook for the future and looked forward to the end of the building work and to a period of stability. The consensus of opinion was that Heath Bank was a good home and it was hoped that the present management and staff team would stay and that the home
Heath Bank Nursing Home J52J01_s40605_heath bank_v244953_170805.doc Version 1.40 Page 18 could further develop. People felt that they were being consulted more just recently. Some relatives said they had completed questionnaires giving their views about how the home was conducted. The view was that people would be happy to play a more active part in the future of the home. Heath Bank Nursing Home J52J01_s40605_heath bank_v244953_170805.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 3 x x x x 3 3 STAFFING Standard No Score 27 x 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 1 3 x 3 x x x x x Heath Bank Nursing Home J52J01_s40605_heath bank_v244953_170805.doc Version 1.40 Page 20 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 29 Regulation 19 Requirement All staff must have enhanced CRB checks and POVA checks before they take up employment at the home Timescale for action With effect from 17/8/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard None Good Practice Recommendations Heath Bank Nursing Home J52J01_s40605_heath bank_v244953_170805.doc Version 1.40 Page 21 Commission for Social Care Inspection Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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