CARE HOMES FOR OLDER PEOPLE
Heath House Care Centre 81 Walkers Heath Road Kings Norton Birmingham B38 0AN Lead Inspector
Sean Devine Unannounced 10th May 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 House Care Centre E54 S153005 Heath House Care Centre V228145 100505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Heath House Care Centre Address 81 Walkers Heath Road, Kings Norton, Birmingham, West Midlands, B38 0AN 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) 0121 459 1430 0121 486 1728 Exceler Healthcare Services Limited Gillian Pratt Care Home 50 Category(ies) of Dementia - over 65 years of age (50), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (50), Old age, not falling within any other category (50) Heath House Care Centre E54 S153005 Heath House Care Centre V228145 100505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service user categories; dementia over 65, Mental disorder, over 65, care with nursing, 50 places Date of last inspection 4th November 2004. Brief Description of the Service: Heath House offers nursing care for up to 50 older adults with mental health needs. This includes both dementia and those with longer-term psychiatric diagnoses. There is a skill mix in the qualified nursing staff, but they are predominantly RMNs. The premises is a conversion and extension of an existing property and is situated to the south of Birmingham. It is located close to public transport links. The building is divided into two units, “Heathside” and “Walkers Lodge”. There is limited off road parking to the front of the premises and an enclosed garden area to the sides and rear. Accommodation is a mixture of single and shared rooms. All bathing facilities are shared, although some bedrooms have en-suite toilets. There are communal dining areas and lounges on the ground floor, together with the kitchen, offices and laundry, smoking area and some bedrooms. The first floor consists of bedrooms and bathing/toilet facilities but has no communal space. It is accessed by stairs or shaft lift. Heath House Care Centre E54 S153005 Heath House Care Centre V228145 100505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was conducted on an unannounced basis over a period of one day. The inspector was able to meet with some residents and staff, one member of staff was interviewed on a more formal basis. Records in relation to the care provided and the health and safety practices of the home were seen. Meal times were observed and the residents ‘communal facilities inspected. The home has addressed the majority of improvements required at the last inspection, however some improvements have not been completed and have been carried forward. What the service does well: What has improved since the last inspection?
Heath House Care Centre E54 S153005 Heath House Care Centre V228145 100505 Stage 4.doc Version 1.30 Page 6 Since the last inspection the home has developed the information available to prospective residents including identifying the homes aims, objectives and philosophy of care. The practice of disposing of medicines has improved, ensuring better stock control. Staff are better supported and receive more frequent and pertinent supervision with the managers. Staff are more aware of the importance of a relaxing environment and this has positively affected the meal times at the home. Furniture and carpets in lounge areas have been replaced where needed, some minor repairs in residents rooms have been completed. The home has improved some areas of hygiene and infection control practice, such as storage of dentures, appropriate transfer of clothing to the laundry and ensuring good hand washing facilities. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Heath House Care Centre E54 S153005 Heath House Care Centre V228145 100505 Stage 4.doc Version 1.30 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 House Care Centre E54 S153005 Heath House Care Centre V228145 100505 Stage 4.doc Version 1.30 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) 1,3 The home does provide some information for prospective residents to make an informed choice on whether they would like to live at this home, however a residents guide is needed. Residents are fully assessed prior to admission; this enables the home to make a decision on whether they can meet the needs of prospective residents. EVIDENCE: The manager has further developed the statement of purpose to include what the aims and objectives of the home are and also detailed its philosophy of care. The information provided within the statement of purpose reflects upon the service, resources and accommodation provided at the home, it does provide the prospective resident with some useful information. As identified at the last inspection the home has developed a residents’ / service users’ guide, however this as yet is not in print and is not available at the home. This information is needed to provide prospective residents with all necessary information in forming a judgement as to whether they would like to live at the home. Residents’ files were sampled and all included a full assessment of need, for example, social and spiritual needs, communication, personal hygiene and
Heath House Care Centre E54 S153005 Heath House Care Centre V228145 100505 Stage 4.doc Version 1.30 Page 9 mobility. Risks had been assessed and where needed a management plan had been introduced. All assessments are reviewed on a monthly basis. Heath House Care Centre E54 S153005 Heath House Care Centre V228145 100505 Stage 4.doc Version 1.30 Page 10 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) 7,8,9 Some care plans were good and some were inadequate, and these need reviewing to enable the staff to know what support and assistance residents need. It is not clear that all residents receive their medicine as prescribed by their doctor thus residents are not adequately supported to take their medicines. EVIDENCE: Sampled residents’ files all included written plans of care, these consisted of normal day care needs and health specific plans such as pressure sores, disorientation and confusion and epilepsy. It was evident that the standard of information varied within the plans for normal day care needs, some were informative for staff and detailed all care needed, however others were less informative and lack detailed or specific guidance. The review of care plans is undertaken monthly, some reviews were seen to be informative and reflected upon whether or not the care plan was effective, however some reviews were dated but no evidence of how effective the plan was had been recorded. The home assesses risks in relation to pressure sores, nutrition and manual handling, where needed risk management strategies are introduced. Records of multi-disciplinary involvement are maintained, these detailed GP and dental
Heath House Care Centre E54 S153005 Heath House Care Centre V228145 100505 Stage 4.doc Version 1.30 Page 11 support, however no support in relation to chiropody and opticians was recorded. Medication is provided mainly in blister packs from a local chemist, these packs are managed well. A full audit trail of medicines received and disposed of is available, however the inspector is concerned that boxed medicine is not fully accounted for. Three residents had excess stock left in boxes, staff had signed to confirm that all medicine had been administered, it was clear that either stock levels were inaccurate or the medicine although signed for had not been administered. Other concerns in relation to safe medicine practice are recorded in the requirements section of this report. Heath House Care Centre E54 S153005 Heath House Care Centre V228145 100505 Stage 4.doc Version 1.30 Page 12 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 Residents are able to keep in contact with family and friends, this enables them to retain links based upon their choices. Mealtimes provide a healthy nutritional diet as well as a stimulating social opportunity. EVIDENCE: At the time of inspection many residents were receiving visits from family and friends. The assessments completed by the home included information about family involvement, how much contact and the roles family would take, for example managing personal allowance, visiting at weekends and purchasing clothing and toiletries. The menu was seen to be healthy, pasta, vegetables and meat was served at the time of inspection. Two residents confirmed that they enjoyed the meals at the home. The meal times in both units of the home were seen to be social occasions, staff were able to encourage residents to eat and assisted when needed. Plastic plates were in use, a member of staff explained that these plates are used for residents who could knock the plate on the floor, however a resident being assisted to eat by staff also had their meal served on a plastic plate. Heath House Care Centre E54 S153005 Heath House Care Centre V228145 100505 Stage 4.doc Version 1.30 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) 16,17,18 Residents and their representatives are supported to make complaints, these are dealt with effectively and outcomes are used to improve the service. The residents are adequately protected from the risks of abuse through good policies and staff training in residents’ welfare issues. EVIDENCE: The home has a complaint register that records and details the nature of complaint, outcome, response and the follow-up to the complaint. How to make a complaint is detailed on notice boards, within contracts and will be included in the service users guide. The home has received one complaint in the past 12 months, no complaints have been received at the commission. The home has a policy on protecting adults from abuse and has appropriately implemented this policy on three occasions in the past twelve months. Staff receive ongoing training during an induction period, this includes training in residents welfare. Residents continue to be supported to take part in the civic process, many of the residents recently voted with the support from staff and family in the general election. Heath House Care Centre E54 S153005 Heath House Care Centre V228145 100505 Stage 4.doc Version 1.30 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) 19,26 The premises are safe, however they are not altogether well maintained, works identified in the Legionella risk assessment and poor management of offensive odours, indicates a risk to residents in respect of poor hygiene. EVIDENCE: The manager confirmed that the repairs and improvements in standard 21 and 24 as identified at the last inspection had not been fully addressed. The manager has updated the statement of purpose, it now includes details of how residents can access all fixtures and fittings they need. The curtain dividing a shared room on Walkers Lodge had come away from the hooks and needs repair. The environment in communal areas is tidy and meets with local fire service requirements. The external grounds are well maintained and spacious for residents to use. The home was seen to be clean, communal areas including toilets had appropriate hand washing facilities and clinical waste containers and contracts were in place. The corridor leading to the dining area on Heathside had a noticeable offensive odour; this was identified at the last inspection. The manager confirmed that no action in relation to work identified in the Legionella risk assessment had been completed.
Heath House Care Centre E54 S153005 Heath House Care Centre V228145 100505 Stage 4.doc Version 1.30 Page 15 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) No judgement made as standards in relation to staffing were not assessed at this inspection. EVIDENCE: Standards in relation to staffing were not assessed at this inspection. Heath House Care Centre E54 S153005 Heath House Care Centre V228145 100505 Stage 4.doc Version 1.30 Page 16 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) 35,36,38 The management and administration of the home ensures the health and safety of residents and staff alike is positively addressed. Staff are equipped to monitor and improve areas of concern which enables residents to be safely cared for. EVIDENCE: The home manages some money on behalf of residents, it is stored safely and accounts of all transactions are maintained, balances were found to be correct. The home has a letter from relatives authorising them to spend money on behalf of the residents, receipts in respect of the expenditure were available. Nursing and care staff are frequently supervised, supervisions are used to monitor performance and also to impart knowledge, for example the new fire policy, the use of bedrails and care planning. Supervision is also linked closely to appraisal and improvement action plans are completed. The home has developed extensive risk assessments for the premises, staff, fire and food, these are broken down into specific risk categories for example,
Heath House Care Centre E54 S153005 Heath House Care Centre V228145 100505 Stage 4.doc Version 1.30 Page 17 laundry hazards and COSHH, use of bedrails and the food risk assessment. All risk assessments are regularly reviewed and shared with the staff team. The home maintains the health and safety of the premises and equipment, including the service, testing and maintenance of fire equipment, gas, electric, clinical waste, lift and water. Heath House Care Centre E54 S153005 Heath House Care Centre V228145 100505 Stage 4.doc Version 1.30 Page 18 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 2 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 x x x x 3 3 x 4 Heath House Care Centre E54 S153005 Heath House Care Centre V228145 100505 Stage 4.doc Version 1.30 Page 19 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5(1) Requirement The home must develop a service users / residents guide. Previous timescale of 31/12/04 not met, this requirement is carried forward. . Residents care plan reviews must include information about how effective the plan has been. Previous timescale of 31/12/04 not met, this requirement is carried forward. . Normal day care need plans require improvement to detail exactly what support is needed and how this is to be delivered. Normal day care need plans for residents who are diabetic must be further developed to include how they are to be supported. Where needs are identified for example, in respect of social activity, expressing sexuality and communication a plan must be developed to identify how the resident is to be supported. Risk management plans, including falls risk assessments must be updated and reviewed following an incident, for Timescale for action 30/09/05 2. OP7 15(2)(b) 31/8/05 3. OP7 15(1) 31/8/05 4. OP7 15(1) 31/7/05 5. OP7 15(1) 31/7/05 6. OP7 17(1)(3)( a) 31/7/05 Heath House Care Centre E54 S153005 Heath House Care Centre V228145 100505 Stage 4.doc Version 1.30 Page 20 7. OP8 17(1)(3)( a) 17(1)(3)( a) 13(2) 8. OP8 9. OP9 10. OP9 13(2) example when a resident falls from bed. All residents must have the support provided by chiropody and the optician fully documented. All visits and outcomes made by healthcare professionals including the GP must be recorded. The manager must audit all boxed medicines in respect of current stock control and administrations, discrepancies must be fully investigated and corrective actions undertaken. All creams, ointments and solutions (e.g. oilatum) must be dated when opened and disposed of within 28 days of opening. All staff that administer or handle medicines must complete an accredited course in the safe handling of medicines. 31/7/05 31/7/05 17/5/05 30/6/05 11. OP15 12. OP21 Previous timescale of 30/11/04 not met, these requirements are carried forward. 16(2)(g) Plastic plates must only be used where a risk is identified and following the development of a risk assessment. 23(2)(b)(c The home must repair extraction ) fans that are not working. The flooring in the assisted bathroom on Walkers Lodge Unit must be replaced. Previous timescale of 31/12/04 not met, these requirement are carried forward. All residents rooms must have appropriately suited locks on the doors Previous timescale of 31/1/05 31/7/05 30/9/05 13. OP24 23(2)(c )(e) 31/12/05 Heath House Care Centre E54 S153005 Heath House Care Centre V228145 100505 Stage 4.doc Version 1.30 Page 21 not met, this requirement is carried forward. The privacy curtains in Room 7 (shared room), must be repaired... The manager must take measures to address the areas of malodour within the home. With specific attention to residents rooms and corridors. All works as identified in the legionella risk assessment must be completed. Previous timescales 30/11/04 and 31/12/04 not met, these requirements are carried forward. 15. OP30 18(c )(i) Nursing staff must receive clinical practice updates. Not assessed at this inspection and is carried forward. 30/9/05 14. OP26 13(4)(c ) 31/7/05 31/7/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Heath House Care Centre E54 S153005 Heath House Care Centre V228145 100505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Birmingham and Solihull Local Office 1st Floor Ladywood House, 45-46 Stephenson Street, Birmingham, B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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