Inspection on 14/06/07 for Heath House Care Centre

This inspection was carried out on 14th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Heath House Care Centre 07/05/09

Heath House Care Centre 28/04/08

Heath House Care Centre 03/10/06

Heath House Care Centre 20/09/05

Heath House Care Centre 10/05/05

Heath House Care Centre 04/11/04

Heath House Care Centre 16/07/04

Heath House Care Centre 17/02/04

Heath House Care Centre 12/12/03

Similar services:

Ashcroft Hollow Nursing Home

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

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

CARE HOMES FOR OLDER PEOPLE Heath House Care Centre 81 Walkers Heath Road Kings Norton Birmingham West Midlands B38 0AN Lead Inspector Karen Thompson Key Unannounced Inspection 14 June 2007 09:00 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 Heath House Care Centre DS0000024852.V336933.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Heath House Care Centre DS0000024852.V336933.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heath House Care Centre Address 81 Walkers Heath Road Kings Norton Birmingham West Midlands B38 0AN 0121 459 1430 0121 486 1728 heath.house@ashbourne.co.uk 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) Exceler Healthcare Services Limited Elizabeth Ansah 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 DS0000024852.V336933.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service user categories; dementia over 65, Mental disorder, over 65, care with nursing, 50 places Within the 50 places, the home may accommodate 10 named service users under the age of 65 at time of admission. 3rd October 2006 Date of last inspection Brief Description of the Service: Heath House offers nursing care for up to 50 older adults with mental health needs. This includes both dementias and those with enduring mental illness. The premises are a conversion and extension of an existing property and are 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 are good car parking facilities 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, large conservatory (designated smoking area) and some bedrooms. The current fees charged by the home including the registered nurse contribution to care ranges from £450.00 to £598.00 per week. This fee includes the nursing element, which is retained by the home. The first floor consists of bedrooms and bathing/toilet facilities but has no communal space and is accessed by stairs or shaft lift. Heath House Care Centre DS0000024852.V336933.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that needs further development. This inspection was unannounced and conducted over two days commencing on 14 June 2007. This was the first statutory key inspection for 2007/2008 and the manager was present for the duration of the inspection. Information was gathered from a number of sources: a questionnaire was completed prior to the inspection by the manager (AQAA) and on the day of the inspection a tour of the building was undertaken; records and documents were examined in relation to the management of the home, conversations took place with managerial and care staff plus visitors and residents. A number of residents were unable to communicate their views verbally to the inspector so direct and indirect observation was used to form the inspection process. Three residents who live in the home were ‘case tracked’ which involved establishing the individuals’ experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on the outcomes of their lives in the home. Tracking people’s care helps us understand the experience of people who use the service. Concerns from relatives and other professionals had been raised prior to this inspection. These concerns were looked at during the inspection and are commented upon in the main body of the report. The Primary Care Trust (PCT) had been liaising with the home and nursing staff are now able to seek advice from a specialist nurse (employed by the PCT) if they have concerns about a resident health care needs as well as accessing the general practitioners service. What the service does well: Meals are healthy and nutritionally well balanced, they reflect the cultural diversity of residents and also provide for choice and different tastes. Food and dishes from countries from around the world are included within the current rotation menu. Staff at the home have introduced a new system to monitor the food intake of residents that are considered to be nutritionally at risk. This system should ensure that residents’ well being in relation to food is promoted. Snacks and hot soup are available throughout the day for residents, promoting independence and choice. Heath House Care Centre DS0000024852.V336933.R01.S.doc Version 5.2 Page 6 Staff are recruited safely ensuring all required checks such as CRB disclosure are made before appointment. The fire alarm was set off by accident during building work however all staff were seen to responded appropriately. Visiting was flexible and staff welcomes visitors. Birthdays and special events are celebrated, so enhancing the quality of residents’ lives. What has improved since the last inspection? What they could do better: The assessment and care planning process needs to improve in identifying, recording and monitoring needs of residents. Where needs have been identified they must be consistently met by staff who are familiar with the agreed care plan. There needs to be more attention to meeting residents personal and nursing needs whilst respecting their privacy and taking their wishes into consideration These needs must be monitored by the staff and management team at the home and reviewed as necessary. Medication management must improve to ensure the health and well being of residents’ are protected and promoted. Continued improvements are needed in the management of odour in the home especially some of the communal areas of the home. Heath House Care Centre DS0000024852.V336933.R01.S.doc Version 5.2 Page 7 Further staff training is required to ensure staff have the appropriate skills and knowledge to care for residents effectively and in a consistent manner. The system for dealing with concerns and complaints needs to be more thorough with all concerns/complaints investigated and acted upon to ensure residents are adequately protected and learning is achieved to lead to continued improvements. A review of staffing levels and skill mixes should be undertaken and action taken to ensure there are adequately trained staff in appropriate numbers at all times to meet residents needs. Systems in relation to odour control and cross infection must be reviewed to ensure that residents live in a pleasant environment. The home must keep the Commission informed of any effects that have an adverse effect on the well being of residents’ to allow for monitoring of the home between inspection visits. 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. Heath House Care Centre DS0000024852.V336933.R01.S.doc Version 5.2 Page 8 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 Heath House Care Centre DS0000024852.V336933.R01.S.doc Version 5.2 Page 9 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): Standards 1. 3 and 6 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Information about the service or facilities is not routinely available to residents and or their representatives to enable them to make an informed choice about the home. The pre-admission assessment process was not consistently comprehensive therefore residents cannot be assured their needs will be meet when moving into the home. EVIDENCE: The Service Users Guide and Statement of Purpose was not inspected during this visit. Discussions with the management team revealed that the home only Heath House Care Centre DS0000024852.V336933.R01.S.doc Version 5.2 Page 10 has a master copy Service User Guide and residents are not issued with one individually. Changes to the Care Home legislation in 2006 now makes it a legal requirement that each resident is provided with one to inform them of the services and facilities available in the home. The home must also ensure that the Service User Guide is in a format accessible to residents. A copy of the service users guide was available in the reception area. A number of residents’ files were inspected to determine the admission process Enquiry forms are generated and added to as required which may lead on to a pre-admission assessment. Following this pre-admission assessment staff draw up a draft care plan these were found to be in place but in once instance had been drawn up a week after the resident had been admitted to the home, therefore staff did not have any guidance or instructions on how to care for this resident at the time of admission. The home does not provide an intermediate care facility. Heath House Care Centre DS0000024852.V336933.R01.S.doc Version 5.2 Page 11 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): 7.8.9.11 Quality in this outcome area isadequate. This judgement has been made using available evidence including a visit to this service. Poor record keeping and procedures are placing residents at potential risk of not receiving safe and appropriate care. The home shows signs of improving its arrangements for referring residents to external Health Care Professionals to ensure health needs are recognised and met. Medication management is mixed and could potentially place residents at risk. EVIDENCE: The care records of three of the people living at the home were looked at in detail and other records were sampled. Care plans are based on the assessment that is completed before the person moves into the home. The care planning documentation is comprehensive with an array of risk assessments taking place such as skin integrity, nutrition, falls and moving and Heath House Care Centre DS0000024852.V336933.R01.S.doc Version 5.2 Page 12 handling. However the finding of these are not automatically being linked into the care planning process. Care plans sampled did not always demonstrate that individual needs were being fully assessed, planned or evaluated. Social profiles had taken place for residents but the information obtained was also not being linked into the care planning process, to ensure the individual likes, dislikes preferences and experiences were being acknowledge or met. Also residents cultural and religious needs were not being acknowledged via the care planning process. One resident’s spiritual needs were being meet according to staff spoken to at the time of the inspection but these were not acknowledged in the care planning process. Another resident whose preadmission details clearly acknowledge spiritual needs was nevertheless not having these met by staff at the home. Furthermore staff were unaware of these needs despite this being recorded on the admission documentation. Residents had been referred to the tissue viability service but in one instance where concerns had been raised the recommendations of the tissue viability service had not been fully followed or acknowledged in the care planning or delivery of care. Also care planning records in relation to skin integrity do not acknowledge how pain or how skin suppleness is to be maintained. These elements along with others are integral to the management of skin integrity. No all care plans were being evaluated monthly. Evaluations that did take place were not always being linked back to the care planning process. One diabetic residents’ insulin was being omitted by staff but there was no clear written instructions from the G.P as to when the insulin should be omitted. This particular resident had been referred to a diabetic clinic and the management team during the inspection ensured that the instructions were clarified with the GP, but it is concerning as staff were omitting medication without any clear guidance to do so. Food and fluids charts were also found not to be completed for residents who had been identified as being at risk. The home has purchased an educational package in relation to nutrition and introduced systems to help in the monitoring of those at risk. All these are positive initiatives but staff practice for recording is poor therefore these initiatives will fail and compromise the well being of residents. One concern raised with the Commission prior to the inspection was in relation to meeting personal needs of one particular resident. During the inspection the needs of this resident were reviewed. The resident on the day of the inspection was clean and well presented. Personal care and care planning records about this resident and others within the home could not show what personal care was being given to residents. These records were discussed during the inspection with the management team and care staff. All residents living in the home have recently been offered an eye test, resulting in a number of residents being prescribed new glasses. This was Heath House Care Centre DS0000024852.V336933.R01.S.doc Version 5.2 Page 13 confirmed by a number of residents. The questionnaire returned by the manager stated a number of external health professional referrals had been made recently after a review of residents needs had taken place and this was confirmed by the residents records sampled. Referrals were made to a wide range of disciplines, which included skin integrity, chiropodist, continence, occupational therapy and physiotherapist services. The medication was stored in a medication trolley and storage cabinets in a specially dedicated medication room. Medication trolleys were observed to be clean and organized. The home’s medication system consisted of a blister and box system with printed Medication Administration Record (MAR) sheets being supplied by the dispensing pharmacist on a monthly basis. The home had copies of the original prescription (FP10’s) for repeat medication, so they were able to check the prescribed medication against the MAR chart when it entered the home. On inspection of the medication for the current month it was found that the blister system was satisfactory. Medication stored in boxes was not always auditable and the number of tablets available would suggest in some instances that medication had not been given despite being signed for on the MAR chart. The medication fridge temperatures are not consistently recorded and on occasions recordings demonstrated that the temperature in the fridge exceeded 8c. Records for one resident demonstrated a request for covert administration of medication by relatives. The home’s staff have recorded that this had been agreed with the G.P. This was discussed with the management team at the time of the inspection and the managers reassured the inspector that this was not taking place. Covert administration of medication is not a decision to be decided only by staff at the home and family members but needs to be a multi-disciplinary team as the rights and risks to the resident need to be assessed. During the inspection an immediate requirement was left with the management team to investigate why a resident did not receive their prescribed medication for several days. Staff informed the inspector that staff do attend residents funerals and flowers are sent from the home. Care plans sampled did not contain end of life care plans. Heath House Care Centre DS0000024852.V336933.R01.S.doc Version 5.2 Page 14 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): 12.13.14.15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were no rigid routines and visitors could visit at times that suited them enabling residents to maintain contact with them. The home is good at providing residents with a stimulating and purposeful life. EVIDENCE: Visiting is flexible enabling relatives to visit at a time that suits them and residents to maintain contact with them. Feedback confirmed this and it was stated that drinks were offered on occasions. The questionnaire completed by the manager prior to the inspection stated that the home had started “managers surgery” for relatives and other interested persons. The home has an activity co-ordinator who works three days a week, however during the time of the inspection they were not able to work so this role was being covered by the care staff. During the inspection the home was preparing Heath House Care Centre DS0000024852.V336933.R01.S.doc Version 5.2 Page 15 for a Caribbean evening, which was open to relatives and guests, in aid of Elder Abuse awareness. There is a weekly and annual plan for activity in and outside of the home, including church services, trips to local areas of interest such as Stratford on Avon, colouring, singing and Tuesday coffee morning. Residents’ doors have been personalized with individual colours and the new manager has plans to theme residents’ bedroom corridors to make them more individual. Staff and residents spoke enthusiastically about activities that had or were planned to take place within the home. During the inspection the inspector observed residents and staff singing happy birthday whilst a birthday/anniversary cake was shown to residents and then distributed to residents. Care plans did not reflect specific spiritual needs and how these were being met or would be meet if the need arose. The chef advised the inspector of the recent change to the menu planner to include not only traditional English food but also food from around the world. Breakfast and lunch was observed during the inspection. The mealtime experience was observed to be unhurried and staggered. The organization has recently introduced a system where those residents identified as being nutritional at risk have a blue rimmed plate or bowl which alerts staff visually to the need to assist and monitor that particular resident’s nutritional intake. Staff were observed doing this for residents who had cognitive impairment and were leaving the table. The resident would gently encourage coming back to the table to eat, however records were not being kept comprehensively to demonstrate what residents had eaten. Staff were observed to offer discreet assistance to residents during meal times. Heath House Care Centre DS0000024852.V336933.R01.S.doc Version 5.2 Page 16 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 adequate This judgement has been made using available evidence including a visit to this service. The policies and procedures and staff knowledge about safeguarding procedures and complaints met the standard but the recent cluster of complaints and concerns from relatives indicates lack of confidence in the homes ability to deal with these directly by the complainants. EVIDENCE: Since the previous inspection the home has recorded one formal complaint and one adult protection referral. The Commission was contacted prior to the inspection by two separate sets of relatives with concerns regarding the personal care provided by staff and the cleanliness and infection control of and within the home. The findings for these are commented upon in more detail in the Health and Personal Care and Environmental section of this report. The concerns raised in relation to the environment have not been resolved and were commented upon in the last inspection report. Health and Personal Care concerns need to be addressed swiftly and can be linked to the general running of the home. Shortly after the inspection the Commission was informed of further concerns that were being looked at under Adult protection procedures by a Social Workers team. Heath House Care Centre DS0000024852.V336933.R01.S.doc Version 5.2 Page 17 During conversations with staff it was clear they have a good understanding of how to protect residents from abuse. There is an ongoing programme of training for protection of vulnerable adults however a refresher course in this topic has lapsed for a significant proportion of staff. The home has written policies and procedures for the protection of the vulnerable adults and complaints that meet the standard. Staff at the home during the inspection were taking part in a national campaign to raise awareness of elder abuse and collect donations for this cause. This involved staff collecting donations in Kings Heath high street for Elder Abuse Charity and the home holding a Caribbean evening for both residents’ and guests. Heath House Care Centre DS0000024852.V336933.R01.S.doc Version 5.2 Page 18 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. 20. 21. 24.25 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is improving its décor and facilities in order to enhance the environment for residents. Odour management and the potential for cross infection needs to be improve to ensure that residents live in a clean, safe and hygiene environment. EVIDENCE: At the time of the inspection the home was warm although, there were some isolated areas of slight odour. One of the concerns raised with the Commission recently identified malodours as an issue. Whilst staff were able to explain the history of one particular malodour it does not explain the odours experienced during the inspection or at previous inspections where it has been commented Heath House Care Centre DS0000024852.V336933.R01.S.doc Version 5.2 Page 19 upon. The questionnaire completed by the management team prior to the inspection identified continence promotion as an area that requires staff training and education. This may help to eliminate some odours in the home along with an ongoing refurbishment programme. Bins for disposal of waste material are not foot operated, and possess a potential cross infection risk. On both units within the home it was evident that a continuous programme of redecoration and refurbishment was in place. Both units have access to a large lounge area, large dining areas and a conservatory that is the designated smoking area for residents. Residents’ can access the garden from the conservatory and from the dining rooms. The conservatory is well used by residents of both units. At the time of the inspection the roof in the conservatory was letting in rainwater. The home’s management team were in the process of organising this to be repaired and during the inspection it was observed that workmen were assessing the problem. Across both units there are four shower rooms and four bathrooms. Each room is different and facilities vary. Twenty-five residents have an en-suite toilet facility (all in single rooms) and further toilets are available in all bathrooms and shower rooms. One sluice rooms was visited and this contained a pot disinfector, however it was also being used as a storage room for a variety of items. These items need to be removed from the sluice, as they possess a risk of cross infection. Some residents share their rooms with other residents (there are five shared rooms in total). These rooms are larger that the forty single rooms. Privacy curtains are fitted in all shared rooms. All rooms had adequate storage areas and comfortable seating and many contained items of personal belongings such as photographs, pictures and small items of furniture. The laundry area was clean and clean items are kept separate from dirty items. All residents have their own box for clean clothes. The flooring is impermeable and the laundry was observed to be appropriately separated and put into colour-coded bags before being taken for laundering. Heath House Care Centre DS0000024852.V336933.R01.S.doc Version 5.2 Page 20 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 arrangement for staffing the home covering all areas of skills is variable. Further staff training is required in a number of areas to ensure staff have the necessary knowledge and skills to meet residents needs effectively. Current arrangements place residents at risk. EVIDENCE: There were forty-nine residents living at the home at the time of the inspection visit. The care manager provided staff duty rotas, which reflected that there were not always two qualified nurses was on duty for the home. Also on some occasions there was not a first level qualified nurse on duty. It was not checked at the inspection whether the second level nurses left in charge of the home had the necessary experience and skills to do this and this will be looked at in some detail at the next inspection visit. The home had one full time and part time vacancy for trained nurses at the time of the visit. The number of care staff allocated to work during daylight hours appears to have decreased by one since the previous inspection, which is concerning as the needs of residents has not decreased and in some instances has increased. Therefore a review of staffing levels and the skill mix within the staff will need to be Heath House Care Centre DS0000024852.V336933.R01.S.doc Version 5.2 Page 21 undertaken to determine the staffing requirements to meet the current residents’ needs. At night there is always a minimum of two trained nurses and two care staff on duty. Again staffing levels have dropped from previously having three care staff on duty a nighttime. Staff files were inspected and it was found that a satisfactory recruitment process had been implemented with an application form, health declaration, two references and Criminal Record Bureau Check. The home’s training matrix did not state how many staff had completed an NVQ 2 or above however the returned questionnaire from the manager stated that “92 . …have achieved or are currently undertaking NVQ training.” Training has elapsed in a number of areas such as fire safety, manual handling, food hygiene, and adult protection. On the first day of the inspection visit, the deputy care manager was in the process of training a number of staff. Training consisted of one-hour sessions covering topics such as basic food hygiene, dementia, infection control, pressure area care, manual handling, fire awareness, health and safety and protection of vulnerable adults. The time span allotted to these topic mean they can only be viewed as a introduction to the topics and further training in these areas is required to ensure staff are fully competetent. Manual handling training was discussed with the management team during the inspection visit. As well as the one hours session staff receive a theory session on manual handling. This suggests that the home is not following an accredited teaching plan in relation to manual handling therefore it cannot be guaranteed that staff are being trained to a competent level. The home had no manual handler trainer working at the home at the time of the inspection, however the inspector was informed that over fifty percent of staff had received manual handling training from an external provider. Very few staff have received training in pressure area care and following recent concerns raised in relation to this it is imperative that staff receive training in this area. The home has its own programme for induction, and the shadowing of other members of staff. The manager confirmed that the induction programme does not encompass the Skills for Care programme. The home must revise the induction programme to include all elements of the Skills for Care programme in order to ensure that care staff are competent to carry out their roles Heath House Care Centre DS0000024852.V336933.R01.S.doc Version 5.2 Page 22 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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management and administration systems are lacking insome areas to ensure residents needs are fully met. The arrangements for managing the home safety compromise residents. EVIDENCE: The home has a Registered Manager with a wide breath of experience and knowledge. The questionnaire completed prior to the inspection by the care manager identified a number of areas that was felt the home could develop further; these included for example dementia care and staff training in equality Heath House Care Centre DS0000024852.V336933.R01.S.doc Version 5.2 Page 23 and diversity. During the tour of the home and conversation with the care manager plans to enhance the environment were discussed in specific relationship to the meets of residents with dementia care and mental health. Records were available to demonstrate that residents, relatives and staff meeting were taking place in the home. Monthly audits are carried out in a variety of areas internally by the management team at the home. Residents’ personal monies are safely stored. The records of residents’ money had been computerized. During the inspection an unannounced financial audit was being carried out by the organization. Discussions with the administrators demonstrated that this is standard procedure for the organization and is deemed to be good practice to ensure that residents money is safe and accountable. All money checked by the inspector were auditable. Records in relation to fire, water and gas were sampled in respect of maintenance and servicing of equipment. These records demonstrated that maintenance and servicing of equipment was taking place on a routine basis promoting the well being of residents. The home had recently been visited by the West Midlands Fire Service and followed by a report and a number of requirements. The inspector was informed that these requirements were being met by the home. Residents’ records demonstrate that all notifiable incidents under Regulation 37 of the Care Homes Act are not being forwarded onto the Commission. Heath House Care Centre DS0000024852.V336933.R01.S.doc Version 5.2 Page 24 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 3 2 3 3 X X 3 2 2 STAFFING Standard No Score 27 1 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 2 Heath House Care Centre DS0000024852.V336933.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15(2)(b) 15(1) Requirement 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. Staffs recording in care records must be an accurate account of what is required and what has occurred and must not risk residents’ rights and freedoms. 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. Previous timescale of 31/7/05 not met, this requirement is carried forward. All care plans must be based on a comprehensive assessment and following this assessment a holistic person centred care plan must be drawn up. Staff must be familiarized with each Heath House Care Centre DS0000024852.V336933.R01.S.doc Version 5.2 Page 26 Timescale for action 31/01/08 2. OP7 15(1) 31/01/08 persons care plan and any changes in condition or need must be reflected in the care plan and staff made aware of this to ensure needs are meet appropriately and consistently. 3. OP7 15(1) Where risks are identified a management plan must be written and implemented. The effectiveness of the management plan must be reviewed on a regular basis. Previous timescale of 30/10/06 not met, this requirement is carried forward. Comprehensive records must be kept in relation to food, fluids and delivery of personal care so that care can be monitored effectively and the appropriate care provided based on the monitoring of these needs Recommendations made by 30/11/07 external health professionals to ensure the well being of persons living at the home must be followed; this will ensure that best practice and care is provided appropriately to meet the residents needs. All medication must be auditable 30/11/07 to demonstrate that persons living in the home have received their prescribed medication and systems are in place to ensure they do. Medication must be administered 30/11/07 as pre prescribes instructions unless there are specific reasons no to. The reasons for none administration of medication must be documented and discussed with the prescribes to ensure the safety and well being of the resident. DS0000024852.V336933.R01.S.doc Version 5.2 Page 27 30/11/07 4 OP8 12(1) 5 OP9 13(2) 6 OP9 13 (2) Heath House Care Centre 7 OP26 13(3) 8 OP27 18(1) 9 OP30 18(1)© 10 OP30 12(1) 18(1)(c)(i ) The sluice area should not be used for storage of equipment to reduce the risk of cross contamination. A review of staffing levels and skill mix must be undertaken and appropriate action taken to ensure residents needs are met at all times. The commenced process of ensuring that all staff receives mandatory training in respect of Fire Safety, Food Hygiene, Tissue Viability and Adult Protection, must continue to ensure that staff have the knowledge and skills to under take their role competently The registered person must ensure that all staff are fully trained to practice appropriate manual handling techniques. Previous timescale of 30/11/05 not met, this requirement is carried forward. 30/11/07 30/11/07 30/12/07 30/12/07 11 OP30 18(1)(c)(i ) Systems must be in place to ensure an effective induction programme for new staff to ensure they have the knowledge to care for residents initially. Previous time scale not meet 30/11/06 30/12/07 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 OP1 Good Practice Recommendations The registered person is advised to produce the service user guide and complaints procedure in large print to DS0000024852.V336933.R01.S.doc Version 5.2 Page 28 Heath House Care Centre 2 OP9 3 4 5 OP16 OP26 OP26 6 OP38 assist those persons who are visually impaired. A comprehensive set of records must be kept in relation to the temperature of the medication fridge. This will demonstrate that medication is being stored at the required temperature and promotes and protects residents from any adverse effects. Complaint management must be reviewed to ensure that the underlying causes are dealt with appropriately and systematically to prevent repeated failings The registered person must review the provision of waste bins though out the home to ensure they are foot pedal operated to reduce the risk of cross contamination. The registered manager must take measures to address the areas of malodour within the home. Previous timescales of 30/11/04 not met, this requirement is carried forward. The Commission must be notified of incidents affecting the health and well being of residents so that the home can monitor between inspection visits. Heath House Care Centre DS0000024852.V336933.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Heath House Care Centre DS0000024852.V336933.R01.S.doc Version 5.2 Page 30 - 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. 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