Inspection on 28/04/08 for Heath House Care Centre

This inspection was carried out on 28th April 2008.

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

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

Other inspections for this house

Heath House Care Centre 07/05/09

Heath House Care Centre 14/06/07

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 28th April 2008 08:00 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.V363250.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.V363250.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 lizansah@aol.com www.schealthcare.co.uk Exceler Healthcare Services Limited 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) Mrs Elizabeth Dwusu-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.V363250.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. 14th June 2007 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 have been converted with an extension of an existing property and are situated to the south of Birmingham. The home 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. The accommodation provides 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 first floor consists of bedrooms and bathing/toilet facilities but has no communal space and is accessed by stairs or shaft lift. Fees vary and are dependent on the needs of the service users. Items not covered by the fees include toiletries, private treatments such as physiotherapy and chiropody, hairdressings and newspapers. The current scales of charges for the home range from £372.96 to £502.96 per week. The home retains the nursing element of the fee, which is paid by the Primary Care Trust. For up to date fee information the public are advised to contact the home. Heath House Care Centre DS0000024852.V363250.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which was carried out by three inspectors (one of whom is a specialist pharmacy inspector) over a one-day period. The focus of inspection undertaken by us is about outcomes for people who live in the home and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirement, minimum standards of practice and focuses on aspects of service provision that need further development. The inspection commenced at 8:00am and the home/provider did not know that we were coming. The manager was present for the duration of the inspection. Information used in the report was gathered from a number of sources: a questionnaire (AQAA Annual Quality Assurance Assessment) was completed before the inspection by the management team of the home. On the day of the inspection a tour of the building was undertaken, records and documents were examined about the management of the home, conversation with managerial and care staff plus visitors and a number residents. Some residents were unable to communicate their views verbally to the inspector so direct and indirect observation was used to inform the inspection process. Two residents who live in the home were ‘case tracked’ which involves establishing individuals experiences 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 including their health . Tracking people’s care helps us understand the experience of people who use the service. Questionnaires were forwarded to a randomly selected number of residents, relatives and health professionals prior to the inspection. Comments from residents and relatives spoken to during the inspection have been incorporated into the report, along with comments from staff working at the home. The inspectors would like to thank the residents, relatives, management and staff for their hospitality throughout this inspection. The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. What the service does well: Relatives stated they could visit at a time that suited them, therefore residents were always able to maintain contact with their family and friends. Heath House Care Centre DS0000024852.V363250.R01.S.doc Version 5.2 Page 6 Staff recruitment procedures were robust with appropriate checks undertaken to ensure residents were protected by the employment of new staff. Money, which is held on behalf of residents by the home, was accounted for and there were good systems in place to ensure residents’ finances were respected and protected. The home has three activities co-ordinators working within the home to provide purposeful and stimulating activities for residents. The home also plans to expand the provision of activity co-ordinators to seven days a week. Comprehensive pre-admission assessments are carried out ensuring that no one moves into the home without their needs being fully assessed so that people can be sure that all their needs are met. What has improved since the last inspection? What they could do better: The Service Users Guide should be reviewed and amended so that the information available is current and correct. It is recommended that the home explore the possibility of a pictorial form for the Service Users Guide for some of the residents so that information is available in a format they can access. Care planning and record keeping about changes in residents behaviour was not being recorded so that trends and patterns were not being picked up. Residents care was therefore not always being adjusted were necessary. Continence promotion needs to be reviewed so that residents’ dignity is maintained at all times. Care plans must include assessment and strategies to met this need. Staff will also need training in this area. Heath House Care Centre DS0000024852.V363250.R01.S.doc Version 5.2 Page 7 The external grounds risk assessment must be revisited and gaps in the perimeter fence mended to address the risk of intruders accessing the homes grounds. The home should contact its local Environmental officer to ensure that they are compliant with the new no smoking legislation. The availability of working hoisting equipment must be looked at to ensure that residents do not have to wait an excessive amount of time for equipment. Staff need training in the new Mental Capacity Act to ensure that the rights and any risks for residents are identified, maintained and promoted. Staff need to have training, supervision and their practice monitored in all aspects of adult protection matters to ensure residents dignity, choice and welfare are maintained The home must continue to improve the way in which it notifies the CSCI of incidents that affect the well being of its residents to ensure their welfare is protected. 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.V363250.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.V363250.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): 1.3 Quality in this outcome area is good Information about the service or facilities is available to residents and or their representatives to enable them to make an informed choice about the home. The pre-admission assessment process was comprehensive therefore residents can be assured their needs will be meet when moving into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the Service Users Guide was given to the inspectors at the time of the visit. The manager confirmed that these are given to all residents on admission to the home and can usually be found in the residents’ wardrobe in their bedroom. The service user guide is available in other formats such as Heath House Care Centre DS0000024852.V363250.R01.S.doc Version 5.2 Page 10 audiocassette although no resident in the home has a service user guide in this format. It is recommended that some residents living at the home might access the information available more easily if it was presented in a pictorial format and the home should consider this as an alternative. The Commission for Social Care (CSCI) Birmingham office has recently moved and the Service user guide will need to be amended to reflect this along with references to the Oxford CSCI office. Also the section “Management and Administration” in relation to resident finances further clarification is needed and possible amendment in order to provide people with all the necessary information. Enquiry forms are generated and added to as required which may lead on to a pre-admission assessment. The Care Manager or deputy manager will visit potential residents prior to admission at their home or in hospital to carry out a pre-admission assessment to make sure that the home can meet their needs. Following this pre-admission assessment staff draw up a draft care plan these were found to be in place. The Care Manager confirmed that admission to the home only takes place if they feel they can meet the prospective residents needs. A letter is then sent to the prospective resident to confirm that the home can meet their needs. The organisation has an admissions policy and procedure. A resident confirmed that their had been invited to visit the home prior to deciding to live there No intermediate nursing care is provided at the home. Heath House Care Centre DS0000024852.V363250.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. 10 Quality in this outcome area is adequate Residents care needs were not consistently met in an effective manner despite a comprehensive care planning system being in place. The medicine management is good within the home. Nursing staff practice good systems and administer the medicines as prescribed and support the clinical needs of the people who live in the home This judgement has been made using available evidence including a visit to this service. 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. Heath House Care Centre DS0000024852.V363250.R01.S.doc Version 5.2 Page 12 The care planning documentation is comprehensive with an array of risk assessments taking place such as skin integrity, nutrition, falls and moving and handling. Care plans were being evaluated monthly. The staff have worked hard to improve the care plan records. Care plan records sampled did not always clearly show that individual needs were being fully planned for or evaluated. Incidents of aggressive behaviour were not being recorded so that trigger or trends could be established. The majority of staff have now received training in pressure area care following a requirement made in the previous inspection report. The tissue viability nurse working for the Primary Care Trust carried out an audit in the home August 2007, the manager confirmed that following this audit a number of beds and mattress have been replaced as part of a rolling programme. The home has no intention at present to review the seating for residents at risk but pressure-relieving cushions are supplied for those at risk. One resident who was identified as having a tissue viability risk, had the appropriate pressure relieving mattress on their bed but was observed throughout the day not to be sitting on a pressure reducing cushion that would help reduce the risk of their skin breaking down. A number of external health professionals’ referrals had occurred for a wide range of disciplines, which included skin integrity, chiropodists and optician. One resident was observed asking for the toilet but it took staff twenty minutes from the point of the resident asking to being taken to the toilet. Staff informed the inspector that the reason for the delay was due to only one stand aid being available in the home with a sling they could use to safely transfer this resident. Another resident was observed walking up the corridor when they had clearly been incontinent. Also another resident was observed asking to leave the dining room. It was evident that they had been incontinent and unfortunately they fell in the hallway on leaving the dining room thus revealing they had no undergarments on. Finally another resident informed the inspectors that they had asked for a urine bottle to be provided for their use during the nighttime and staff informed them to “pee in your pad”. This was discussed with the Care Manager at the time of the inspection, who agreed to look into the matter. It is clear there is an issue with continence management in the home, from staff having the right equipment to the understanding of continence needs. The care plans identify continence needs in the form of whether the resident is incontinent to what pad they require. This approach is reactive and staff need to identify what type of incontinence the resident has so that the cause can be elimated or modified and individual strategies can be put in place to promote continence. Staff need training in this area to ensure they have the skills to meet residents’ continent needs. Care in relation to respect and dignity was mixed within the home. Whilst some good practice was observed the inspector observed on one occasion a resident being spoken to harshly upon requesting assistance. This was pointed Heath House Care Centre DS0000024852.V363250.R01.S.doc Version 5.2 Page 13 out to the Care Manager at the time of the inspection. An inspector carried out a short observation framework inspection (SOFI) at the home, which is a specialist tool used by inspectors developed for the Commission by Bradford University. The observation demonstrated that the interaction was either positive or neutral, for example staff would be laying the table for lunch but did not speak or acknowledge residents sitting at the table. The pharmacist inspection took place at the same time as the key inspection. Five residents’ medicines were looked at together with their daily records and care plans. Two nurses on duty were spoken with. On entry to the home the we found that the door to the medication room was unlocked and medicines awaiting return to the clinical waste company for destruction had not been locked away due to lack of cupboard space. This gave full access to medication to anyone in the home, which may have caused serious harm if taken. The medication refrigerator was monitored daily to check that the temperatures lay within the safe limited to safely stored the medicines within. No action was taken though when the temperature fell outside these limits, indicating that the medication had not been stored correctly. The two nurses completed the medication round at 11:30am. The next medication round was due to start at 1 o’clock. This left insufficient time between rounds, which may increase the risk of residents being overdosed. The home has installed a good system to check the prescriptions and medicines received into the home. Audits indicated that the medicines had been administered as prescribed. Staff undertook a time consuming auditing system to ensure that they administered the medicines correctly. This certainly extended the length of the medication round. The actual timing of the auditing system could be reviewed to speed up the medication round. Good practice was seen where medicines that had been prescribed, to be administered every week, for example, had clear guidelines when the dose was due. Further good practice was seen where some occasionally used medicines had supporting protocols detailing their use. These though were not consistent for all medication administered when required. The two nurses spoken with during the inspection had a very good knowledge of the clinical conditions of the residents who live in the home and what the medicines were for. This would enable them to support the residents fully and was commended. All controlled drug balances were accurate and they were stored correctly ensuring the residents safety and well being. Heath House Care Centre DS0000024852.V363250.R01.S.doc Version 5.2 Page 14 Heath House Care Centre DS0000024852.V363250.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12. 13. 14. 15 Quality in this outcome area is good 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. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Arrangements for visiting were flexible enabling relatives to visit at a time that suited them and residents to maintain contact with them. The questionnaire returned to us stated that the home now had protected meal times. This means that visitors are asked not to visit during meal times, however one relative did inform us that they could have a meal at the home if they wanted one. Residents, relatives and staff confirmed an array of activities were taking place in the home and also that residents did go out to various places e.g. the park Heath House Care Centre DS0000024852.V363250.R01.S.doc Version 5.2 Page 16 and the local public house. The Roman Catholic priest visits the home on a regular basis and sees a number of residents. The forth-coming local elections and residents ability to take part in the political process was discussed with the Care Manager. The Care Manager stated that residents could either use the postal vote option or go down to the polling booth in a taxi. A number of residents have chosen in the past to go down to the polling station. Residents’ bedrooms were personalised with their own possessions so providing a more comfortable and homely environment. The mealtime experience was observed to be unhurried and staggered so that all residents could eat their meal at a pace that suited them. The provider has introduced a system where those residents identified as being at nutritional 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 to offer discreet assistance to residents during meal times. Records of fluid and food intake are kept. One resident commented on being asked about meals at the home “food is brilliant” “food is lovely” “Can have a cup of tea when you want it”. However this resident and another confirmed that choice was not always available. An example given was that morning they had asked for weetabix and got porridge. The questionnaire returned to us identified that the home has a number of residents from a variety of ethnic backgrounds. Cultural preference in meals was discussed with the Care Manager at the time of the inspection as the menus were not regularly catering for the diverse cultural mix of residents living within the home. The Care Manager stated this would be explored with residents. Heath House Care Centre DS0000024852.V363250.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16.18 Quality in this outcome area is adequate Systems for picking up and recognising complaints are satisfactory. Not all residents are safeguarded appropriately and this can affect their health and well-being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has written policies and procedures for the protection of the vulnerable adults and complaints that meet the standard. Since the previous inspection the home has recorded six formal complaints and three adult protection referral. The six formal complaints were about care practice issues. All adult protection issues have now been resolved, one was upheld and two were withdrawn. During conversations with staff, their understanding of how to protect residents from abuse was mixed. They would report adult protection matters to the most senior person available but beyond this they were unsure of what they must do. The Care Manager confirmed that the full procedure is available to staff in the nurses’ station. There is an ongoing programme of training for protection of vulnerable adults. According to the training matrix 83 of staff have received training in abuse and Heath House Care Centre DS0000024852.V363250.R01.S.doc Version 5.2 Page 18 protection of the vulnerable adult. The training matrix identifies those members of staff who have received training, those who need to renew soon and those who require training to meet the standard. Staff have not as yet received training in the Mental Capacity Act. However a training package has been obtained to start this. This is important legislation that requires an assessment of residents’ capacity to be done if there is any doubt about the resident’s capacity to make decisions. If they are assessed as not having capacity an Independent Mental Capacity Advocate (IMCA) can be appointed to help them with this. Inspectors witnessed an episode of challenging behaviour in one of the dining rooms at breakfast time. The two dining rooms are divided by a passage way and a corridor at the side. The two care staff had gone into the kitchen to collect food for breakfast leaving both dining rooms unsupervised. Whilst both carers were in the kitchen one resident became verbally aggressive towards another resident and objects were thrown. This behaviour continued for a minute with neither carers returning to the dining room. The volume of the incident was very loud and eventually another member of staff come in from the corridor to calm and defuse the situation. The care planning process is not monitoring these occurrences as stated in management and administration section of the report. Heath House Care Centre DS0000024852.V363250.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19. 20. 21. 24. 25. 26 Quality in this outcome area is good The home has improved its décor and facilities in order to provide a suitable environment for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On both units within the home it was evident that a programme of redecoration and refurbishment had taken place. Both units have access to a large lounge area, large dining areas and a conservatory that is the designated smoking area for residents. The conservatory is a favourite area used by residents of both units. The use of the conservatory as a smoking area was discussed with the Care Manager and they will need to revisit their policy and Heath House Care Centre DS0000024852.V363250.R01.S.doc Version 5.2 Page 20 procedure in relation to the Health Act 2006 which allows smoking in care homes although there are restrictions which they must adhere to. Corridors have been redecorated and named after locations. Murals have been painted on some of the corridor walls, which have improved the environment for residents by individualizing areas. Residents’ bedroom doors have also been re-painted and the Care Manager informed the inspectors that residents had chosen the colour for the doors themselves. A nursery area has been created in the home as part of providing a therapeutic environment for residents. The Care Manager felt this had been of benefit to residents and the dolls that reside in the nursery also come down to the main lounge areas for residents to hold. Residents’ can access the garden from the conservatory and from the dining rooms. The garden perimeter fence was broken in a number of areas. The Commission was notified recently that an intruder was observed in the garden This is concerning as it potentially places residents at risk. The home needs to revisit its premises and grounds risk assessment and ensure measures are put in place to reduce any potential risk. Across both units there are four shower rooms and four bathrooms. At the time of the inspection a new assisted bath was being fitted on the ground floor. Each room is different and facilities vary. Twenty-five residents have an ensuite toilet facility (all in single rooms) and further toilets are available in all bathrooms and shower rooms. Some residents share their rooms with other residents (there are five shared rooms in total). These rooms are larger than 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 home was warm on the day of the inspection. There was only one slight malodour noticed in the morning. The management of malodours has improved since the previous inspection, the refurbishment programme replacing flooring and fabrics may have helped this. One sluice room was visited and this contained a pot disinfector and was found to be tidy and well organised. Staff were observed wearing gloves and aprons. The home has a system where blue aprons and gloves are worn for serving food, which is good practice. Staff were observed wearing gloves for a variety of tasks, and on occasions these would not have been necessary e.g. walking a resident along the corridor. Staff were not able to give an explanation as to why they continued to wear gloves and aprons when not giving personal care or serving food to residents. The wearing of gloves puts a physical barrier between resident and staff. Bins were available around the home for disposal Heath House Care Centre DS0000024852.V363250.R01.S.doc Version 5.2 Page 21 of waste material but these are not always foot operated therefore increasing potential risk of cross infection. The laundry area was clean. Clean items are kept separate from dirty items. A keypad lock was observed on the door to the laundry however staff had immobilised the lock for easy of access. The keypad lock is in place to prevent residents entering the laundry area and exposing them to a variety of risks. All residents have their own box for clean clothes. The impermeable flooring in the laundry was observed to be cracking in a number of places. Also the approach to the laundry is via a carpet area where dirty and clean laundry. The carpet in this area is not appropriate as it is part of the laundry and this flooring cannot be cleaned to the necessary standard to prevent cross infection. Heath House Care Centre DS0000024852.V363250.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27. 28. 29. 30 Quality in this outcome area is adequate. Whilst training and numbers of staff have increased, staff practice still remains poor in a number of areas therefore residents needs are not always being meet in a consistent manner. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were forty-seven residents’ livings at the home at the time of the inspection visit. The Care Manager provided staff duty rotas, which stated that there was two qualified nurses on duty for the home both day and night. Staffing levels have been reviewed since the previous inspection. The number of carers on night duty has increased to four. The Care Manager stated the home was in the process of increasing the number of activity co-ordinator hours with the eventual plan to ensure that activities are provided seven days a week. A sample of newly recruited 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. Heath House Care Centre DS0000024852.V363250.R01.S.doc Version 5.2 Page 23 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 “our NVQ is currently 68 .” The deputy manager whose role involves training staff has qualifications in training. Training has taken place in a number of areas such as fire safety, manual handling, food hygiene, and adult protection. The time span allotted to these topics has been reviewed since the previous inspection. Staff have not had training in the Mental Capacity Act 2005 however a training package has been obtained. An induction training programme was in place in the home. Care staff confirmed that induction training had taken place and that they work with a senior carer initially when they start working at the home. The inspector was not able to see staff booklets in relation to the induction programme to confirm whether it is compliant with the Skill Care Council. Heath House Care Centre DS0000024852.V363250.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31.33. 35. 38 Quality in this outcome area is adequate Overall the management systems in the home in relation to administration are good however improvement in some areas of care practice and protection of residents is needed so residents are fully cared for and not put at risk. This judgement has been made using available evidence including a visit to this service. 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 it was felt the home could develop further. These included for example to develop a separate activities Heath House Care Centre DS0000024852.V363250.R01.S.doc Version 5.2 Page 25 programme that is occupational therapy based for residents who are less cognitively impaired. The Care Manager stated that peer review was taking place in relation to quality assurance. This means another manager from the organization comes to the home and carries out internal audits. The Care Manager stated that this had been a very positive move in looking at the homes systems and functions. Records were available to demonstrate that residents, relatives and staff meetings were taking place in the home. Reports held at the home demonstrated that a provider’s representative was visiting on a regular basis. The Care Manager has recently implemented a new staffing structure to ensure that residents’ needs are being met consistently. Feedback from staff was positive to this new practice. Whilst it must be acknowledge that a lot has been achieved in the past twelve months, further work is required around staff practice and this new initiative may help resolve some of the issues. Senior staff must ensure that staff supervision and support covers all areas of staff practice and in particular when it falls short of a safe and adequate standard. Residents’ finances were discussed with one of the provider’s auditors. Residents’ money is held in a bank account, which has sub accounts for each individual residents money. The inspector was informed that the bank account pays interest to each individual resident whose money is held in the account. The Service Users Guide states money held in the bank account does not pay interest. Clarification is need on this matter to ensure residents are fully aware of the situation in relation to their money. The auditor stated that only a small amount of cash is held on site, but if residents wanted cash this could be obtained for them. The provider’s auditor informed the inspector that their visits are never announced to the home before hand. The management team also confirmed the visits were unannounced. Records in relation to fire, water, electrics 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. Accident records for a number of residents were looked at and these were cross-referenced with individuals care plans. The majority of accident records sampled were not referred to in the residents care plan. Consequently triggers for incidents were not been monitored by the care planning process. The Commission has not received regulation 37 forms in relation to some of these accident records. Some of the accidents records recorded injury to other residents. The Commission was informed prior to the inspection of a social workers review which discovered that the person they were reviewing was assaulted resulting in a paramedical team being called, but neither residents’ social worker nor the Commission were informed about this. Heath House Care Centre DS0000024852.V363250.R01.S.doc Version 5.2 Page 26 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 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 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 3 17 X 18 2 2 3 3 2 X 3 3 2 STAFFING Standard No Score 27 3 28 3 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.V363250.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP18 Regulation 13(6) Requirement Systems for monitoring challenging behaviour should be reviewed to ensure that the appropriate strategies are in place to meet resident’s needs. Residents identified, as having continent management needs must have their needs assessed to includes the type of incontinence and appropriate management strategies drawn up to meet these needs. This will promote and ensure the dignity of the resident. Timescale for action 20/06/08 2 OP7 12(1) 20/06/08 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 It is recommended that the Service User Guide be reviewed and amended. Also the Service User Guide should be available in pictorial form for those resident that might find the information more accessible in this format. DS0000024852.V363250.R01.S.doc Version 5.2 Page 28 Heath House Care Centre 2 OP8 3 4 OP8 OP9 It is recommended that the home discuss with the tissue viability nursing service appropriate seating when it comes to replacing the present chairs. This will ensure that residents’ needs are meet and that the need for separate cushions is eliminated in some instances. Residents identified as needing a urine bottle to meet their continent needs must be provided with one. It is recommended that action is taken if the temperature of the refrigerator is outside the recommended limits of 2°C and 8°C to ensure that the medicines are safely stored within to maintain their stability It is recommended that all medicines are stored in locked cabinet at all times including the medicines that are due to be destroyed. It is recommended that the quality assurance system is changed to ensure that the medication round is completed in a timely fashion and at least four hours is left between medication rounds It is recommended that all service users receive a full medication review in line with the national service frameworks for older people who live in the home and supporting protocols for all occasional use medicines are written to support their use. Staff must receive training and supervision in promoting and protecting residents dignity, choice and rights. Staff practice must be observed to ensure that residents are spoken to appropriately and treated respectfully and any training needs identified from this must be put in place It is recommended that the home obtain a copy of the Department of Health guidance “Mental Capacity Act 2005 residential accommodation” published July 2007 The perimeter fence must be made secure and the grounds risk assessment reviewed to ensure that any risk identified are reduced to ensure the security and well being of residents. The home must review its smoking policy and procedure and it is recommended that they contact their local Environmental health officer for advise and guidance in meeting the new legislation The provision of hoisting equipment and slings must be reviewed so that residents do not wait excessive amounts of time to have their needs meet. The registered person must review the provision of waste DS0000024852.V363250.R01.S.doc Version 5.2 Page 29 5 OP9 6 OP9 7 OP9 8 OP10 9 10 OP18 OP19 11 OP19 12 13 OP22 OP26 Heath House Care Centre bins though out the home to ensure they are foot pedal operated to reduce the risk of cross contamination. 14 15 OP30 OP38 The home must ensure that the induction is compliant with the Skills Care Council 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.V363250.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Text phone: 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.V363250.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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