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Inspection on 03/10/06 for Heath House Care Centre

Also see our care home review for Heath House Care Centre for more information

This inspection was carried out on 3rd October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents` needs are fully assessed prior to an admission, to ensure the home is able to offer and provide an appropriate service that will meet the care and nursing needs of the resident. This process does involve other healthcare professionals. The home has started to develop a process to support person centred planning which means that the lifestyle choices, including likes and risks of the resident is fully considered when planning the care. The home clearly manages the daily life and social activity of residents in a positive, varied and individual fashion. Outcomes for residents in most areas are very good providing them with a stimulating and purposeful life. Residents were observed enjoying some activities, they were concentrating and clearly in a state of well being. The new manager was able to describe good practices, which will enable the home to manage future complaints and protection of adult issues. Relatives indicated in the survey that they know how to complain and that they believe the residents are supported safely. 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 cyclical menu. Relatives have recently been involved in a revision of the menu. There are good numbers of staff on duty to meet the needs of residents, they are recruited safely ensuring all required checks such as CRB disclosures are made before appointment. Two residents indicated that staff are good, one said "most of them are okay (pointing towards staff)" and another said "they`re alright" when asked about the care staff. The new manager appears to be making some very positive changes with a focus on providing individual care for residents with a dementia and for those with an enduring mental illness. The opinion of one relative was that the amount of activities had increased since the new manager started. The opinion of some staff about the new manager was for many reserved as she had only recently commenced, however comments were more than positive.

What has improved since the last inspection?

The majority of improvements required at the last inspection have either been partially or fully completed. A new statement of purpose and residents guide is available for prospective residents and their representatives, these documents provide some information about the home, the organisation, resources, policies and procedures and staffing. Medication management has improved including recording and stock control. There have been many recent developments in the home, including a new large conservatory, replacement arm chairs, new flooring in some corridors and the garden is currently being developed to include a sensory area (herb garden), a safe water feature and many overgrown trees and plant life have been cut back. Relatives were positive about how the home is improving one relative commented on the survey form "that slowly but surely things are improving" and another said that "although changes are being made it does take time".

What the care home could do better:

The residents care records are in a transition period, whereby new Southern Cross records need to be completed. The manager must ensure that as a priority health care plans are available for all residents. It is also very important that the transition process is completed quickly and comprehensively. There are positive outcomes for many residents who are able to engage themselves in activities, however for residents with severe cognitive impairment and severe mental illness their level of engagement and ability to benefit from activity needs to have care plans to guide staff within this specialist activity area. Risk assessments for residents, as required at previous inspections are not always adequate to inform staff of what they need to do in order to maintain safety and reduce risk; an example of this is manual handling, as equipment used and amount of staff to assist movement of a resident are not recorded. The garden wall, which was very recently discovered to be cracked when plant life was cut back, must be assessed for safety. Continued improvement is needed in the management of odour in the home especially in residents` rooms; one relative commented in the survey that "I have never visited and been totally happy about freshness, there always seems to be a lingering smell". The staff induction training programme must reflect the standards identified by Skills for Care and be fully implemented. All staff must receive training in moving and handling.

CARE HOMES FOR OLDER PEOPLE Heath House Care Centre 81 Walkers Heath Road Kings Norton Birmingham West Midlands B38 0AN Lead Inspector Sean Devine Key Unannounced Inspection 3rd October 2006 09:30 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.V311390.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Heath House Care Centre DS0000024852.V311390.R02.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 Vacant. 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.V311390.R02.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. 20th September 2005 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. There is a skill mix in the qualified nursing staff, but they are predominantly RMN’s. There is a dedicated care team and residents are further supported by ancillary staff being catering, domestic, laundry and maintenance. Two members of staff are appointed as activity organisers. The premises is a conversion and extension of an existing property and is situated to the south of Birmingham. It is located close to public transport links. The building is divided into two units, Heathside and Walkers Lodge. There is 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 £410.00 to £533.00 per week. The new manager has indicated she is considering providing an art room, sensory area and additional facilities for some residents to make their own refreshments. 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.V311390.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was conducted by one regulation inspector, unannounced over a period of two days. Prior to the inspection the new manager provided information upon a questionnaire and four relatives completed and returned a survey form. During the inspection the inspector was able to meet with many residents, however due to the nature of their dementias it hindered the ability of most residents to clearly communicate their views and opinions about the service they receive. The evidence to judge the homes performance was mainly gathered through, observation of care, care records, discussions with staff and management, viewing communal rooms and residents rooms and also from the pre inspection information. The registered manager and a care manager have very recently left the home and the Southern Cross organisation have taken over from Ashbourne. A new manager has been appointed and she fully expects to shortly recruit a deputy manager. The inspector was also able to meet two area managers from Southern Cross during the inspection, who were both available on separate days to discuss the findings. What the service does well: Residents’ needs are fully assessed prior to an admission, to ensure the home is able to offer and provide an appropriate service that will meet the care and nursing needs of the resident. This process does involve other healthcare professionals. The home has started to develop a process to support person centred planning which means that the lifestyle choices, including likes and risks of the resident is fully considered when planning the care. The home clearly manages the daily life and social activity of residents in a positive, varied and individual fashion. Outcomes for residents in most areas are very good providing them with a stimulating and purposeful life. Residents were observed enjoying some activities, they were concentrating and clearly in a state of well being. The new manager was able to describe good practices, which will enable the home to manage future complaints and protection of adult issues. Relatives indicated in the survey that they know how to complain and that they believe the residents are supported safely. Heath House Care Centre DS0000024852.V311390.R02.S.doc Version 5.2 Page 6 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 cyclical menu. Relatives have recently been involved in a revision of the menu. There are good numbers of staff on duty to meet the needs of residents, they are recruited safely ensuring all required checks such as CRB disclosures are made before appointment. Two residents indicated that staff are good, one said “most of them are okay (pointing towards staff)” and another said “they’re alright” when asked about the care staff. The new manager appears to be making some very positive changes with a focus on providing individual care for residents with a dementia and for those with an enduring mental illness. The opinion of one relative was that the amount of activities had increased since the new manager started. The opinion of some staff about the new manager was for many reserved as she had only recently commenced, however comments were more than positive. What has improved since the last inspection? What they could do better: Heath House Care Centre DS0000024852.V311390.R02.S.doc Version 5.2 Page 7 The residents care records are in a transition period, whereby new Southern Cross records need to be completed. The manager must ensure that as a priority health care plans are available for all residents. It is also very important that the transition process is completed quickly and comprehensively. There are positive outcomes for many residents who are able to engage themselves in activities, however for residents with severe cognitive impairment and severe mental illness their level of engagement and ability to benefit from activity needs to have care plans to guide staff within this specialist activity area. Risk assessments for residents, as required at previous inspections are not always adequate to inform staff of what they need to do in order to maintain safety and reduce risk; an example of this is manual handling, as equipment used and amount of staff to assist movement of a resident are not recorded. The garden wall, which was very recently discovered to be cracked when plant life was cut back, must be assessed for safety. Continued improvement is needed in the management of odour in the home especially in residents’ rooms; one relative commented in the survey that “I have never visited and been totally happy about freshness, there always seems to be a lingering smell”. The staff induction training programme must reflect the standards identified by Skills for Care and be fully implemented. All staff must receive training in moving and handling. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Heath House Care Centre DS0000024852.V311390.R02.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.V311390.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,3 and 6. The quality in this outcome area is good. This judgement has been made using available evidence and a visit to the home. The home demonstrates it has the ability to help support residents when they choose a home by ensuring they gather information about the needs of the resident, which helps the home decide on whether they can provide an appropriate service. Residents and their representatives are provided with information about what to expect from the service. EVIDENCE: A statement of purpose and residents’ guide is available at the home, which informs residents, relatives and representatives about the service and what they will provide. The manager is considering different ways to share these new documents and their contents with residents and relatives. Four residents care files were sampled. It was evident that the home is still in the process of transferring information from the Ashbourne organisation documents onto Southern Cross documents. Heath House Care Centre DS0000024852.V311390.R02.S.doc Version 5.2 Page 10 However original assessments by social workers, mental health workers and hospitals were available and on all files the home had conducted its own assessment. The most recent admission had an initial enquiry form and a very detailed assessment by the home covering areas, such as levels of dependency, risks, personal care needs, current medication and dementia assessments. There were many other areas of the assessment. The new documentation (Southern Cross) provides the referring agency / person with a letter advising whether the home can offer a placement, it also allows for the nursing staff to develop a draft care plan, which would be in place prior to the admission. The inspector is pleased to see such developments and will assess how this has improved the admission process at the next key inspection. The home does not provide an intermediate care facility. Heath House Care Centre DS0000024852.V311390.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10. The quality in this outcome area is adequate. This judgement has been made using available evidence and a visit to the home. The home at present is not fully demonstrating it has the ability to plan the care of residents, recent omissions indicate that the immediate physical healthcare needs maybe overlooked and the heath and welfare of residents put at risk. EVIDENCE: The home is attempting to develop a person centred planning approach to care. Many assessments support this process, such as life histories and client social profiles. These were available on some of the residents files, however the standard of information and content varied and would not always help support a person centred approach to planning care. Areas of omission were being actively improved at the time of inspection. This included checking old Ashbourne care plans to ensure that key areas of health care had not been overlooked when the Southern Cross care planning forms were completed. Heath House Care Centre DS0000024852.V311390.R02.S.doc Version 5.2 Page 12 Until residents needs have been fully established and new care plans written the manager advised that staff would refer to some of the old care plans, whilst ensuring new care plans for immediate health concerns are in place. Other key areas for residents that did not have care plans included social care and daily life, the impact of dementia on the individual, cultural diversities, risk management where concerns had been identified and managing challenging behaviours. All sampled files did have risk assessments for dependency, moving and handling, nutrition, skin integrity and falls. As identified where risks were prevalent a clear and concise management plan was not always available; an example of this was moving and handling where the residents needed to use aids, however which aids, environment and staff support was not described. All residents do have a record of visits by healthcare professionals, this is also at times recorded within daily records, it was evident from these records and from surveys from relatives that appropriate healthcare support is sought routinely and in an emergency. The nursing staff do manage all medicines on behalf of the residents. Including ordering, storing, administration and disposal. There is a monitored dosage system in place provided by a community chemist. Copies of the GP prescriptions are taken to check medicine received into the home for accuracy. When receiving medicines into the home the nurses normally record when it was received, the quantity and who received it; however for this months supply records were found to be incomplete. Medicines are sometimes stored in a fridge and usually the nurses monitor the temperature to ensure safety, yet at times this is not completed. Some ointments have the date opened recorded to ensure that it is disposed within the guidelines of the product. The majority of nurses have attended a course for the safe handling of medicines; the manager did advise that all nurses would undertake this course. A medicines policy is available but does not fully reflect the use of a monitored dosage system and medicines that are boxed or bottled are regularly audited to assess the accuracy of stock. Care staff, ancillary staff and nurses were seen to spend a great deal of time either supporting residents with their care needs, providing activities or in general discussion. At all times a respectful approach was observed and the residents were treated with dignity and professionalism. This is certainly positive and was supported by relatives in their surveys. Heath House Care Centre DS0000024852.V311390.R02.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All standards. The quality in this outcome area is good. This judgement has been made using available evidence and a visit to the home. The home clearly manages the daily life and social activity of residents in a positive, varied and individual fashion. Outcomes for residents in most areas are very good providing them with a stimulating and purposeful life. EVIDENCE: The residents’ surveys commented upon the increased amount of activities in the home and how these varied. The home employs two part time activity organisers, who work very closely with the care staff. Records of activities for each resident are well maintained including a tick chart and a weekly report on participation. There is a weekly and annual plan for activity in and outside of the home including church services, raffles, trips to local areas of interest such as Walsall illuminations, celebrations of religious events, colouring, singing and dancing, art and one to one discussions. During the inspection residents were seen to colour pictures, make collages and play games of dominoes, always with the support where needed of staff. The manager and maintenance person advised of how the garden is being developed to include a sensory / herb area and also an allotment for residents who are keen on gardening. Heath House Care Centre DS0000024852.V311390.R02.S.doc Version 5.2 Page 14 An area of the home is also being developed into an art room and there are plans to develop a sensory area for mainly residents with severe sensory and cognitive difficulties and also to assist some residents with relaxation. Many residents doors have been fitted with name plates, letter boxes and knockers and residents have been able to choose the colour of their door. The manager advised that staff are and will continue to be supported through training to develop the home in this area and that this is in line with organisational strategies. During inspection very few relatives were seen to visit the home, however during a conversation with two residents they confirmed that members of their family did visit. The home also extends invitations for relatives to attend meetings and the manager has started a “managers surgery” for relatives and other interested persons. The visiting hours are not set and one staff member commented that those that do visit normally avoid busy times of the day. All residents are unable to safely manage their own financial affairs; further information about finances is recorded within standard 35 of this report. Residents and relatives are provided with information about external agencies that may advocate for residents, this is available on a notice board, within the complaints policy and staff are provided with this information in a booklet. The manager and chef advised of the recent changes to the menu planner to include not only traditional English food but also foods from around the world. The chef was seen talking with residents and staff about the curry he planned to cook for the next day and informed the inspector and manager of how well this was received. The residents’ lunchtime was observed on both days; the menu was on display upon a chalkboard; on the first day Heathside unit it was seen to be extremely busy, with lots of noise and did not provide residents with a positive and social experience. The area manager and manager suggested ways of improving the lunchtime such as staggering mealtimes for some residents. The staff managed the mealtime very well, ensuring all residents were assisted where needed and encouraging others who were reluctant to eat. On the second day on Walkers Lodge unit the experience was very different, on all tables residents were in conversation with each other and staff, it was social and residents enjoyed their meals, often asking for more. One resident commented “as long as I get my food, I’m happy” another resident said “I enjoyed my dinner”, it was also evident that many other residents enjoyed their lunch. The menus sent to the inspector as part of the questionnaire, returned by the manager indicated they are well balanced and nutritional; that choices are available and that where special diets due to medical conditions are needed, that these are provided. The recent environmental health officers’ report was very positive about health and safety and the chef does maintain food safety risk assessments. Heath House Care Centre DS0000024852.V311390.R02.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. The quality in this outcome area is good. This judgement has been made using available evidence and a visit to the home. The home does demonstrate it has the ability and processes in place to enable residents and their representatives to raise their complaints and does have the skills and competencies to fully protect residents from abuse. This ensures residents safety and well-being is at all times well managed. EVIDENCE: There is a detailed and comprehensive complaints policy available for residents and their representatives; it is on display in the corridor close by the entrance to the home and guides the person through all stages of the process. Since the last inspection there has been one complaint, the care manager investigated this and a response with actions was made to the complainant. The commission has not received any complaints about the home in the past twelve months. Residents and relatives did not raise any complaints. During conversations with the staff and the manager it was clear they have a good understanding of how to protect residents from abuse. Recently, the staff have raised concerns about a resident and the manager reported this to the appropriate office of the Social Care and Health department; under their adult protection procedures. She has been involved in strategy meetings to improve the safety for this resident. There is an ongoing programme of training for the protection of vulnerable adults and at present nearly 80 of staff have been trained. Heath House Care Centre DS0000024852.V311390.R02.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,20,21,24,25 and 26. The quality in this outcome area is adequate. This judgement has been made using available evidence and a visit to the home. In many areas the home has demonstrated it has the capacity to provide residents with a safe and comfortable environment that both promotes their individual and communal living needs, yet there are some areas in need of improvement to ensure this it is always safe and does not put the health and safety of residents at risk. EVIDENCE: A tour of all communal areas of the home was undertaken. It was evident that a continuous programme of redecoration and refurbishment was in place. The inspector noticed many new items of furniture and new flooring and also repainting of residents’ room doors, work had commenced to improve the garden. Records seen also indicate that regular checks of the premises are done and that where needed repairs are made. During the tour minor repairs to tiling in the downstairs bathroom and shower room on Heathside unit was noticed. Heath House Care Centre DS0000024852.V311390.R02.S.doc Version 5.2 Page 17 During feedback this was discussed with the manager who advised of premises audits and arranging repair. Large areas of the garden had been cleared of over growing trees and plant life, the inspector noticed that a wall had some loose breeze blocks and had some cracks. The manager arranged for this area of the garden to be cordoned off and had started making arrangements for a structural assessment. On both units the residents have access to large lounge areas, large dining areas and a newly built conservatory, which 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 and interim measures to heat the conservatory have been made, this will need improving for the cold winter months. During the tour of the home care staff advised about which residents are able to use the varied bathing and shower facilities, this depends very much on the mobility and movement needs of residents and which room is spacious enough to maintain safety. Across both units there are four shower rooms and four bathrooms, each room is different and facilities vary for example, one bathroom has facilities to meet all mobility needs yet another is a step in bath. Twenty-five residents have an en-suite 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, in one shared room the inspector was concerned that due to the residents mobility needs and the need to use a hoist and wheelchair that safety due to lack of space would be a concern. This was discussed with the manager and efforts are being made to remedy this issue. All rooms have adequate storage areas and comfortable seating and many contain items of personal belongings such as photographs, pictures and small items of furniture. Bathrooms and shower rooms including toilets have where needed clinical waste bins and a contract is in place to dispose of this waste. One relative advised in the survey that there remains a problem with odours, yet the inspector noted some improvement in the communal areas of the home. However in some residents’ rooms odour control remains an outstanding issue. The laundry area is clean and infection control is well managed, clean items are kept separate from dirty items. All residents have their own box for clean clothes. The flooring is impermeable and laundry is appropriately separated and put into colour-coded bags before being taken for laundering. All high-risk areas have good hand washing facilities. Heath House Care Centre DS0000024852.V311390.R02.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30. The quality in this outcome area is adequate. This judgement has been made using available evidence and a visit to the home. The home has demonstrated it has the ability to recruit staff safely and to ensure there are good numbers of staff on duty to support residents. The home has not fully demonstrated it has the ability to train staff which may lead to residents receiving poor standards of care and may also put them at risk. EVIDENCE: The manager provided staff duty rotas with the questionnaire and these were compared with the working rotas at the home. These reflect that at all times a qualified nurse is on duty on each unit and that they are supported by a minimum of four care staff on each unit. The manager advised that there are some vacancies for registered mental nurses however these shift are covered as the home has its own bank of nurses. At present the manager is recruiting a deputy manager who will be a trained nurse. At night there is always a minimum of two trained nurses and three care staff on duty. Since the inspection the manager has advised that fifteen staff have completed NVQ level2 in Care (in excess of 50 ), that six are currently studying the award and that six staff have completed NVQ level 3 in Care. During discussions with the manager and the area managers the inspector was advised that new care staff to the Southern Cross organisation do undertake induction training based upon TOPSS now known as Skills for Care. However there was little evidence to support this training. Heath House Care Centre DS0000024852.V311390.R02.S.doc Version 5.2 Page 19 Four staff recruitment files were sampled and at it was evident that the process is comprehensive and includes all required checks. For all staff an application form and interviews notes were available. Checks all included POVA register, CRB disclosures, two written references and a health screening. Staff are provided with a statement of terms and conditions and a job description. The manager provided a training matrix with the questionnaire, which indicated that most staff are receiving training in many safe working practices including food hygiene, fire safety, health and safety, and infection control. However there remain concerns that only 52 of staff have been trained in moving and handling techniques, which forms part of their every day care for many residents. Two residents and one relative advised that the staff are good at their jobs and are available to help when they need it. Heath House Care Centre DS0000024852.V311390.R02.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35 and 38. The quality in this outcome area is good. This judgement has been made using available evidence and a visit to the home. The ability of the management and administration of the home is good and clearly effective to support all staff, through good leadership and safe practices to positively meet the health and social care needs of residents. EVIDENCE: The home now has a new manager who has been in post two months. During the inspection she was seen to effectively manage staff and was familiar with the policies and procedures of Southern Cross. The manager had not worked for Southern Cross prior to this appointment. She was able to provide the inspector with her CV, which indicated she is a Registered Nurse with experiences including managing health services, care homes, psychotherapy, counselling and lecturing. Heath House Care Centre DS0000024852.V311390.R02.S.doc Version 5.2 Page 21 The manager also provided a statement of her professional interests and aspirations; this included developing the dementia services at the home, developing the staff team and herself to support these developments and also future plans to separate the service for those residents with a dementia and those with mental health needs. Since the inspection the manager has advised that she is in the process of completing the required CRB check along with the application to become the registered manager of the home. Residents and staff varied in their opinions of the new manager, residents commented she is ”okay” another said “I don’t see much of her” whilst staff were positive and one said “she will need time to adjust before she starts making improvements” another member of staff said “she manages very differently to the previous manager”. The manager provided evidence of residents, relatives and staff meetings, which are conducted frequently at the home. It was apparent within the minutes of these meetings that relatives in particular are able to suggest changes and share their opinions; an example of this was the changing food menus. The area manager advised of questionnaires being issued to residents, relatives and visiting professionals to gather their opinions on the performance of the home. This will enable an analysis and to make a score of quality assurance. As yet this has not been completed and a report on quality has yet to be produced and is not available for the residents and interested parties. The home does manage money on behalf of many residents and provides a safekeeping service. Approximately 50 of the residents have money forwarded to the home by the Social Care and Health department and 50 have money managed by families. Records of money kept at the home are good, all transactions are signed by two staff, and where the home has paid for a service on behalf of the residents such as hairdressing or chiropody or has purchased toiletries, receipts are available to confirm this. Health and safety practices at the home include risk assessing many areas such as fire, premises, food safety and staff. These were all seen to have measures taken to reduce the risks and were all regularly reviewed. The home employs two maintenance persons, who besides managing the maintenance of the premises and equipment they also test the fire systems and check water temperatures. Records available show it is tested regularly. Other utilities are regularly tested and serviced including gas and electric. Equipment such as the passenger lift, nurse call system and residents hoists are repaired and serviced as needed and routinely. One resident has had many accidents and has sustained injury mainly skin tears and bruising, the records indicate that some of the accidents occur not witnessed, in the bedroom. The manager advised that she would be auditing this bedroom to assess how safety can be improved for this resident. Heath House Care Centre DS0000024852.V311390.R02.S.doc Version 5.2 Page 22 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 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 3 2 3 3 X X 3 2 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 2 X 3 X X 3 Heath House Care Centre DS0000024852.V311390.R02.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Requirement The registered person must ensure that all residents have care plans to guide staff in how the needs and abilities of residents are to be met. Timescale for action 13/10/06 2 OP7 15(2)(b)1 5(1) The care plans must be extensive and include all care needs of residents as assessed; also ensuring they include the immediate physical health needs of residents and the support provided by visiting professionals such as the GP. Residents care plan reviews 30/11/06 must include information about how effective the plan has been. Previous timescale of 31/12/04 not met, this requirement is carried forward. 31/10/06 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 3 OP7 15(1) Heath House Care Centre DS0000024852.V311390.R02.S.doc Version 5.2 Page 24 4 OP7 15(1) 31/7/05 not met, this requirement is carried forward. Residents risk assessments must be informative for staff and include specific information e.g. manual handling assessments must include details of type of hoist and sling sizes. Previous timescale of 30/11/05 not met, this requirement is carried forward. 31/10/06 5 OP9 13(2) 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. The registered person must 31/10/06 ensure that all medicines received into the home are fully recorded including when received, the quantity received and who received it. The registered person must ensure that all medicines are safely stored. The registered person must ensure that a medicine policy is in place that reflects all areas of current practice, including the use of a monitored dosage system. The registered person must ensure that damaged tiles in bathrooms and shower rooms are repaired. The registered person must ensure that a structural assessment of the cracked garden wall is completed and make any required improvements. The registered manager must DS0000024852.V311390.R02.S.doc 6 OP9 13(2) 30/11/06 7 OP19 23(2)(b) 30/11/06 8 OP19 23(2)(b) 31/12/06 9 OP25 23(2)(p) 30/11/06 Page 25 Heath House Care Centre Version 5.2 10 OP26 13(3)(4)( c) 16(2)(k) ensure that at all times adequate heating is provided within the conservatory. The registered manager must take measures to address the areas of malodour within the home. With specific attention to residents rooms. Previous timescales of 30/11/04 not met, this requirement is carried forward. The registered person must ensure that all newly appointed care staff receive an induction based upon the Skills for Care standards. The registered person must ensure that all staff are fully trained to practice appropriate manual handling techniques. Staff training must include training staff to assess the full manual handling needs of residents. Previous timescale of 30/11/05 not met, this requirement is carried forward. The registered person must ensure that quality audits of the homes performance in key areas are undertaken to ensure that the home plans for continual improvement and produces an annual report on quality. 30/11/06 11 OP30 18(1)(c)(i ) 30/11/06 12 OP30 12(1) 18(1)(c)(i ) 31/12/06 13 OP33 24 31/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Heath House Care Centre DS0000024852.V311390.R02.S.doc Version 5.2 Page 26 No. 1 Refer to Standard OP15 Good Practice Recommendations It is recommended that as identified in the most recent EHO report that the chef undertakes the intermediate food hygiene course. Heath House Care Centre DS0000024852.V311390.R02.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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.V311390.R02.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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