Inspection on 23/08/06 for Heath Mount Nursing & Residential Care Home

This inspection was carried out on 23rd August 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.

Other inspections for this house

Heath Mount Nursing &... 30/01/06

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Heath Mount Nursing & Residential Care Home Rake Liss Hampshire GU33 7PG Lead Inspector Tim Inkson Unannounced Inspection 23rd August 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Heath Mount Nursing & Residential Care Home DS0000065932.V301069.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 Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heath Mount Nursing & Residential Care Home Address Rake Liss Hampshire GU33 7PG 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) 01730 894485 01730 891088 heathmount@ashbournehealthcare.uk Ashbourne (Eton) Limited To Be Confirmed Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31), Physical disability (31), Physical disability of places over 65 years of age (31) Heath Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. All service users must be over the age of 55 years. Date of last inspection 31st January 2006 Brief Description of the Service: The home provides nursing care for service users over the age of 55 years. It also registered to accommodate service users with a physical disability.Heath Mount is situated on a site with two other homes. They are all part of the Southern Cross group. Accommodation is provided in 21 single and 5 shared rooms. 20 single and 5 shared rooms have en suite facilities. These are located on three levels of the home. Communal space comprises two lounges, an annexe and a large well appointed dining room. Main meals are cooked and transported from one of the other main homes. Heath Mount contains the laundry for all the 3 care homes on the site. The home is situated in extensive grounds, in a rural area and close to Liss a small town with shops and public transport links. Potential residents are given a brochure about the home and a copy of the home’s “Service Users Guide” that provides information about the services and facilities provided by the home is made available in all bedrooms. The home’s manager at the time of a fieldwork visit on 24th August 2006 also said. “If there is a telephone enquiry I tell them about the home using a written guide. I tell them about the activities programme that includes coffee mornings and landmark events as for example the up and coming harvest festival. I invite them to spend some time with us and stay for lunch. I talk about care plans and for example relatives have taken pictures of a bedroom to show someone that was in hospital. I tell them that they can bring furniture and so on. They are sent a brochure”. A copy of the report of the last inspection of the home is kept readily available in the entrance hall of the home. At the time of the fieldwork visit to the home on 23rd August 2006, the home’s fees ranged from £350 to £850 per week. This did not include the cost of hairdressing; newspapers; chiropody and dry cleaning. Heath Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This fieldwork visit was unannounced and took place on 23rd August 2006, starting at 08:50 and finishing at 16:10 hours. The process included viewing the accommodation including bedrooms, communal/shared areas and the home’s kitchen and laundry. Documents and records were examined and staff working practices was observed where this was possible without being intrusive. Residents, visitors and staff were spoken to in order to obtain their perceptions of the service that the home provided. At the time of the inspection the home was accommodating 24 residents and of these 5 were male and 19 were female and their ages ranged from 64 to 102 years. No resident was from a minority ethnic group. The home’s proposed manager who had only been in post for 5 weeks was present throughout the visit and was available to provide assistance and information when required. Other matters that influenced this report included a pre-inspection questionnaire with other relevant and helpful documentation e.g. sample menus that had been completed and provided by the proposed manager. Also information that the Commission for Social Care inspection had received since the last fieldwork visit made to the home on 31st January 2006 such as statutorily required notices received about incidents/accidents that had occurred. What the service does well: Detailed information was obtained and recorded by the home about the help that residents required both before and after they moved into the home. This helped to ensure that the care and support they received was planned properly and their needs were met. Potential risks to residents’ welfare were identified and documented and plans put into place to eliminate as far as possible any harm that individuals could suffer. The home liaised with other relevant professionals to ensure that residents’ healthcare needs were managed appropriately. The friendly and caring attitude of the staff was appreciated by both residents and relatives and most residents also felt they were well cared for, their privacy was respected and they were safe. Residents were able to participate in a range of social and other activities that were organised by the home. The home promoted the right of residents to make choices for themselves and exercise personal autonomy as far as was reasonably possible, including dealing with their own finances. Management systems and procedures in the home worked well including, dealing with medication, managing complaints, staff recruitment, quality monitoring, and health and safety. Heath Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Heath Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heath Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were procedures in place to ensure that the home identified the assistance and support that potential residents needed before they moved into the home. EVIDENCE: A sample of the records of 4 residents was examined including those concerned with identifying the help and care that people needed. There was evidence from these documents that the admissions to the home of the individuals concerned had all been planned and that staff with the appropriate knowledge and skills had visited potential residents and identified the support that they needed before they moved into the home. In some cases draft care plan had been prepared for the person concerned setting out how staff in the home would provide the help that person needed. The documentation that identified the areas of each persons needs was comprehensive and the physical and social aspects covered were as follows: Environment; communication and mental state; hearing and vision; breathing; eating and drinking and oral hygiene; elimination; personal cleansing, dressing and skin; controlling body temperature; mobilising; working and playing; Heath Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 9 expressing sexuality; sleeping; dying; baseline observations i.e. temperature, pulse, weight, blood pressure, and height. Religion; school; work; war years; marital history; place lived; community involvement; social contacts; family relationships; smoking preferences; dietary preferences; alcohol preferences; afternoon nap; breakfast, luncheon and evening meal arrangements; hairdressing; daily paper/journals. The home’s proposed manager said that all potential residents were written to following these assessments of needs and informed as to whether the home could successfully meet them. One resident spoken to said that she recalled being visited by someone from the home to see what help she needed before she actually moved into her accommodation at Heathmount. More detailed assessments of a resident’s needs and more particularly potential risks to an individual were identified conducted when they moved into the home. As also were more comprehensive detailed and “permanent” care plans developed (see next section). There was documentary evidence that assessments of residents needs were reviewed regularly and revised as necessary when an individual’s circumstances had changed. The home does not provide intermediate care. Heath Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had systems in place to ensure that the personal and healthcare needs of residents were met and medication was managed safely and effectively. Staff working practices ensured that residents’ privacy and dignity was promoted. EVIDENCE: A sample of the plans of care of 4 residents was examined. Among the sample was an individual who had leg ulcers. The documents examined were detailed and the plans were based on the assessments the home carried out in order to identify what help individuals needed (see previous section). Potential risks were assessed such as pressure sores; falls; nutrition; moving and handling; malnutrition; the need to use bed rails; etc. Where a pressure sore assessment indicated that an individual was at risk it was noted that the corresponding plan of care for the person concerned referred to the use a pressure relieving aid e.g. airflow mattress. Heath Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 11 The plans examined set out clearly the actions staff had to take and what specialist equipment was needed to provide the support and assistance each person required. Where care plans referred to the use of equipment or how a specific need was to be met this was observed to be available, provided or in place or confirmed by the individuals receiving the help e.g. pressure relieving aid; walking sticks; eye-drops; hoist; soft diet/pureed meal; bed bath; etc. • “I can’t use my legs anymore - they move me with that hoist and in bed with a special sheet. They give me a bed bath – they use that screen when they do that”. Records indicated that care plans were reviewed/evaluated at least monthly and daily notes referred to the actions taken by staff to provide the needs set out in those plans. There was no written evidence that residents or their relatives/representatives were involved in developing the plans of care. There was a specific place in the documentation for individuals to sign and date it to indicate that they had been involved in and agreed to their care plans, but none of the sample examined had been signed by the resident concerned. One relative spoken to did say that she had been involved in developing her mother’s care plan and subsequently reviews of the care she was receiving. The home’s proposed manager who had only been in post for 5 weeks was aware of this matter and intended to ensure that in future there would be clear evidence that individuals were involved in planning the care that they received. Comments both written (see below at section on management and administration) and verbal from residents indicated that the vast majority felt they were well cared for. • “ I think they have the skills to look after me and the others, although I don’t know what training the have”. • “The staff are brilliant”. • “I get help with walking, dressing and washing. They look after me properly”. Records examined also indicated that a range of healthcare professionals visited the home and that arrangements were made for treatment for service users when it was necessary. Residents said that they saw and received treatment from among others, doctors, podiatrists and opticians and when required arrangements to attend outpatient clinics were made by the home. • “The doctor comes once a week and I have seen him several times”. • “I have seen the chiropodist about my feet and a nurse about my ulcers” There was evidence that home had when necessary made referrals to and arranged specialist support from among others a tissue viability nurse, optician, and speech and language therapist. There were specific wound care plans in place for the individual who had leg ulcers (see above). The wound healing process was monitored and recorded, using pictures, diagrams and descriptions to evidence changes in the condition of the lesions. Heath Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 12 Individuals’ baseline health was monitored routinely and regularly e.g. blood pressure and weight. The home had written policies and procedures concerned with the management and administration of medication. Medication was kept in a locked and secured medicine trolley and locked cupboards and where required in a locked refrigerator. Controlled drugs were stored securely in a locked metal cabinet. A sample audit was done of the controlled drugs being stored and it was correct and up to date. The home operated a monitored dosage system. A pharmacist provided most prescribed medication every 28 days in blister packs for each person concerned. Other medicines that could not be put into blister packs because they could spoil, such as liquids or those that were to be taken only when required were dispensed from their original containers. The only staff in the home that dispensed and were responsible for the management and administration of medication on a day-to-day basis were registered nurses. The home had only recently changed to this system and the pharmacy providing it had also provided training for all the registered nurses. The home strongly promoted the independence of residents and those residents assessed as being able and who wished to were encouraged to keep, and take their own medication. At the time of the fieldwork visit however only one resident was managing some of her own medicaments. The home’s proposed manager was in the process of doing an audit of the medication system and had identified some weaknesses in the home’s practice that she was going action without delay. Records were being kept of the receipt, administration and disposal of medication. It was suggested that the home obtained a more up to date copy of British National Formulary. Most residents were accommodated in single rooms and screens were available to promote privacy in shared rooms. Residents spoken to confirmed that staff promoted their privacy and dignity (see above and comments in the section about management and administration below). Staff were observed knocking on bedroom doors and it was noted from minutes of a staff meeting in July 2006 that this issue was one topic of discussion. Care plans examined included references to among other things these specific important principles e.g. “Provide daily wash and weekly bath – maintain privacy and dignity – use screen and close door”. Heath Mount Nursing & Residential Care Home DS0000065932.V301069.R01.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): 12, 13, 14, and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home organised a range of social activities that could provide stimulation and it also promoted residents self-determination, enabling residents to exercise choice about all aspects of their daily life. Residents were able to maintain links with relatives and representatives. The dietary needs of residents were catered for with a varied selection of food that satisfied most tastes and choices. EVIDENCE: The home employed an activities organiser and there was evidence from discussion with residents that there was a programme of events in which they could participate. Clergy visited the home and the routines of the home were relaxed enabling residents to exercise choice about day-to-day life. A notice board in the hallway of the home was displaying pictures of residents participating in some recent activities such as trips out, arts and crafts and a cream tea. There was an information board about activities that was advertising a forthcoming harvest festival. Some residents spoken to said that they that they preferred their own company but they were fully aware that they could join in things if they wanted to. Comments expressed about the matters above included the following: Heath Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 14 “I read mainly, I love reading, my head is always stuck in a book. I can’t be bothered with TV. They have a good library and the books are changed every 8 weeks. I am quite happy reading”. • “It is my choice not to join in activities as I am not particularly sociable, but they have parties and things like that. I tend to eat in my room. There are no rules here it is quite relaxed”. • “I don’t join in the activities, it is hard work because of my condition but I have things to do, I read and listen to my radio”. • “They have various things and I join in some of them, a bus that takes us out. I eat in the dining room but sometimes here in my bedroom” • “We can draw and paint and have the opportunity do what we can and the minibus makes a tremendous difference it means that we are not “locked in”. We have a lady with dogs that comes and we have TV. We play cards and get together. I never used to speak to anybody but now I never stop. • We have visiting clergy. The catholic priest comes to see me and I take communion”. (See also residents’ comments in the section about management and administration below). The home’s proposed manager said that she was concerned that some individuals who did not join in activities or who were bedfast did not become isolated. She stressed that the activities organiser kept individual care plans for each resident and a record of activities in which they participated. Also that she would provide one to one sessions for individuals too frail to join in things and offer hand and foot massage or sit and read or talk with them. Details of the leisure interests and individuals preferred lifestyle were recorded in their care plans. During this fieldwork visit a number of visiting relatives were seen and both residents and visitors that were spoken to all said that visiting arrangements were relaxed and maintaining contact was easy. The home’s administrator said that although most residents handed over the responsibility of the management of their finances to relatives or representatives, a number of individuals continued to control their own financial affairs and “pay their own bills”. There was information in the entrance hall of the home about a number of organisations that could provide independent advice, information or advocacy services for residents and/or their relatives. Residents were able to bring personal items into the home including furniture and several individuals had taken trouble to personalise their bedrooms. Sensitive information about residents was kept securely either in the manager’s office or administrators office. The home had written policies and procedures about the control of records and access to personal files. • Heath Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 15 There were mixed views expressed by residents about the food provided by the home (see also residents’ comments in the section about management and administration below). The menus and records of food provided indicated that there was a wide variety of meals provided with a selection of choices every day. In addition special diets and individual preferences and needs were catered for e.g. soft and pureed meals, diabetics and vegetarians. The Menu provided as information before this visit took place for the weeks commencing 17th July 2006 and 24th July 2006 indicated that residents were provided with 3 meals a day and a wide variety. There were choices of main meal every day e.g. starter was soup or fruit segments, or fruit juice and main course of Gammon with parsley sauce or meatballs in tomato sauce with duchesse or mashed potatoes and seasonal vegetables followed by baked rice pudding with jam. The menu stated that all cooked meals could be liquidised. The ingredients of pureed meals were prepared separately to enable the meal to be presented more attractively. Residents could choose where to eat and a number preferred to eat in their rooms. They were able to select the meal that they wanted from the menu choices that were made available to them the day before. The menu for the day was on display in the entrance hall to the home. The week’s menu was seen to be available in the bedrooms of many of the residents spoken to during this visit. The cook met regularly with the home’s manager to discuss menu planning and also attended residents meetings and the minutes of the last meeting held during July 2006 included the topic of food. The manager had introduced sherry everyday before lunch as an aperitif before she took up post it was only available on Sundays. Residents appreciated meeting before the meal and socialising with a drink that helped with their appetites. Residents confirmed that they had three meals a day and could have snacks and drinks at other times and comments from residents about the food provided included the following: • “Sometimes the meat can be a bit tough – there is plenty – and we have plenty of fresh fruit and vegetables. The girls bring the menu to me”. • “The food is not too bad but they give you too much” • “I went to a residents meeting and we are able to express our views about things There is an argument there about food - it is not too bad”. • “Food could be better, it is just not to my taste, but there is more than enough” • “Food is in the main really good. There is always an alternative, salads, omelettes and things”. • “The new manager has initiated sherry at lunchtimes”. . Heath Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had systems and procedures in place to address residents concerns and to protect them from harm. EVIDENCE: The home had a written policy and procedures about how complaints could be made about the service that it provided. A copy was clearly displayed in the home’s entrance hall. All residents and relatives spoken to were confident about raising any concerns with the home’s manager. • “I have complained once or twice and I know who to complain to”. • “I would speak to the manager if I had a complaint” • “We usually complain to the staff” • “If I was unhappy I would speak to the manager”. The home kept records of complaints that detailed the issue, and set out any agreed action to remedy the matter and the outcome. There had been no complaints made to the Commission for Social Care Inspection about the home since the last inspection of the home on 31st January 2006. The home had written procedures available concerned with adult protection. Heath Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 17 Staff spoken to said that they received training about protecting vulnerable adults and an examination of staff training records confirmed this. Staff spoken to were also able to demonstrate an awareness of the different types of abuse and the action they would take if they suspected or knew that it had occurred. The home’s proposed manager also said that “All staff attended training in abuse during “Adult Protection Week” earlier this year”. Heath Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s environment was safe and generally well maintained. There was an infection control policy and procedures in place and staff practice ensured that as far was reasonably possible residents were protected from the risk of infection. EVIDENCE: The exterior and interior of the premises, its décor, furnishings, fittings and equipment were generally in reasonable repair. Some things noted that would benefit from attention and/or replacement included: • Furniture such as easy chairs that were becoming worn • Exterior fittings and in particular windowsills and frames with flaking paint and exposed woodwork The proposed manager was aware of a number of areas of the premises that required such attention including a patio at the rear of the premises that could not be used because a surrounding balustrade was unsafe. She said that this would be repaired and made safe before next year. Heath Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 19 New carpets had been installed in communal rooms and corridors and at the time of the visit maintenance personnel were working on redecorating and refurbishing vacant bedroom accommodation. Other vacant rooms that were viewed that had also been redecorated to a high standard. The home’s proposed manager said the organisation that owned the home (the registered provider) was spending money on the premises but the previous owners had not invested any capital in the building. The organisation that owned the home also had an estates division/department that organised and arranged major maintenance, repair and redecoration of the home. The proposed manager had also in the short time that she had been in post, as she said “reclaimed some of the building for residents”. A room that had previously been used by staff had been was converted into comfortable “lower lounge” and an area that linked the home to another care home on the site and had been used for storage had been converted into an attractive “garden room”. The organisation/company that owned the home had a designated fire safety officer (facilities manager) who had visited the home. There was a fire risk assessment in place and the facilities manager was due to visit the home with the specific purpose of providing fire safety training for staff in October 2006. The local environmental health officer had visited the home on 10th March 2006 and had identified a number of concerns. These had subsequently been addressed. The home had comprehensive procedures in place concerned with infection control and protective clothing was readily available and staff were observed using gloves and aprons appropriately. The home was clean and odour free at the time of the fieldwork visit and residents spoken to all said that the home was kept clean. • “They certainly keep it clean”. • “It is OK they keep it clean” • “They look after the building, it is spotless”. The home’s laundry also provided a service for the two other care homes that shared the site with Heathmount. It was suitably equipped and located. There were good procedures in place for the management of soiled laundry items. The home had specialist equipment for cleaning carpets Heath Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was a satisfactory level and reasonable mix of staff that ensured the needs of residents were met. The home had robust staff recruitment procedures that promoted the protection of residents and there were systems in place that ensured most staff training and development needs were identified to enable them to acquire the skills and knowledge necessary to provide the care and support residents required. EVIDENCE: The total number of staff employed to work in the home at the time of the fieldwork visit was 37, this included registered nurses and 21 health care assistants and of the latter 5 had a qualification equivalent to a National Vocational Qualification level 2 in care (i.e.25 ). The home’s proposed manager said that another 4 health care assistants would be starting working towards the qualification from 21st September 2006. Other staff working in the home comprised; administrator; domestic supervisor; domestics; laundry; maintenance; gardener; and servery assistant. Residents and relatives spoke very positively about the attributes and abilities of the staff responsible for providing care and support and the general consensus was that there were usually sufficient staff on duty at all times. Heath Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 21 Comments from residents about these matters included: • “I don’t know if there are enough staff but I can say I have some good bath ladies”. • “Its quite good here – they come to see me regularly to see if I am alright. • The staff are polite. Normally I think that there are enough staff, on occasions they may be short because of holidays”. • “I don’t think there are enough because sometimes the lunch is late. They have day nurses and night nurses. I think they have the skills to look after me and the others although I don’t know what training the have. They answer the bell quickly” • “Sometimes there are a lot of staff, sometimes they are short because a lot are on holiday”. • “The staff are brilliant”. At the time of the fieldwork visit the care staff rota setting out the minimum number and skill mix deployed at any time in the home was as follows: 08:00 to 14:00 1 5 6 14:00 to 20:00 1 4 5 20:00 to 08:00 1 2 3 Registered nurses Care assistants Total Records were examined of 4 staff of which 3 had been employed to work in the home since the last fieldwork visit to the establishment on 31st January 2006. All statutorily required information and checks had been obtained and conducted before they had started work in the home to ensure that they were suitable to work with vulnerable adults. There was evidence from records and discussion with staff that all new staff received induction training. The home’s proposed manager made available some documentation that the registered provider had recently developed that comprised an induction training programme that satisfied the requirements of the training body for the social care workforce i.e. “Skills for Care” (previously the Training Organisation for Personal Social Services [TOPSS]). The proposed manager had responsibility for co-ordinating training in her last post and had conducted a staff training needs analysis and produced a “training tracker”. It clearly indicated what outstanding training was required by the home’s staff team and this included fire safety training of all staff which was a requirement arising from the last inspection of the home on 31st January 2006. A number of training events for staff were advertised in an area close to the manager’s office including 4 fire safety training sessions to be held on 9th October 2006 and the names of the staff required to attend them. Although a requirement from an inspection of the home concerning the provision of regular fire safety training for staff was outstanding as the Heath Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 22 timescale for compliance was 1st March 2006. The home’s proposed manager had only been in her post for 5 weeks and had clearly identified the need for this training and had also taken action to address the matter. The requirement has therefore been carried over and a new timescale of 30th November agreed. Heath Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 23 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): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s proposed manager was providing effective leadership There were systems and procedures in place for monitoring and maintaining the quality of the service provided and promoting the safety and welfare of everyone living and working in the home. EVIDENCE: The home’s proposed manager had been appointed some 5 weeks prior to this fieldwork visit and was in the process of applying to be registered with the Commission for Social Care Inspection. A registered nurse, her previous experience included working as deputy manager in another of the care homes on the same site as Heathmount, working in a community hospital and 14 years in the Queen Alexandra’s Royal Army Nursing Corps. Heath Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 24 It was evident from discussion with the proposed manager, staff and residents as well as from observation that the proposed manager had in a very short space of time identified matters where action needed to be taken and initiated changes that would improve life for residents e.g. “reclaiming some of the building for residents” (see above in section about the “environment”). She had acted as a role model in matters such as supporting colleagues when there were staff absences. She was also providing clear direction for the home’s staff team in matters such taking leave by imposing restrictions on the numbers and grades of staff that could be on holiday at the same time. In describing her management style she said, “I give definitive guidelines so people are not headless – I have an open door policy for staff and residents – I am a doer and will take action to put things right. Any decision I make will be trialled first and if it works it will be changed – in some things I am autocratic in other things I am flexible”. The home’s proposed manager’s proactive approach was recognised by her line manager in notes written in monthly audit/report of 26/07/06: “…….the home manager who is already working hard to improve practices, etc. However a lot of things have not been maintained or kept going during the time of the home manager post being vacant”. The organisation that owned the home had procedures in place for monitoring the quality of the service that it provided and they included monthly audits of various aspects such as, the kitchen and the system for managing medication. The home’s manager also had to complete a detailed report each month that was validated by her line-manager (see above). On display in the entrance hall of the home were the results of a recent residents’ satisfaction survey and the perceptions of the participants were mainly positive. A range of meetings took place in the home enabling staff and residents to influence the service provided. One resident said that he had attended a meeting and one of the issue discussed was food. Minutes of the meetings were made available and were also on display. • • “I went to a residents meeting and we are able to express our views about things There is an argument there about food….” “I get the notes of residents meetings”. Heath Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 25 The collated views of 10 residents received from comment cards sent to the Commission for Social Care Inspection before this fieldwork visit took place are set out below: Do you like living here? Do you feel well cared for? Do the staff treat you well? Is your privacy respected? Do you wish to be more involved in decision making within the home? Does the home provide suitable activities? Do you like the food? Do you feel safe here? If you are unhappy with you care, do you know who to speak to? Do you or a relative wish to speak to an inspector about your life in the home? Yes 6 8 9 9 5 5 3 8 6 1 No 1 1 Sometimes 3 1 1 1 3 5 4 1 1 2 3 1 3 9 The home had a large number of comprehensive policies and procedures most of which were those of the previous registered provider. The current registered provider had an “intranet” and the corporate policies and procedures could be accessed on the home’s computers but there were relatively few hard copied that staff or residents could refer to for guidance or information. It is suggested that this situation should be remedied without delay. The home did not manage the financial affairs of any residents but it did look after some money on behalf of some individuals to enable them to pay for things such as hairdressing or chiropody. Accurate records were being kept of all such transactions i.e. incomings and outgoings. Records examined indicated that the home’s equipment, plant and systems were checked and serviced or inspected at appropriate intervals i.e. passenger lift and hoists; boilers; fire safety equipment alarms, emergency lighting; hot water mixer valves; and portable electrical equipment. There was a fire risk assessment in place and regular risk assessments of the premises were undertaken. Guards covered all radiators in the home and all windows above the ground floor were fitted with restrictors. The home’s proposed manager was an accredited moving and handling trainers and there were hoists, and other equipment in the home to promote safe working practices. Among other health and safety procedures noted in the home were the following: • Records of accidents were kept • The efficacy of bed rails; wheelchairs; thermostatic valves and window restrictors were checked and recorded every month. Heath Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 26 • A range of posters with advice about working practices were on display e.g. room cleaning guide; wheelchair safety checks; reporting and investigating accidents and near misses There was one matter of concern about health and safety matters that was identified during this fieldwork visit. This was about staff fire safety training and this is referred to in the previous section and a requirement was imposed on the registered persons. Heath Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 X X X X X X 3 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 3 Heath Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 28 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 OP38 Regulation 23(4)(d) Requirement The registered persons must ensure that all staff receive regular training in fire prevention and the use of fire safety equipment. (Previous timescale of01/03/06 not met). Timescale for action 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Heath Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Mount Nursing & Residential Care Home DS0000065932.V301069.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!