Inspection on 20/12/05 for Heath Street Nursing Home

This inspection was carried out on 20th December 2005.

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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heath Street Nursing Home 24/10/07

Heath Street Nursing Home 05/10/06

Heath Street Nursing Home 11/03/05

Heath Street Nursing Home 27/08/04

Heath Street Nursing Home 31/03/04

Heath Street Nursing Home 05/09/03

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Heath Street Nursing Home 103 Heath Street Chesterton Stoke-on-Trent Staffordshire ST5 7ND Lead Inspector Irene Wilkes Unannounced Inspection 20th December 2005 10:00 Heath Street Nursing Home DS0000026949.V273993.R01.S.doc Version 5.1 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 Street Nursing Home DS0000026949.V273993.R01.S.doc Version 5.1 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 Adults 18-65. 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 Street Nursing Home DS0000026949.V273993.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Heath Street Nursing Home Address 103 Heath Street Chesterton Stoke-on-Trent Staffordshire ST5 7ND 01782 563259 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) Choices Housing Association Limited Ms Jayne Warrington Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Heath Street Nursing Home DS0000026949.V273993.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th September 2005 Brief Description of the Service: 103 heath Street is a care home with nursing that is registered to provide care for six people with a learning disability and who also require some degree of nursing care. The property is located in a residential area of Chesterton, a suburb of Newcastle-under-Lyme. The home is a bungalow on one level and has wide corridors and with rails throughout to assist both those who use wheelchairs and those people with reduced mobility. All of the bedrooms are single occupancy and are equipped with a wash basin and a nurse call system. Each bedroom is well personalised for the individual. Bathrooms with toilets are well located in the home, being close to bedrooms and communal areas. One bathroom has been specially designed with sensory equipment and an assisted spa bath. The lounge is tastefully decorated and fitted with soft furnishings that provide a domestic style environment. The dining room is spacious and pleasant with adequate dining furniture and room for the specialist chairs of some of the service users to be fitted around it. The dining area opens on to a spacious kitchen that has been refitted to allow access for those who use wheelchairs, and it also has appropriate height work surfaces. A small garden area is available at the rear of the property. Parking facilities are situated at the front, although the space is limited. Heath Street has good access to roads and local amenities. The home has an experienced manager and a committed staff team. Heath Street Nursing Home DS0000026949.V273993.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over an afternoon in December 2005 by one inspector. All six people living at Heath Street were at home at the inspection. The service users have a learning disability and other physical and health needs apart from one service user who is fully mobile. The home has aids and equipment to help with moving the service users. One service user is able to chat, while the other people do not talk, and the inspector has to rely on staff to assist her to try to understand them. The manager was not on duty during the visit. There were three qualified staff and a support worker available during the earlier part of the afternoon, with one qualified member of staff and two support workers after 3pm. One of these support workers had only commenced working in the home and in care on that day. A discussion was held with the care staff about transport issues, staffing levels and the general morale of staff. The records of three of the residents were looked at, as well as other records such as staff rotas, medication, staff training, menus and records about fire safety and other general health and safety areas. What the service does well: The home works hard to trying to develop the life skills of each person and to identify new activities for them to enjoy a varied lifestyle. This is looked at during an annual review of each person, when their family and others are also invited to attend. At this review all of their healthcare needs are also looked at, and the home plan any appointments that are needed to help ensure they are kept well. They also make sure that any additional equipment that will make the residents more comfortable is provided. In this way the home does its best to keep each person safe, well and happy. The staff team work hard to help the service users and care for them in a thoughtful and kind way. When they are not helping them with their personal care or to do any activities they can be seen watching them all of the time to make sure that they are comfortable. In a group discussion with the staff it was clear that they want to do their best for the people in their care. Heath Street Nursing Home DS0000026949.V273993.R01.S.doc Version 5.1 Page 6 One of the ladies is able to talk. She said ‘I’m happy’ when she was asked about living at Heath Street. She also spoke about doing baking with the staff, about the flower club that she goes to, and said about the Christmas meal at the pub that she had been to with the staff. Although it is a nursing home, Heath Street has a very homely feel. It is well decorated and the furniture is generally the same as found in any house. Although a number of the service users have specialist chairs these are very modern and look comfortable. The home is very clean and hygienic. What has improved since the last inspection? What they could do better: Although the home plans at the reviews for each person to go out more in the community, this doesn’t always happen. This was the same at the last inspection, and they were asked to look at the staffing levels and to provide a report on their findings to the Commission. This report hasn’t been received and must be sent in. As well as looking at the number of staff on duty, the home doesn’t have good access to transport. The service users need special transport because of their special needs. The organisation has been saying that they are looking at this but nothing has changed. Some improvements have to be made, as the residents are not getting out of the home as much as they should. Some of the records that the home has to keep so that they can show that people are kept safe from harm were not up to date. Fire drills for staff need better records, and keeping such as fridge and freezer temperatures so that it is clear that food is stored safely. Heath Street Nursing Home DS0000026949.V273993.R01.S.doc Version 5.1 Page 7 The organisation has been asked to send to the Commission some reports written by an outside adviser about how the home is operating and about an incident that occurred in the home earlier in the year. They haven’t sent this information and need to do so. They also need to share some of this information with the manager and the staff so that they find out about what someone else thinks about the home. 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 Street Nursing Home DS0000026949.V273993.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heath Street Nursing Home DS0000026949.V273993.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the standards were inspected at this visit. The service users at the home have lived there for some considerable time, and past inspections have identified that good practice is followed and the intended outcomes are met for each of the above standards. EVIDENCE: Heath Street Nursing Home DS0000026949.V273993.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 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 6, 7 and 9 The care plans at Heath Street clearly show the assessed needs of each person and the intended outcomes in relation to goals. Good practice is in evidence to support decision making for those people who cannot advocate for themselves, and thoughtful risk assessments are in evidence. This shows how staff are trying to promote a valued lifestyle for each individual, but the home must be mindful to review all of these records in line with their own procedures, as this had not always happened. EVIDENCE: Three service user files were inspected. The home operates a person centred planning (PCP) approach to care planning that identifies the needs of each individual and how desired outcomes will be met, with monthly evaluations to check progress and an annual review to determine longer term progress, and to set new outcomes for the next year. This monthly evaluation is seen as good practice, as the national minimum standards set a requirement of reviews to take place at the request of the service user or at least every six months. Heath Street Nursing Home DS0000026949.V273993.R01.S.doc Version 5.1 Page 11 Examination of the three files showed clearly the 24 hour support plan, specific care plans, risk assessments etc. and the plans in place to maximise community presence, self determination, etc. They had been drawn up with the involvement of the service user and/or family where this was possible. All three of the plans seen had been fully reviewed in September of this year, but only two of the three plans had been evaluated since these annual reviews. The home is reminded that this does not meet with its own internal procedures for the review of each person’s plan on a monthly basis, and should ensure that these procedures are followed in every case. Some concern about the limited progress against the intended outcomes shown in the plans for two of the three service users are highlighted in other sections of this report. The needs of the service users at Heath Street are complex and while staff do their utmost to try to promote some decision making in day to day living, for more major decisions the involvement of others, such as family and advocates is sought. The home also has access to an Ethics Committee from Choices organisation where any issues arising for an individual with no family input can be more widely deliberated. This is seen as good practice. Each of the three service user files examined showed a range of risk assessments relating to each person, such as bathing, pressure areas and tissue viability, use of a wheelchair, accessing community facilities etc. In each case a qualified nurse, as the key worker to the service user, had drawn up the assessments and this person is also responsible for ensuring that the risks are regularly reviewed. In one instance such a review had not taken place since September, although each risk assessment clearly stated that it should be reviewed on a monthly basis. It is a requirement of this report that all risk assessments should be reviewed to the timescale indicated on the risk assessment/risk management strategy form. Heath Street Nursing Home DS0000026949.V273993.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 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 12, 13, 14 and 17 Staff do their best to engage the service users in activities within the home, but their involvement in the local community and in wider leisure activities is poor. This must be improved before it can be stated that service users lead a fulfilling lifestyle. EVIDENCE: The needs of the service users at Heath Street are complex and none of the current residents are able to participate in paid work or further education training at the local colleges. However, one of the service users attends a day care group for people with learning difficulties, and the other service users take part in what is called ‘active support’ at the home. This includes activities such as assisting with the laundry, putting goods away, assisting with meals etc. The resident who attends the day care centre also enjoys baking and ironing. The individual plans for each service user show that it is intended that all those living at Heath Street are part of the local community and that they are able to engage in a range of leisure activities both within and outside the home. While Heath Street Nursing Home DS0000026949.V273993.R01.S.doc Version 5.1 Page 13 it is clear that the staff do engage the residents in home based activities such as manicures, massages, sensory and aroma baths, listening to music, peg boards, gardening etc. the involvement in the community and community based activities does not meet the levels that are planned. The targets set for outside involvement are around four per month for each service user, which in itself is not considered to be high. However, evidence showed that over a number of months this had not been achieved except for one person. In December two out of the three people whose plans were seen had not been out at all. For some considerable time over the last 12 months the organisation has had problems with transport arrangements, following a change in the system to that of ‘pool’ transport that must be pre booked. At the last inspection the inspector was advised that the transport arrangements were being closely monitored by senior managers with a view to overcoming the difficulties. This does not appear to have an outcome as yet, which is disappointing. Discussion with the staff showed that this situation is frustrating. Attempts are made to access specialist taxis, but as this resource is limited it has to be booked well in advance and so does not allow for spontaneity. Staffing issues, which also affect the ability to escort people into the community are also of concern, and these issues are addressed later in the report. These issues have been highlighted by the inspector over a number of past visits. Whilst allowances were made at the most recent visit in September due to an unfortunate incident this is in the past and the current situation is not acceptable. Requirements of this report are that community links and social inclusion are increased for each person and that leisure activities are increased in line with the intended outcomes for each person as identified in their individual plan. The menu plans were looked at and these showed clearly that service users enjoy a healthy diet which meets their individual dietary needs. There was a good range of nutritious meals taken as shown in the menu record. Some of the service users at Heath Street need help to eat or are artificially fed and although not observed on this occasion it has been seen in the past that assistance is given discreetly with staff clearly focussing their attention on the individual. At this visit one of the service users joined staff in the kitchen when they were preparing the evening meal. Meals are taken in the dining room which is the ‘hub’ of the home. It was seen that drinks were freely available throughout the time of the visit. Heath Street Nursing Home DS0000026949.V273993.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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 18, 19 and 20 The privacy and dignity of the service users in the provision of personal care is maximised, and their physical and emotional health needs are met, including appropriate practices in the provision of medication. This means that the health and welfare of the service users is maintained as far as possible. EVIDENCE: All but one of the service users at Heath Street requires considerable support in mobilising, and each care plan had good information about how each person should be guided, moved, supported and transferred. There are appropriate aids and equipment in place that had been obtained following professional input. Aids had been changed as the service users’ needs changed. At this visit one of the service users had received a new ‘Kirton’ chair and the design of this was allowing her to take part in more activities within the home. Personal support was clearly provided in private and very discreetly. Service users are encouraged to make their own choices about their clothes, hairstyle and make-up, and although this individual choice is not always possible due to the needs of the service users it was clear that the staff made every effort to purchase clothes for them that reflected their age and Heath Street Nursing Home DS0000026949.V273993.R01.S.doc Version 5.1 Page 15 personality. One of the service users particularly likes clothes and she is assisted to make purchases via catalogues or visiting the shops. She is also assisted to be independent more independent in personal care by the use of a pictorial guide that the staff had developed to assist her in dressing, doing her hair etc. Consistency and continuity of support for service users is provided by the use of a system of care co-ordinators. The qualified nurses take the lead responsibility in this, and the support workers work with them to form a team of staff who have overall responsibility for each service user. To support this arrangement, the 24 hour plan of care also clearly sets out the preferred routine and likes and dislikes of each person in receiving care. At the time of the annual review a comprehensive ‘OK Health Check’ is completed for the service user. This covers all aspects of physical and emotional well being, and highlights any additional health input needed by the service users. One of the outcomes for one service user from the last review completed in September was that an eye test and audiologist test was overdue, but there was no evidence seen that these tests had been organised in the three months that have elapsed since then. This must be addressed. There were appropriate records held regarding other health inputs from a range of professionals, and an up to date diary listing follow up appointments. Records showed that all the professional advice received was followed through by the home. All those living at Heath Street require the support of staff with medication. There are appropriate procedures in place for the receipt, recording, storage, handling, administration and disposal of medication. There is always a Registered Nurse on duty in the home and they are responsible for the administration of medication. Medicines are handled in accordance with the Medicines Act 1968, and controlled drugs used in the home are appropriately stored and managed. Records showed that staff had received advanced module training in relation to medication from a pharmacist. The home had sound procedures in place for the administration of PRN (as and when) medication, and for the provision of homely remedies. A small sample of MAR (Medication Administration Record) charts were examined against the relevant dosette boxes and the medication tallied with the chart. There were no gaps in the recording on the chart. Heath Street Nursing Home DS0000026949.V273993.R01.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 22 Little evidence is available to support a judgement, except that it is clear that staff do their best to interpret the sounds and gestures made by the service users to act in accordance with their wishes. EVIDENCE: One of the service users who is able to communicate said that she is happy with the home and the staff. There have been no complaints received by the Commission and none by the home. There is an appropriate complaints procedure in place, and each service user has a copy in pictorial format contained in the Service User Guide. The service users at the home are particularly vulnerable as all but one is unable to communicate verbally. The home involves family and friends as much as possible to advocate on behalf of each person, and a communication log is used to record how over time the staff have learned to interpret gestures and sounds to gain a better understanding about when the service user is happy or something is wrong. This interpretation of communication is then used in day to day situations. Heath Street Nursing Home DS0000026949.V273993.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Heath Street provides a very pleasant domestic style and spacious home that is very clean and hygienic. It very adequately meets the needs of the service users. EVIDENCE: The home has six single occupancy bedrooms that provide sufficient space and the aids and adaptations necessary to meet the needs of the current service users. Each bedroom has been decorated and furnished individually. The home is domestic in appearance from the outside and is situated in a street of terraced and semi detached houses. There is a small parking area and enclosed garden laid with slabs, although there is adequate greenery around the sides of the property. The kitchen is well planned and fitted to meet the needs of the service users so that they are able to assist in meal preparation, or for one of the service users to bake etc. Corridors and door widths are of sufficient size to easily accommodate wheelchairs. Heath Street Nursing Home DS0000026949.V273993.R01.S.doc Version 5.1 Page 18 There are two bathrooms that provide assisted baths. The temperature of one bathroom that has no outside ventilation has been a cause of concern in the past as it became very hot, but it was pleasing to note at this inspection that this has now been addressed by the fitting of an air conditioning system. Furniture and fittings throughout are domestic in character and every effort has been made to provide a pleasant home. The laundry is well sited away from the kitchen and dining areas. The wall and floor fittings and the equipment available are suitable to prevent the spread of infection. There are appropriate policies and procedures in place to prevent the spread of infection, including the safe handling of clinical waste, dealing with spillages, provision of protective clothing and acceptable handwashing facilities. Staff were seen to follow these procedures. The home was clean and hygienic at the visit, as is always found at this home. Heath Street Nursing Home DS0000026949.V273993.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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 32, 33 and 34 The home follows appropriate recruitment practices and has a committed staff team that understands the needs of the service users. There is still some concern about staffing levels, which may contribute to the poor access to community facilities by the service users. The lack of response by the organisation for a review to be undertaken of staffing levels is an issue, and this review is again a requirement following this visit. EVIDENCE: Staff were discreetly observed supporting the service users and they were seen to be interested in them and committed to meeting their needs. This was also evidenced from conversation in a group discussion held with the staff at the start of the visit when the needs of all of the service users were discussed. The home is staffed by nurses qualified in the needs of people with a learning disability and by well trained support staff who have the skills and experience necessary to support the service users and their specific conditions. It is known from past inspections and from knowledge of Choices policy, although not specifically looked at on this occasion, that the majority of support staff are trained to at least NVQ 2. Heath Street Nursing Home DS0000026949.V273993.R01.S.doc Version 5.1 Page 20 In conversation with staff, and from the staff rotas it was found that in general there are three or four staff on duty in a morning and two people on duty in the afternoon and evening, with two night staff. This is some improvement since the last inspection when evidence showed that generally there were only two staff on duty on each shift. Discussion with staff suggested that any day time shift with only two staff on duty presents problems, as two people are required to use the hoist for the majority of the service users, and one service user requires 1:1 attention at all times, which can prove impossible. They are also finding it very physically demanding. Evidence also suggests that these demands on staff time may also be adding to the problem of supporting the service users to go out. Staff reported that there had been some recent recruitment that should help with staff cover. At the inspection there was a new qualified nurse on the staff team and a support worker who had started that day. The last report made a requirement that a formal review of the ratios of care staff to service users be undertaken linked to the assessed care needs of the service users. A copy of this review was required by the Commission, with an action plan with timescales provided to address any staffing increase necessary that the report may indicate. While information was received from the home manager stating that staffing had improved and enclosing a copy of a weeks rotas to support this, it is disappointing that although the deadline has passed for the information to be provided it has still not been received. It is a requirement of this report that this review and the information produced from it is provided to the Commission, and further action may be taken should this requirement not be met this time. The staff files were locked away as the manager was not on duty at the time of the visit. However, a new member of staff had commenced working at the home that day, and she confirmed the recruitment process that had been followed with her. She had completed an application form, had undergone a formal interview, was aware that two references had been received for her and that she had a CRB check. She also confirmed that her first day at work had involved her observing practice all day within the home. This evidence, together with known Choices recruitment practices in other homes is satisfactory to confirm that the standard is met. Heath Street Nursing Home DS0000026949.V273993.R01.S.doc Version 5.1 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 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 37, 38, 39 and 42 The home is generally well run although there were a few areas where record keeping could be improved. The organisation needs to be more open with staff about the findings of an external review. This will lead to a happier staff team which will in turn benefit the service users. EVIDENCE: The registered manager is a qualified nurse in learning disabilities and has several years experience in running the home. She has completed her Registered Managers Award. She is involved in various sub committees that have been set up Choices organisation to improve practice and undertakes periodic training to maintain and update her knowledge and skills. In discussion the staff were very positive about the manager and the support that they receive from her and her expertise in running the home. An incident that took place at the home some months ago had affected staff morale but at Heath Street Nursing Home DS0000026949.V273993.R01.S.doc Version 5.1 Page 22 this visit the staff said that morale was improving and that people were working together again as a cohesive team. An issue for the wider Choices organisation to take on board is the disappointment expressed by staff that in spite of its obvious importance to the home, and the fact that some of them had contributed to it, the staff team had not seen the report on the review of the home undertaken by an outside consultant (the general review and not that of the incident). In a later telephone conversation with the manager she confirmed that she had not been given a copy of the report, although she had been made aware of its general content. The national minimum standards require that the processes of managing and running the home are open and transparent, and it is considered by the inspector that this reluctance to share the findings of the report is not in the spirit of such openness and transparency. It is required that a copy of the report from the external consultant is provided to the manager and it is strongly recommended that the report is shared with the staff of the home. In addition to the above, the Commission has requested a copy of the report made by the external consultant on the untoward incident at the home, but this has not yet been received. Both the provision of this incident report and a copy of the report on the general review of the home by the consultant are requirements of this inspection. The service users at the home are generally unable to express their views about the quality of the service that they receive, and the home relies on the input of relatives and other professionals at the individual review meetings to express their views. In addition the year on year development of each service user is also monitored via the progress against outcomes made in the individual plan. Choices organisation undertakes a bi-annual audit of the services that are provided across all of their homes and schemes. Representatives of service users, staff and relatives, together with outside representatives undertake this review. The next one is scheduled for November 2006. The standards require continuous self-monitoring of each individual home that involves the service users living there, where possible, with an internal audit being undertaken at least annually. An audit of the home has been undertaken recently by an external consultant and a copy of this report has been required as shown above. The organisation is reminded that an annual quality assurance report for the home will be required in future years in order to meet this standard. Heath Street Nursing Home DS0000026949.V273993.R01.S.doc Version 5.1 Page 23 A sample of records were examined relating to health and safety with the following findings: Moving and handling risk assessments were in place and there was appropriate equipment available, e.g. hoists, assisted baths, which had been regularly serviced to support the safe moving of service users. All the appropriate fire checks were timely completed, but whilst it was clear that fire drills were undertaken it was not clear that each member of staff had taken part in the number of fire drills that each requires. It is a requirement of this report that this is addressed. Fridge, freezer and food probe checks for safe temperatures had been intermittently recorded during the month of December, which was the only record seen. It is a requirement that these temperatures are recorded on every occasion. COSHH (Control of Substances Hazardous to Health) regulations were being followed and the environment as found at the time of the inspection was considered safe. There was no Accident Book available in the home. Telephone discussion with the manager evidenced that the previous book was full and had been returned to the head office, and a new one had not yet been received. A new Accident Book must be provided. Heath Street Nursing Home DS0000026949.V273993.R01.S.doc Version 5.1 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 x 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 x ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 3 35 x 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 2 14 2 15 x 16 x 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 2 3 x x 2 x Heath Street Nursing Home DS0000026949.V273993.R01.S.doc Version 5.1 Page 25 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 Standard YA9 YA13 YA13 Regulation 13(4) 16(2)m 16(2)m Requirement Ensure that all risk assessments are reviewed to the timescale set for their evaluation. Provide sufficient staff time to support service users outside the home. Ensure that better access is available to transport service users to leisure and other activities. Increase the level of external leisure activities for the service users. Undertake a formal review of the ratio of staff to service users in the home linked to service users dependency needs, and provide a copy of the review to the Commission, together with how any required action identified will be implemented, with timescales. (This was a requirement of the previous inspection and has not been met) Provide a copy of the report into the general review of the home undertaken by the external consultant to the manager. DS0000026949.V273993.R01.S.doc Timescale for action 28/02/06 31/01/06 31/01/06 4 5 YA14 YA33 16(2)m 18(1)a 31/01/06 31/01/06 6 YA38 12(5)a 31/01/06 Heath Street Nursing Home Version 5.1 Page 26 7 YA38 24(2) 8 YA38 17 YA42 9 23(4)d 10 YA42 16 Provide a copy of the general review of the home undertaken by the external consultant to the Commission. Provide a copy of the report provided by the external consultant into the untoward incident at the home to the Commission. Ensure that each member of staff takes part in a fire drill at the required intervals, and ensure that a record of this is kept. Ensure that fridge, freezer, water and food probe temperatures are recorded on every occasion. 31/01/06 31/01/06 31/01/06 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA38 Good Practice Recommendations Discuss the findings of the review into the home with the staff team Heath Street Nursing Home DS0000026949.V273993.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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. 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