Inspection on 24/10/07 for Heath Street Nursing Home

This inspection was carried out on 24th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 Street Nursing Home 05/10/06

Heath Street Nursing Home 20/12/05

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 Key - Unannounced Inspection 24th October 2007 09:30 Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 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.V348062.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 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.V348062.R01.S.doc Version 5.2 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) heathst@choiceshousing.co.uk Choices Housing Association Limited Ms Jayne Warrington Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (1), Physical disability (6), of places Physical disability over 65 years of age (6) Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th October 2006 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 or physical 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 support 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 washbasin 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, although small, 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 although the fact that it is situated on a steep incline restricts access for the majority of the residents to the community other than by transport. The home has an experienced manager and a committed staff team. Costs for the service range from £339 to £687 per week (current prices). Residents pay for their own hairdressing and personal toiletries. Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection. This means that all of the national minimum standards that the commission for social care inspection consider most greatly affect the health, safety and welfare of the residents were looked at. The inspection took place over an 8.5-hour period. All of the residents were at home throughout the visit. The 1 resident who is able to communicate verbally was asked about her views of the home. 1 resident survey form was returned from the resident mentioned above, and 2 survey forms were received from relatives. 6 staff completed survey forms to inform the commission about aspects of their recruitment and training, and their views about how the home is run. The manager and her deputy and 2 care workers were on duty and each contributed to the inspection process. The inspection included examining a sample of 3 residents’ files and a sample of health and safety documentation including maintenance records and the records relating to fire safety. The arrangements for administering medication were looked at as well as the arrangements for safeguarding residents’ finances. The menu plan for the week was seen. . A couple of hours were spent sitting with the residents in a communal area of the home. This was to enable us to have a look at resident’s welfare and how staff treated them during this period. These observations were used alongside other information gathered to assess the quality of care. The recruitment procedures were looked at as well as the training provided to the staff. This included inspection of 3 staff files. A tour of the home was undertaken. What the service does well: People living at Heath Street seem contented living there. The 1 resident who is able to speak said that she was happy with ‘everything.’ The other residents seemed contented during the time that we sat with them. The staff do all that they can to understand the needs of the residents. They write down all of the things that they think that their body language and facial gestures mean, so that they can understand when they are happy, sad or in pain so that they can help them. The health needs of all of the residents are given a high priority. The staff ensure that they have all of the health appointments needed and make sure Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 Page 6 that the support that each person needs to improve their health is understood by everyone and acted upon. There is a range of specialist equipment used in the home, and most of the residents have special chairs to ensure that they are safe and can sit comfortably all of the time. The manager and staff make sure that although the residents have complex needs they are given opportunities to develop their skills and promote their self-esteem. Each person has a range of activities that they take part in throughout the week, that includes helping in the kitchen and with the laundry to the level that they are able. Staff are properly vetted so that people are kept safe. All of the staff are very well trained to meet the individual needs of each resident. The manager makes sure that she is up to date with good practice and with any new legislation that is introduced. People are kept safe by good attention to all of the areas that could affect their health and safety, such as keeping equipment in good condition, sound fire safety practices, keeping the home free of infection. The manager consults with relatives to see if they think any improvements are needed in their relative’s care, or in the way the home is run. Relatives of the residents told the commission that they are very pleased with the care that is being provided. ‘The kindness and thoughtfulness with a warm welcome when I visit makes for a happy house. First class attention to all of the residents needs.’ ‘Staff are very good at keeping me informed.’ What has improved since the last inspection? At the last inspection the home was required to take the residents out more, so that they could become more of a part of the community. The organisation has paid attention to this and provided better access to transport that is having a good effect. At the last inspection the medication records had a number of gaps where staff had not signed that they had given the medication, or if medication had not been given why this was so. This is important for the safety of the residents. The manager now monitors this and takes action if there are any omissions, and at this visit no problems were found. Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 Page 7 Better vetting of new staff was required at the last visit while a full Criminal Records Bureau check was awaited. This now happens. Individual fire risk assessments for all of the residents are now in place. This means that the staff know exactly how to best ensure people’s safety should there be a fire. Some furniture has been taken out of the lounge to free up more space for residents who sit in their special chairs. This makes the environment safer. 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. The summary of this inspection report can be made available in other formats on request. Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 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.V348062.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use services and their representatives have the information needed to choose a home that will meet their needs. Their needs are assessed before a place at the home is offered. EVIDENCE: There had been no new residents since the last visit. Previous inspections have identified that a thorough assessment of each persons’ needs was undertaken prior to them moving into the home. Needs are regularly reviewed. Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Every effort is made to communicate with residents so that they are involved in decisions about their lives, and the views of significant others are listened to so that person centred planning is promoted EVIDENCE: The files seen were all based on person centred planning principles and showed in detail all aspects of personal and social support and healthcare needs. The plans are evaluated on a monthly basis by the lead nurse, and then quarterly by the manager and there was evidence to see that this is done in a meaningful way and not just as a ‘tick box’ exercise. Each resident has 2 key workers, comprising of a nurse and a support worker. 1 of the support workers was questioned about the needs of the person who she is key worker to, and she had a very good understanding of their needs, including an understanding Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 Page 11 of their body language and facial expressions, as the person does not verbally communicate. There was also evidence seen in team meeting minutes that the needs of all the residents and their plans are thoroughly discussed. The residents living at Heath Street have a high level of needs and only one person can verbally communicate. The home has always evidenced that they try to gain an understanding of people’s wishes by studying their body language and facial expressions, and at this inspection further strides have been made in relation to this. Each file inspected showed a comprehensive communication plan highlighting the collective staff teams understanding of people’s likes, dislikes, signs of pain etc, that had been gained from experience. This understanding and the interpretations are then used to promote individual resident’s wishes and to promote some decision making in daily living. For more major decisions the involvement of advocates and family is sought. Evidence was seen of this. Choices organisation also has an Ethics Committee where any issues arising for an individual in relation to choice or human rights are discussed. There was a range of risk assessments that showed thoughtful and thorough assessment of the individual risks presenting for each person across the whole of their care. The assessments had been drawn up by the key worker and in each case had been reviewed on a monthly basis by that person, with a quarterly audit being carried out by the manager. There was evidence that any risks that restricted freedom of movement had been thoughtfully considered and the resident’s family had been involved in the decisionmaking. These included the use of bed rails and a fire risk assessment that limited some freedom for 1 person to keep them safe in an emergency situation. Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use services are supported to make choices about their lifestyle, and supported to develop their life skills. EVIDENCE: The residents living at the home are unable to participate in work or attend further education training due to their levels of need. However over the course of successive inspections in the last 3 years evidence has been seen that the home has put an increasing focus on understanding the interests and capabilities of the residents and developing their daily lives with a focus on meaningful activities and the development of self esteem. This is called ‘active support’ at the home. Each file showed a programme of activities to be followed for each person, which included tasks of daily living such as putting the laundry away, assisting with meals, watering the plants, to more personal or therapeutic activities including art work and hand and foot massages. At the Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 Page 13 inspection one resident helped to prepare a salad, someone had a hand massage and someone else was following a programme to help them become less touch averse. There were good records to show the tasks and activities for each person that had been followed over the days/weeks. The resident who is able to verbally communicate said that she enjoyed helping in the kitchen, baking, and putting her clothes away. An external professional provides an in-house music session once a month. Some of the residents show an interest in music and at the inspection they enjoyed watching/listening to a video of irish dancing and music that was clearly enjoyed. All residents have a holiday every year. One resident has been supported to travel abroad. At previous inspections there has been a concern that the residents were not accessing the community enough, although there have been periods of improvement. At this inspection it was discussed that transport issues have been addressed and staff reported that this access to transport has considerably increased their ability to take people out. There is currently also a full staff team. It was seen that a minimum number of outside activities per month are planned via the person centred planning reviews. These range from 2 to 7 per person per month, based on the experience of staff to the response of residents to the varied activities that are tried in the community. Only 1 resident goes out in the evening, and this is only once a month. Staff said that evening outings were being planned for everyone during the lead in to Christmas. The calendars kept for each person show that the number of activities decided at the review meetings is largely followed, and there was evidence that for some people more than the minimum is achieved. Discussion with staff on duty suggested that this tends to be related to the enthusiasm and ability of the key worker to plan for activities, and the manager is asked to continue to monitor this to ensure that all staff respond appropriately. It is still considered that residents could go out more, to widen experiences, increase community inclusion and to gain fresh air. The manager is recommended to maximise the opportunities for residents to go out, to include a focus on evening activities that they may enjoy where this is appropriate, to promote ordinary living principles. There was evidence that residents are supported to maintain family links and friendships both inside and outside of the home. 2 relatives comment cards were returned and the following was noted: ‘The kindness and thoughtfulness with a warm welcome when I visit makes for a happy house. First class attention to all of the residents needs.’ Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 Page 14 ‘Staff are very good at keeping me informed.’ Records also showed that the residents are encouraged to maintain friendships that they have made with others living at other Choices homes by return visits by each party, and visitors are also received at Heath Street from the local church. 1 resident attends a local flower club on a monthly basis, and also meets up and travels to the venue with a friend from another home operated by Choices. There was discreet observation that showed staff interacting positively with residents. For example staff were heard on a number of occasions engaging with a resident who walks freely around the home and asking her if she wanted to help them with the laundry or in the kitchen. The daily routines were seen to be flexible, with care plans showing residents preferred choices for rising and retiring, with the communication plan showing how this had been decided. Staff were observed knocking on bedroom doors before entering. Residents have their own keys. Staff were observed noticing residents’ mannerisms to inform when they wished to go to their room for some private space, and they responded immediately. The time spent observing residents daily life and staff care practices found staff to be very patient and spending their time considering the residents needs. Residents at the home have complex needs and most do not verbally communicate, and staff showed a good understanding of their needs when they undertook different activities with them to stimulate them. The residents seemed contented throughout the period that was observed. Staff spent time talking to the residents and engaged in activities with them for the large majority of the time. A slight lapse from this good practice was noted, and this was brought to the attention of the manager. The menu book was inspected and this showed that the residents enjoy a healthy nutritious diet. The service has a member of staff who has undertaken a comprehensive course of study in nutrition, allowing ready access to advice, and other staff have received in-house training in the understanding of a balanced diet. Menus are planned on a weekly basis; there is no rolling programme of menu plans. Evidence showed that the resident’s nutritional needs are assessed and regularly reviewed and there were appropriate risk assessments in place linked to their dietary and eating needs. 1 of the residents who is able to be involved assists in menu planning. The AQAA states that the manager has plans to extend this to other residents in the next 12 months by developing pictures of foods and food groups to support choices. Meals are taken in the spacious dining room and some of the residents have special chairs that enable them to sit comfortably and safely at the table. There was clear evidence to show that drinks and healthy snacks are available throughout the day. Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 Page 15 2 residents were assisted to eat their lunch and the staff involved in this support undertook this in a discrete way and preserved the residents’ dignity throughout. Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: The information available about each person’s needs was comprehensively contained in the support plan and a ‘safer handling plan of care,’ with supporting risk assessments to support all moving and handling procedures for bathing, transferring etc. The home has a range of aids and equipment in place that has been obtained following professional input, and the evidence showed that these items, such as specialist chairs and beds had been changed in line with the changing needs of the residents. The continuing safety of aids such as wheelchairs, hoists, and special chairs are checked at regular intervals, and staff training in moving and handling is up to date. Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 Page 17 Personal support was provided in private, with residents being taken to the bathroom or their bedroom in a quiet, discreet way. Each resident has 2 key workers, with a nurse and support worker taking the lead on their care, and reviewing their plans. The 24-hour support plan has been further strengthened since the last inspection, and the communication plans also show interpretation of facial expressions and arm and hand gestures for each resident to aid support being provided in the way that the resident wishes. A relative responded in a survey form that the staff team would benefit from a male(s) worker. This is something that the home is recommended to pursue as opportunities present. At the visit the residents were all dressed age appropriately. 1 resident who is in a wheelchair has had progressive improvements made to her bedroom furniture, including during the last year the addition of sliding door wardrobes to enable her to more easily select her clothes and take them from the wardrobe. She greatly values this further independence. Each resident had a Health Action Plan in place. There were up to date records in place to further evidence information contained in the AQAA, that all regular health interventions are carried out in a timely way, such as dentist, chiropody, wellman/woman, flu jab, coranary checks, medication reviews, eye test, breast screening, etc in line with each resident’s individual needs. The health records showed that staff promptly put into practice any professional advice received about each individual, and that residents’ health is consistently monitored and any problems are identified and dealt with at an early stage. Records showed a person centred approach to hydration and nutrition. Further professional advice had been sought in instances. The AQAA states that the manager has plans to attend a pain management course for those with limited communication. A DISDAT (Disability Distress Assessment Tool) that has been developed by a palliative care team is being used in the home to try to gain a better understanding if people with no speech are in pain. Its use is in its infancy but is another example of the home seeking ways in which they can best support and care for the residents. All of the residents at the home require support with their medication. Procedures in place for the receipt, recording, storage, handling, administration and disposal of medication were discussed with the manager and were considered suitable. The home uses the Nomad system for medication. There were no controlled drugs being used in the home. There is always a Registered Nurse on duty at all times and it is the nurse’s responsibility for administering medication. The teatime medication was observed and procedures were satisfactory. Training records showed that all of the staff (qualified nurses) that administer medication had received advanced module training from a pharmacist. Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 Page 18 The home has sound procedures in place for PRN (as and when) medication and for the provision of homely remedies that have been agreed to and signed off by the GP. The home undertakes a 6 monthly audit of medication. Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is access to a robust, effective complaints procedure. Residents are protected from abuse, and have their rights protected. EVIDENCE: The home has a clear complaints procedure that is displayed in the home, which includes all the appropriate information including the timescale for a response to complaints. Records also showed evidence that residents and relatives have been given a copy of the procedure, although residents’ understanding may be limited apart from 1 person. The use of other means such as audio could be considered. The 1 resident able to respond to a survey form indicated that they knew that they could complain if not happy with anything, and went on to list those people who they would tell of any concerns. Both relatives who responded to the commission’s survey confirmed that they had been given a copy of the complaints procedure that included the commission’s address and phone number. The home’s staff continue to try to understand what residents are communicating by their demeanour so that they can better realise when something is wrong. The resident who can verbally communicate said that she was happy at the home ‘I’m happy.’ When asked what with she said ‘everything.’ Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 Page 20 Neither the home or the commission have received any complaints about the service. The home has appropriate procedures in place for the safeguarding of adults. Training records showed that all of the staff had received appropriate training, and there was evidence that refresher training is planned for early in the New Year. A further quality improvement could be the testing out of knowledge and understanding in this area at team meetings and during supervision sessions. That said, an individual member of staff was questioned at the inspection on scenarios linked to their understanding of abusive practice and their reporting responsibilities. They responded well to the questions posed. Records showed that all staff received personal safety training, although there is no history of any challenging behaviour by residents. The systems in place regarding residents’ money and financial affairs were inspected. Recording systems and auditing were satisfactory. All of the residents have their own personal safes in their rooms for the storage of money and other valuables. Inspection of recruitment practices, discussed more fully in the ‘staffing’ outcome group showed that all staff are appropriately vetted before they commence working in the home. There were robust risk assessments in place for the use of bed rails, chairs and wheelchair belts, including the involvement in the decision making for their use of significant others. The use of restraint in an emergency situation such as fire, when a resident may need to be strapped into a chair to keep her safe from wandering if the residents were evacuated outside had been thoughtfully considered and discussed with relatives. The AQAA indicated that the manager was aware of the Mental Capacity Act and its implications. Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24, 26 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The overall design and layout of the home generally enables residents to live in a safe, well-maintained and comfortable environment, although more useable space in some bedrooms and more storage space would further assist. EVIDENCE: The home is situated in a street of terraced and semi detached houses with no distinguishable features from the outside that it is a care home. There is a small parking area at the front and an enclosed rear garden laid with slabs, with a garden laid to lawn around the rest of the property. Whilst the home itself was purpose built to accommodate wheelchairs, it is unfortunately situated near to the top of a steep incline and this prevents all but 1 of the residents from going out unless via transport, due to health and safety reasons for staff who would need to push a wheelchair. The 1 resident referred to is mobile and does walk out with a member of staff. This resident Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 Page 22 also accesses public transport on occasions. For the other residents the home uses the organisation’s vehicles and private taxis. There are six single occupancy bedrooms that are well decorated. The last inspection referred to some rooms being cramped when hoists are being used. The organisation has not as yet been able to improve this by moving wardrobes, although some residents have had new wardrobes fitted that better meet needs. Creative thought about making more space is still recommended. The kitchen and dining area is spacious. The kitchen has a suitable height work surface at one end to accommodate wheelchairs and to allow residents to assist with meals or bake. Corridors and door widths are of sufficient size to accommodate the use of wheelchair and specialist chairs. There are two appropriately equipped assisted bathrooms, one containing a range of sensory equipment. Every effort has been made to ensure that the home, whilst continuing to meet health needs via the use of appropriate equipment, retains a homely domestic style. Photographs are displayed around the home. Furniture and fittings are of good quality. The AQAA states that the décor is renewed every 3 years and is selected with the help of the residents. It was noted that furniture has been moved out of the lounge to make it less cramped. This still presents some problems for staff that need to manoeuvre chairs around when residents need to go to the bathroom or elsewhere in the home. It was seen that other residents have to be disturbed to allow this. There also remains a need for more storage space. The home has a planned maintenance and renewal programme, with the manager forwarding the requirements for the coming year via her line manager to the head office to be met within the budget. The laundry is well sited away from the kitchen and dining area. The wall and floor fittings and the equipment available are suitable to prevent the spread of infection. The manager confirmed that the equipment continues to be suitable to meet the home’s needs. 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 satisfactory hand washing facilities. COSHH (Control of substances hazardous to health) products are appropriately stored in the laundry in locked cabinets. There are never any lingering odours noted at visits. All staff have received training in infection control. The home was very clean and tidy at this visit. The AQAA states that a positive report was received from the Environmental Health Department at the beginning of this year. Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 Page 23 Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 33, 34 and 35) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are well trained and skilled and in sufficient numbers to safely support the people who use the service, and to support the smooth running of the service, in line with their terms and conditions of employment. EVIDENCE: Heath Street retains a stable staff team. The inspector had met all of the staff on duty at this visit at previous inspections. The resident who can verbally communicate said that she liked all of the staff and throughout the inspection all of the residents were shown respect. A staff member was questioned about her understanding of the needs of the resident for whom she is key worker, and she gave a very clear picture of the support that they require, including their health needs and their learning disability, and an understanding of their non-verbal communication. The time spent observing residents’ daily life and the care practices of staff overall evidenced very positive staff interactions. The staff spoke a lot to the residents including those where there was no evident recognition of this communication. Other good practice was witnessed, such as recognising when a resident had become bored with an activity and addressing this, noting that a Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 Page 25 resident was trying to look outside and moving the net curtain to enable them to see better. There were a couple of instances where this thoughtfulness slipped a little, such as a staff member tipping a chair back without saying that they were going to do so, and an instance of ‘talking over’ residents, but these were by far in the minority to the good interaction displayed, but were brought to the attention of the manager at the visit to raise with staff. All new staff receive a structured induction programme geared to LDAF (Learning Disability Award Framework). All support workers are trained to NVQ 2 (National Vocational Qualifications), which they commence within 9 months of employment, with the remainder of staff being nurses who have undertaken nursing qualifications. There have been past concerns about staffing ratios at the home, resulting in discussions with the commission and an increase of staff on duty to 4 or 5 regularly on duty on certain shifts for a period of time, which allowed for more 1:1 support for each resident both within and outside the home. The manager reported at this inspection that there was a full complement of staff. The staffing rotas showed that generally there are 3 or 4 staff on until early afternoon, 2 or 3 on until 6pm, and then 2 in the evenings and during the night. Staffing is increased for those occasions when residents are going out to activities, the number of which per month are agreed via their person centred plans. Recommendations about increased social inclusion for residents are made earlier. Sufficient staff on shifts is crucial to this. Nevertheless, staff on duty considered that there were appropriate staffing levels, and the 6 staff survey forms that were returned responded either ‘yes’ (4) or ‘usually’ (2) to the question ‘ are there enough staff to meet the individual needs of service users?’ The manager is recommended to keep the staffing numbers on each shift under regular review. 3 staff files were inspected. Staff recruitment is dealt with via the head office, and then the relevant information is passed to the home. The files showed that all of the records expected to ensure appropriate recruitment and selection procedures were in place. These included an application form, formal interview, receipt of two written references and either a POVA First (Protection of Vulnerable Adults) or CRB (Criminal Records Bureau) check that had been received prior to employment starting. The manager understood the need for supervision arrangements of any worker whilst a full CRB was awaited. Staff had received terms and conditions of employment contracts. Examination of the overall staff record showed that there were a number of long standing staff for whom the CRB reference number was not available. The manager said that these staff had undergone a CRB check and one person on duty to whom this applied confirmed a check had been undertaken. Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 Page 26 There was evidence that the manager had requested the CRB numbers or other evidence of these being undertaken from the head office some time previously, but these had still not been received. It was disappointing that such information was not available for the commission to inspect. It is a strong recommendation of this report that this is addressed. These details should be held at the home. All of the staff at the home are well trained. In addition to the structured induction training that is linked to LDAF, and a staff team that are all qualified to NVQ 2 or with a nursing qualification, the staff files inspected and the training matrix showed that all staff had up to date mandatory training. In addition there was a range of specialist training linked to the needs of the residents. Staff had received training in what is a learning disability, values and attitudes, person centred planning, interpersonal relationships. A staff nurse in the team had completed her A1 assessor’s course. The deputy manager has obtained her RMA. (Registered Managers Award). The AQAA states that there is personal development planning for all staff. 6 staff survey forms were returned. All staff were positive about their training. ‘Choices has an excellent induction package.’ ‘We have regular training courses.’ ‘We can do other courses in our own time and Choices will support you if its relevant to the service users and they will benefit from it.’ The organisation has ‘Investors in People’ status. Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager. 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 undertakes periodic training to maintain and update her knowledge and skills. There was evidence to show that effort is made to take account of up to date research and good practice. The manager has recently received training in person centred thinking, and has completed Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 Page 28 the health and safety ‘working safely certificate.’ Discussion with the manager demonstrated an awareness of the need for effective fiancial management and budgetary control. Records showed that the home operates well within the budget that is set by the organisation. Work systems in place and all of the records kept were to a high standard. The manager undertakes regular audits of the records relating to the residents, and team meeting and review meetings showed evidence of sound leadership. There was evidence to show that the manager motivates the staff team to continuously improve services and provide an increased quality of life for residents. This was particularly evident in the developments noted in the communication plans for each person. The manager is asked to look at gaining greater social inclusion for residents to further develop the quality of the service. Staff said that the manager had an open approach, and that any issues within the team are addressed by good communication and staff being encouraged to express their views. Staff that completed survey forms were positive about the manager and the organisation. ‘Treat service users as individuals and therefore caters well for their needs. Look after the staff and their needs also.’ ‘We usually have house meetings to discuss new care plans in place. We also discuss care needs for individual clients in turn and bring up ideas for new care plans.’ ‘We have thorough policies and procedures to follow.’ ‘The service we provide enables the clients to live as independent a life as possible.’ Service is ‘always there to listen and support you.’ The home is supported by a strong parent organisation and there is evidence of organisational monitoring by more senior staff, with a clear direction for the service. The AQAA, however, showed that a number of policies and procedures have not been reviewed for a number of years, and it would be good practice for all policies and procedures to be more regularly assessed. The findings of this report show that the registered manager, supported by the organisation, ensures that the home complies overall with the Care Standards Act and Regulations and other legal requirements. The manager also demonstrated that she had kept abreast of current legislation such as up to date fire regulations and the Mental Capacity Act. Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 Page 29 The residents are generally unable to express their views about the service that they receive, and the home relies on the input of relatives and others visiting the home, and their input into the annual review meetings of residents. In addition, there is an annual survey of relatives and staff. Evidence was seen that relatives’ surveys have recently been sent out. The service has an annual development plan that takes account of findings from surveys and inspection reports and bi-annual external reviews of the service. The plan shows service targets, objectives and improvements for the coming year. Records showing the quarterly analysis of progress were seen. The home also regularly undertakes audits across all areas of service, such as medication, record keeping, etc. In addition to monthly team meetings the service links with other staff to hold peer meetings (cluster) every two months. This meeting is used to share ideas and set the future direction for the service. Survey forms to relatives sent out by the commission were received from 2 relatives. Both were positive. The AQAA identified that the maintenance of equipment was all up to date. A sample of these related records, including hoists, fire extinguishers and fire systems were checked and tallied with the information given. Fire records were all up to date, including fire training and drills. There were individual risk assessments in place for fire. All records were in place to comply with all health and safety legislation. A tour of the home was undertaken and there was no evidence of any unsafe practices throughout the duration of the inspection. Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 Page 30 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 3 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 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 X 4 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 3 X 3 X X 3 X Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 Page 31 NO 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. Standard Regulation Requirement Timescale for action 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 YA13 Good Practice Recommendations Maximise the opportunities for residents to go out, to include evening activities that they may enjoy where this is appropriate, to promote greater social inclusion and ordinary living principles. Continue to try to increase the useable space in bedrooms to make it easier for staff to assist residents to transfer from bed to chair etc. 2. YA24 3. 4. 5. YA24 YA33 YA34 Provide more storage space within the home. Keep the number of staff on duty under regular review, linked to increasing the social inclusion of the residents. Ensure that the Criminal Records Bureau check number for all longer serving staff is held at the home and not just at DS0000026949.V348062.R01.S.doc Version 5.2 Page 32 Heath Street Nursing Home the head office so that this information is readily available to the commission. Heath Street Nursing Home DS0000026949.V348062.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Birmingham Local Office Commission for Social Care Inspection 1st Floor, Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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