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Inspection on 05/10/06 for Heath Street Nursing Home

Also see our care home review for Heath Street Nursing Home for more information

This inspection was carried out on 5th October 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

What has improved since the last inspection?

There were a number of concerns raised at the last inspection and these have all mostly been addressed. There were issues at the last inspection about residents not being stimulated, either by activities within the home or becoming part of the local community by visiting all of the places that others would attend. The report did, at the same time, recognise the difficulties faced by the home in addressing these issues due to the needs of the residents. It was pleasing to find at this inspection that there had been improvements both in the activities provided in the home, and visits out by residents into the community, although the latter could still be improved upon. Last time some of the records that the home has to keep so that they can show that people are cared for safely were not up to date. These included fire drills and `fridge and freezer temperatures. At this visit all of the required records were up to date and in good order. During the year prior to the last inspection there had been an issue in the home that had resulted in low staff morale. During the last inspection staff spoke at length about their concerns and they were generally unhappy about communication from senior managers. This had changed completely at this visit and all of the staff on duty (some of whom were the same ones as at the last inspection) said that the team were back on an even keel and that the staff team was happy and contented. Observation during the visit confirmed this, which is pleasing to note, as how staff are feeling has a wider impact on their responses to the residents.

What the care home could do better:

Following the last inspection there were some real improvements in residents being able to go out to activities, but although this remains better at this visit than at the last inspection it has again fallen off somewhat. This is in part linked to the absence of some staff due to sickness absence and maternity leave. The home has recently recruited two new staff to work at the home for six months, and it is required that a greater focus is placed on ensuring that planned outings for residents take place as scheduled. While the home has generally very safe procedures in place relating to medication, a sample of the medication charts showed some gaps in recording that is not acceptable. If medication has been taken this needs to be shown, and if it is refused for any reason the charts should show the reason why, so that a clear audit trail is evident. The home has been required to address this issue. Recruitment procedures are generally good, with all of the appropriate checks being completed. However it became apparent during the visit that two staff were due to start before full vetting of their past had been completed. This has been discussed with management at the head office who are responsible for recruitment and they have been made aware that all of the appropriate checks must be in place before any member of staff commences work in any Choices home. Because of additional equipment, such as specialist chairs being required in the home, and a hoist being needed to transfer a number of the residents into and out of bed, the bedrooms and the lounge particularly are becoming cramped. This could lead to a health and safety problem.The home has been recommended to undertake a review of space within the home to include considering the need for some of the furniture, and to also look at ways of providing more storage space.

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 5 October 2006 09:30 Heath Street Nursing Home DS0000026949.V310935.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.V310935.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.V310935.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 Heath Street Nursing Home DS0000026949.V310935.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th December 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 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 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. There was a range of information on display in the home that included the home’s Statement of Purpose and Service User Guide and the Complaints Procedure in easy to read format. The Statement of Purpose states that the information can be provided on audiotape, large print, and pictorial or in other languages, or a staff member can discuss it verbally. Costs for the service range from £355 to £674 per week (current prices). Residents pay for their own hairdressing and personal toiletries. Heath Street Nursing Home DS0000026949.V310935.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 inspection, was unannounced and was undertaken by 1 inspector. All of the core standards as required by a key inspection were looked at. In addition a small number of other standards were looked at where they related to requirements made at the last inspection. The home is registered for 6 people with a learning and physical disability. Within the registration one resident can be over the age of 65 years. The home is currently full, comprising of four females and two males. All six people living at Heath Street were at home at the inspection. Only one of the residents is able to verbally communicate and apart from some limited discussion with this one resident the inspection relied on observation, residents’ records and support from staff to try to gain an insight into how the home was meeting people’s needs. Three staff were on duty throughout the visit, with a ‘change over’ of two staff taking place in early afternoon. All staff were spoken with during the inspection and one newer member of staff was asked about the recruitment process, induction and other training and the support received from the manager and the wider staff team. Because of some difficulties experienced during last year staff were also asked about the morale of the team. Five comment cards were returned from relatives and the GP of the home also returned a survey form. The records of three residents were looked at in detail, and the files of three staff, staff rotas, medication, staff training, menus and records relating to health and safety issues were inspected. The manager of the home was available during part of the visit with the deputy manager liaising with the inspector for the remainder. What the service does well: All of the residents appeared contented in the home. One resident who is able to verbally communicate said that she enjoyed living there and that she liked all of the staff. Five relatives returned comment cards, and they, and the GP who returned a form were all satisfied with the care provided. ‘Every confidence in the way that Heath Street is run. Always made welcome – it’s a pleasure to visit and to see the residents are obviously happy and comfortable.’ Heath Street Nursing Home DS0000026949.V310935.R01.S.doc Version 5.2 Page 6 Observation showed that staff were committed to meeting the residents needs. On a number of occasions they were not aware that the inspector was around, but they were always focussing on the residents and talking to them. Staff were very discreet in the provision of care. Residents were taken to the bathroom in a quiet, unobtrusive way, and it was noted that when supporting residents to eat this was done discreetly. Staff were seen to knock on bedroom and bathroom doors. Respect is shown to the residents in the way that staff assist them in choosing clothes and in their overall dress. There was clear evidence that every effort is made to allow them to make choices in their clothes, and everyone’s appearance suited their age and gender. The resident who can communicate verbally confirmed that she is supported to wear jewellery and have her hair styled. She, and the other residents looked immaculate. Personal and healthcare needs are well met. All of the residents have a health action plan and records showed good attention to all health appointments and any follow up action recommended by other health professionals. Each resident’s file seen contained good information about their particular health needs and staff were able to talk about each person’s needs in a knowledgeable way. Attention to health needs extended to the provision of specialist equipment for each person, including specialist chairs that had been purchased following the advice of an occupational therapist. There is a stable staff team at Heath Street which consists of 7 qualified nurses and 9 support staff. All of the staff are well trained with induction and mandatory training being comprehensively covered. 78 of the support staff have a national vocational qualification, which is the standard of training required for the care worker sector. The manager of the home is experienced and well qualified. Staff said that they respected her and that she was always very supportive with an open management style. She has set up auditing systems within the home that ensure that records and care needs are well monitored which in turn means that the care that the residents’ receive is of high quality. What has improved since the last inspection? There were a number of concerns raised at the last inspection and these have all mostly been addressed. There were issues at the last inspection about residents not being stimulated, either by activities within the home or becoming part of the local community by visiting all of the places that others would attend. The report did, at the same time, recognise the difficulties faced by the home in addressing these issues due to the needs of the residents. It was pleasing to find at this inspection that there had been improvements both in the activities provided in Heath Street Nursing Home DS0000026949.V310935.R01.S.doc Version 5.2 Page 7 the home, and visits out by residents into the community, although the latter could still be improved upon. Last time some of the records that the home has to keep so that they can show that people are cared for safely were not up to date. These included fire drills and ‘fridge and freezer temperatures. At this visit all of the required records were up to date and in good order. During the year prior to the last inspection there had been an issue in the home that had resulted in low staff morale. During the last inspection staff spoke at length about their concerns and they were generally unhappy about communication from senior managers. This had changed completely at this visit and all of the staff on duty (some of whom were the same ones as at the last inspection) said that the team were back on an even keel and that the staff team was happy and contented. Observation during the visit confirmed this, which is pleasing to note, as how staff are feeling has a wider impact on their responses to the residents. What they could do better: Following the last inspection there were some real improvements in residents being able to go out to activities, but although this remains better at this visit than at the last inspection it has again fallen off somewhat. This is in part linked to the absence of some staff due to sickness absence and maternity leave. The home has recently recruited two new staff to work at the home for six months, and it is required that a greater focus is placed on ensuring that planned outings for residents take place as scheduled. While the home has generally very safe procedures in place relating to medication, a sample of the medication charts showed some gaps in recording that is not acceptable. If medication has been taken this needs to be shown, and if it is refused for any reason the charts should show the reason why, so that a clear audit trail is evident. The home has been required to address this issue. Recruitment procedures are generally good, with all of the appropriate checks being completed. However it became apparent during the visit that two staff were due to start before full vetting of their past had been completed. This has been discussed with management at the head office who are responsible for recruitment and they have been made aware that all of the appropriate checks must be in place before any member of staff commences work in any Choices home. Because of additional equipment, such as specialist chairs being required in the home, and a hoist being needed to transfer a number of the residents into and out of bed, the bedrooms and the lounge particularly are becoming cramped. This could lead to a health and safety problem. Heath Street Nursing Home DS0000026949.V310935.R01.S.doc Version 5.2 Page 8 The home has been recommended to undertake a review of space within the home to include considering the need for some of the furniture, and to also look at ways of providing more storage space. 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.V310935.R01.S.doc Version 5.2 Page 9 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.V310935.R01.S.doc Version 5.2 Page 10 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): 2 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Residents’ needs are thoroughly assessed before they are offered a place in the home. In this way relatives can be confident that the service will meet their needs. EVIDENCE: There have been no new residents since the last visit. Previous inspections have identified that a thorough assessment of each persons’ needs had been undertaken prior to them moving into the home. Heath Street Nursing Home DS0000026949.V310935.R01.S.doc Version 5.2 Page 11 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): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that the home keeps comprehensive records about their care and lives, and that any major decisions that may affect their human rights are thoroughly discussed with other relevant professionals. EVIDENCE: The files of 3 residents were inspected. Each of these clearly showed the 24 hour support required by each individual and had care plans, risk assessments, and detailed and informative person centred plans in place showing the desired outcomes and the plans in place to achieve these outcomes for each person. The plans are evaluated on a monthly basis by the lead nurse, and then quarterly by the manager, which is seen as good practice. The person centred plans also have a full annual review. The residents living at Heath Street have a high level of needs and only one person can verbally communicate. Staff work closely with all of the residents to try to promote some decision making in daily living, but for more major decisions the involvement of advocates and family is sought. Choices organisation also has an Ethics Committee where any issues arising for an Heath Street Nursing Home DS0000026949.V310935.R01.S.doc Version 5.2 Page 12 individual in relation to choice or human rights are taken and discussed. This is considered good practice. There was a range of risk assessments in each of the three files sampled 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. Heath Street Nursing Home DS0000026949.V310935.R01.S.doc Version 5.2 Page 13 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): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff try hard to support the residents to enjoy a varied lifestyle, but access to community facilities still requires improvement. EVIDENCE: The current residents living at the home are unable to participate in paid work or attend further education training due to their levels of need. However, since the last inspection the home has increased its focus on providing meaningful tasks and activities for each person through what is classed as ‘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. The programmes set out for each person had been consistently followed, and staff on duty also confirmed that this support was now being provided much more regularly. At the last inspection there was a concern that the residents were not accessing the community enough. Three files were looked at to review the Heath Street Nursing Home DS0000026949.V310935.R01.S.doc Version 5.2 Page 14 progress in this area. The records showed that on average each resident had been out three times each month for the last three months. Trips were mainly doing shopping, cinema visits, visits to another Choices homes and visits to the hairdressers. While there is an improvement since the last inspection, it is still considered that there is room for further improvement in this area. Records showed that a number of trips out had been cancelled and staff on duty said that this would be either because of problems with staffing or transport issues. The home uses either ‘pool’ transport, or specialist taxis due to the mobility needs of the residents, and both of these have to be pre booked, which does not allow for spontaneity. Therefore if a trip has to be cancelled due to staffing problems there is a delay before another outing can be organised due to the unavailability of transport. The position of the home on a steep incline also makes it very difficult for residents to be escorted out on foot, although there was evidence that the one resident who does not require a wheelchair had been out for a walk and also used public transport. It was also noted that for one of the residents his person centred plan of twelve months ago highlighted visits to be planned to 10 pin bowling on a six weekly basis (these had initially taken place but had now ceased), attendance at a football match, (said now to be planned) and trips to an air show and banger racing or go-carting that had not taken place. The Service User Guide for the home states: ‘You will be helped to go out and develop friendships by going to a lot of different places.’ It is considered that in reality the practice does not meet with what is stated in the Service User Guide. For all of the reasons given above, the home is required to further improve the social inclusion of the residents. Staffing levels are discussed later in the report. There was clear evidence that residents are supported to maintain family links and friendships both inside and outside of the home. 5 relatives comment cards were returned and each was positive about the welcome extended to them at their visits. ‘Every confidence in the way that Heath Street is run. Always made welcome – it’s a pleasure to visit and to see the residents are obviously happy and comfortable.’ Heath Street Nursing Home DS0000026949.V310935.R01.S.doc Version 5.2 Page 15 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. The visit evidenced that residents’ rights are well respected and that they are treated with dignity and respect. Discreet observation, sometimes when staff were unaware, showed staff interacting positively with residents and their facial expressions and gestures were closely observed so that staff could gain an understanding of their wishes. For example, one resident pointed down the corridor and the staff said that they had learned that this meant that he wished to go to his bedroom. Staff were observed knocking on bedroom doors before entering and staff were seen to be continually supporting residents on an individual basis and not chatting amongst themselves. As there is only one resident who is able to verbally communicate it was pleasing that staff made every effort to interact with everyone. The menu book was inspected and this showed that the service users enjoy a healthy nutritious diet. Menus are planned on a weekly basis; there is no rolling programme of menu plans, but a fish meal is provided three times a week. 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. On the day of the inspection the residents had smoked mackerel on toast for lunch, and for the evening meal it was lasagne and salad followed by yoghurt. Some of the residents at Heath Street need help to eat or are artificially fed. The staff were discreetly observed providing support and this was done in a very professional and attentive way with the staff focussing their attention very clearly on the individual. 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.V310935.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although there were some shortfalls in medication record keeping, the overall physical, emotional and personal care needs of the residents are well met at Heath Street, where the principles of respect, dignity and privacy are put into practice. EVIDENCE: Five of the six residents living at the home require considerable support in mobilising and each of the three care plans inspected provided good information about how each person should be guided, moved, supported and transferred. The home has suitable aids and equipment in place that has been obtained following professional input, and the evidence showed that aids, such as specialist chairs, had been changed in line with the changing needs of the residents. Personal support was provided in private, with residents being taken to the bathroom or their bedroom in a quiet, discreet way. Wherever possible the residents are encouraged to make their own choices about their clothes, hairstyle and make up, as appropriate. Everyone was dressed in co-ordinated clothes that were age and sex appropriate, and the ladies were wearing fashionable jewellery. One of the ladies is very able to make her own choice of clothes and jewellery items, and as she cannot stand and uses a wheelchair to mobilise, her wardrobe has been altered so that she Heath Street Nursing Home DS0000026949.V310935.R01.S.doc Version 5.2 Page 17 can reach the rails to select her own clothes. As she cannot currently open the wardrobe doors by herself, the wardrobe has now been measured so that sliding doors can be fitted so that she can access her clothes completely independently. This is a good example of how the home is thinking creatively to seek ways of meeting the needs of the residents. The home works on the basis of a support worker and a nurse acting as the key worker team to each resident to ensure that there is consistency and continuity of support. A 24-hour plan of care is also available for each resident and this comprehensively details the preferred routine and likes and dislikes of each person in receiving care. Communication plans also show, as far as can be understood, an interpretation of facial expressions and arm and hand gestures relating to individuals, to aid staff in providing care. A record known as the ‘OK Health Check’ is completed annually for each resident. This covers all aspects of physical and emotional well-being and highlights any additional health input needed by a resident. There were up to date records in place to show that any such input required from any other health professional is pursued for each resident, and there was information showing all follow up appointments. The health records showed that staff promptly put into practice any professional advice received about each individual. The health records also show that residents’ health is consistently monitored and any problems are identified and dealt with at an early stage. 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 reviewed and discussed with a member of staff and were considered suitable, (although note the requirement shown below). There is always a Registered Nurse on duty at all times and it is the nurse’s responsibility for administering medication. Through discussion and inspection of training records it was seen that staff that administer medication had received advanced module training in medication from a pharmacist. It was pleasing to also note that the manager is providing medication training to support workers even though they do not have responsibility for administering medication in the home, to increase their awareness. This training is also planned as refresher training for the qualified nurses. The home has sound procedures in place for PRN (as and when required) medication and for the provision of homely remedies that have been agreed to and signed off by the GP. Whilst all other aspects of medication provision were considered satisfactory, it was disappointing to note that there were some gaps seen in the MAR Heath Street Nursing Home DS0000026949.V310935.R01.S.doc Version 5.2 Page 18 (Medication Administration Record) charts that were sampled. This is clearly not acceptable and the deputy manager was instructed to bring to the attention of all staff the requirement to complete the charts on every occasion, and to note, using the key at the bottom of the chart, the reason why medication had not been taken if this was an outcome. It is a requirement of this report that the MAR charts are properly completed on every occasion. Heath Street Nursing Home DS0000026949.V310935.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Every effort is made by the home to recognise any service shortfalls for individuals, and they are protected from abuse by the policies and procedures of the home and by the appropriate training of staff. EVIDENCE: The home has an appropriate complaints procedure and this is provided in the form of a brochure with both written and pictorial information. Copies were clearly displayed in the home. Neither the home nor the commission have received any complaints since the last inspection. The resident who can verbally communicate said that she remains happy living in the home and with all of the staff. She said that she would tell X (her key worker) if she wasn’t happy about something. The home liaises well with family, friends and other advocates to help to give each person a voice, and they are continually recording gestures and sounds made by individuals to try to gain a better understanding of when they are happy or something is wrong. These interpretations are then used in day-today situations. The organisation has robust procedures for responding to suspicion or evidence of abuse or neglect. There is a history of good communication with the Commission. All staff receive training in the Management of Actual or Potential Aggression and abuse training. Heath Street Nursing Home DS0000026949.V310935.R01.S.doc Version 5.2 Page 20 Although not inspected at this visit, past evidence shows that resident’s monies are handled appropriately and there is safe storage of money and valuables. Procedures in place prevent staff involvement in making or benefiting from residents’ wills. Heath Street Nursing Home DS0000026949.V310935.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a very comfortable, homely and clean environment for residents but consideration needs to be given to the amount of useable space available. EVIDENCE: 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 rear garden laid with slabs, with a garden laid to lawn around the rest of the property. The home has six single occupancy bedrooms that are well decorated. It was particularly noted at this visit, due to the timing of visiting bedrooms with the residents, that some of the rooms are cramped, presenting some difficulty for staff when using the hoist to transfer. Monthly reports received from the senior manager who oversees the home have identified that residents are awaiting new wardrobes. Staff on duty clarified that this was to replace the existing built in wardrobes with free-standing ones, and it is clear that this change would be beneficial to allow re-arrangement of the bedroom furniture that would provide more room for the hoist. Heath Street Nursing Home DS0000026949.V310935.R01.S.doc Version 5.2 Page 22 It is recommended that replacement wardrobes be provided with some urgency to allow safer moving and transfer of the residents where appropriate. The kitchen and dining area is spacious, and the kitchen has been revamped with an accessible area at one end 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. Furniture and fittings throughout the home are domestic in character and every effort has been made to provide a pleasant home. However, again particularly noted at this visit, the lounge was very cramped when the residents were all in there in their specialist chairs. This could present a hazard should an untoward event occur. It was also considered that there is insufficient storage space, with only one storeroom to house stores and some appliances. The home is recommended to undertake a review of the useable space within the home, to include a review of the lounge furniture and what is and is not necessary in the room, and to determine any areas elsewhere in the home that could be used for storage. 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. Staff said that the equipment was sufficient 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) procedures are appropriately stored in the laundry in locked cabinets. The home was very clean and hygienic at this visit. This is always found at this home. Heath Street Nursing Home DS0000026949.V310935.R01.S.doc Version 5.2 Page 23 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): 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. Residents are supported by a competent, well-trained staff team who are committed to meeting their needs. The Commission is confident that weaknesses in recruitment practices will be addressed. EVIDENCE: The majority of staff at Heath Street have worked there for a number of years now, providing a stable staff team. The approach of the staff to the residents was observed throughout the visit and as highlighted elsewhere in the report they were seen to be interested in them and committed to meeting their needs. A discussion was held with a newer staff member and her understanding of the needs of the residents and her enthusiasm for her work was very apparent. The GP for the home returned a comment card that was positive about the response to the care needs of the residents by the home, and their professional approach. All of the staff at the home are well trained. This commences with a thorough induction programme based on LDAF (Learning Disability Award Framework) that provides sound underpinning knowledge for staff to progress towards their NVQ (National Vocational Qualification). Staff then take their NVQ within approximately 9 months of commencement at the home. Currently 7 out of 9 (78 ) of support staff are qualified to NVQ 2 or above, with the remainder of the staff being nurses with a qualification geared towards meeting the needs of Heath Street Nursing Home DS0000026949.V310935.R01.S.doc Version 5.2 Page 24 people with a learning difficulty. All of the staff observed and spoken with had a clear understanding of the needs of the residents to support both their learning difficulties and their specific health related conditions. A discussion with a staff member who commenced working in the home at the beginning of the year confirmed that she had undergone a thorough induction programme and was soon to commence her NVQ2. She reported that she had received excellent support from the organisation and the staff team since she had started at the home, with clear information about the support role and what was expected of her. Previous inspections have highlighted a concern with staffing ratios at the home. The Commission met earlier in the year, following the last inspection, with senior management of Choices, and information was provided to show that staffing ratios had improved greatly with four or five staff regularly on duty on certain shifts, which allowed for more 1:1 support for each resident both within and outside the home. The impact on increased activities for residents was very clear. At this inspection the staff rotas showed that generally there are three staff on duty during the day until 6pm, and then two staff during the evening and night. The deputy manager said that they had been unable to maintain four or five staff on duty in the day due to long term sickness absence and maternity leave. The current shift pattern of generally three staff on duty during the day although disappointing when compared with earlier in the year is nevertheless better than that found at the last inspection. Additionally two new staff are scheduled to commence working in the home very shortly for a period of six months. It is hoped that by then the staff that are currently absent will have returned to work. This visit found, as shown earlier in the report that residents would benefit from greater social inclusion. The availability of sufficient staff is crucial to this. As evidence was available to show that the staffing levels are about to improve, a requirement about staffing is not being made at this visit, but the home is nevertheless recommended to keep the staffing levels under regular review. Four staff files of current staff were inspected and these showed that all of the records expected to ensure appropriate recruitment and selection procedures had been followed for them were in place. These included an application form, formal interview, two written references being sought and a CRB (Criminal Records Bureau) check. The member of staff who was interviewed by the commission confirmed that she had been provided with a copy of the General Social Care Council Code of Conduct and a statement of terms and conditions. Heath Street Nursing Home DS0000026949.V310935.R01.S.doc Version 5.2 Page 25 Whilst discussing the staffing of the home the manager said that two new qualified nurses were starting the following week and working there for six months before moving on to work at other Choices homes. During the inspection their recruitment files arrived from the head office but it was seen that although CRB clearance had been applied for in each case it had not yet arrived. Later discussion evidenced that no POVA (Protection of Vulnerable Adults) First check had been applied for, so the two staff were commencing work without appropriate clearance. Those responsible for recruitment said that the staff would not be working unsupervised until the CRB had been returned. The requirement for staff to have received a clear POVA First check and to work under supervision until a clear CRB has been received, or where not seeking a POVA First check, that a CRB has been received before they commence work at all is unambiguous. This was later discussed with Choices head office and a requirement made that this procedure is followed for all staff recruitment across all of Choices homes. Choices organisation trains its staff well. This was evidenced in the three staff files inspected where a record of all of their mandatory and other additional training was seen. Staff training was also discussed with the manager, and the training records for the staff team were seen, that confirmed that all staff were up to date with all of their mandatory training. A staff member also confirmed all of the training that she had received which clearly showed compliance with training requirements. It has been identified earlier that staff receive Learning Disability Award Framework accredited training, thorough induction and NVQ 2 and above training where required. Heath Street Nursing Home DS0000026949.V310935.R01.S.doc Version 5.2 Page 26 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): 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. A qualified and competent manager, who has a management style based on openness and respect, leads the home and there is good attention to the health and safety needs of both residents and staff. 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. Staff were very complimentary about the manager and following a stressful period at the home last year morale was reported to have considerably improved, and this was also evident in the demeanour of all of the staff throughout the inspection. The findings of this report show that the registered manager ensures that the home complies overall with the Care Standards Act and Regulations and other legal requirements. Her monitoring of records and her tracking of the care received by the residents is to a high standard. Heath Street Nursing Home DS0000026949.V310935.R01.S.doc Version 5.2 Page 27 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 the annual review meetings of residents to express their views. In addition, although the outcome was not seen, the deputy manager also said that the manager sends out annual questionnaires to relatives to seek their views about the service. The commission requires a copy of the outcome of this latest survey. Comment cards used by the commission to seek relatives’ views were received back from five relatives and each was positive about the home. 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, including hoists, assisted baths, which had been regularly serviced to support the safe moving of residents. The report has highlighted a recommendation regarding rearrangement of bedroom furniture to allow more space for transfer. All of the required fire checks were being completed appropriately and to timescale and all staff had taken part in regular fire drills. New fire regulations have recently come into force and greater attention is required to fire risk assessments for the whole building, individual risk assessments for fire for residents and clear contingency plans. Discussion with the registered manager and some records of individual risk assessments demonstrated that the manager has made a start on these, but is also awaiting further guidance from senior managers of the organisation. For example, the individual fire risk assessments for residents need to consider how evacuation would proceed, particularly at night, so that staff are as clear as possible about what they would need to do. Similarly contingency planning needs to consider not just the initial emergency evacuation of residents to another home but longer term care should the unfortunate situation arise that the home was not fit to return to for a number of days. The home is required to continue with the process of formulating records and plans in the event of fire. ‘Fridge, freezer and food probe checks for safe temperatures had all been consistently recorded. COSHH (Control of Substances Hazardous to Health) regulations were being followed. The environment overall was considered safe as found at the time of the inspection, save for concerns highlighted elsewhere regarding useable space. Heath Street Nursing Home DS0000026949.V310935.R01.S.doc Version 5.2 Page 28 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 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 4 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 2 X 3 X 3 X X 3 X Heath Street Nursing Home DS0000026949.V310935.R01.S.doc Version 5.2 Page 29 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. 1. Standard YA13 Regulation 16(2)m Requirement Increase the social inclusion of the residents by increasing the frequency of outings into the community. Ensure that MAR (Medication Administration Records) charts are properly completed on every occasion. Ensure that at least a clear POVA First check is received for any staff member before they commence working in the home. (A CRB check must be received before staff commence working should the home not be pursuing interim POVA First clearance). Continue to review fire precautions and the assessment of the risk from fire, to include individual resident risk assessments, risk assessments for the building and contingency plans to be followed in the event of an emergency Timescale for action 30/11/06 2. YA20 13(2) 06/10/06 3. YA34 19 and Schedule 2 06/10/06 4. YA42 23(4) 30/11/06 Heath Street Nursing Home DS0000026949.V310935.R01.S.doc Version 5.2 Page 30 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 YA24 Good Practice Recommendations It is recommended that the useable space in bedrooms is reviewed, including the removal of fitted wardrobes to be exchanged for free standing ones where this has been identified as required, to allow safer moving and transfer of the residents where appropriate. The home is recommended to undertake a review of the useable space within the home, to include a review of the lounge furniture and what is and is not necessary in the room, and to determine any areas elsewhere in the home that could be used for storage. 2 YA24 Heath Street Nursing Home DS0000026949.V310935.R01.S.doc Version 5.2 Page 31 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. Extracts may not be used or reproduced without the express permission of CSCI Heath Street Nursing Home DS0000026949.V310935.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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