CARE HOMES FOR OLDER PEOPLE
Heathcote 6 Cecil Road Swanage Dorset BH19 1JJ Lead Inspector
Amanda Porter Unannounced 17 June 2005 11:00 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Heathcote D55 S62289 Heathcote V229048 170605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Heathcote Address 6 Cecil Road, Swanage, Dorset, BH19 1JJ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01929 423778 Mr Mark Charig Mrs Lisa Heather Charig Mr Mark Charig Care Home 10 Category(ies) of OP - 10 registration, with number of places Heathcote D55 S62289 Heathcote V229048 170605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 22 September 2004 Brief Description of the Service: Heathcote is an older style property, situated in a quiet residential road close to Swanage town centre. The home has a large garden to the rear and smaller garden with off road parking at the front of the home. Accommodation is offered on the ground and first floor level with the owners private accommodation on the second floor. Access between the first and second floor is by a central stairway and passenger lift. Communal areas include a lounge and a seperate dining room. The home is registered to Mr and Mrs Charig and Mr Charig is the registered manager. Heathcote is registered to deliver personal care to up to 10 people over the age of 65 years. Residents in the home are generally of a low dependency and retain a high level of self-determination; as such the home does not provide night care staff although the owners living on the premises, are on call throughout the night. Residents at Heathcote have the benefit of the local seaside town and the amenities it offers including shops, post office etc. Heathcote D55 S62289 Heathcote V229048 170605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over four and a half hours and was one of the two anticipated inspections of the year. It was the first inspection of the home since change of ownership and Mr and Mrs Charig, the registered providers, were on hand throughout to aid the inspection process. Two residents of the six living in the home and two members of staff were spoken with and asked their views of the home. Comments from residents included “Staff are very good” “I like the food” “My family is made welcome when they visit.” Some documentation was reviewed, including care files, personnel files, policies and procedures. A tour of the premises was undertaken. What the service does well:
Heathcote is an informal and friendly home. Staff have developed good relationships with the residents and this results in a supportive and caring environment in which the residents feel secure and comfortable. The home carries out thorough assessments prior to residents moving in and assurances are given that individual needs can be met. Residents’ health needs are well catered for and people spoken with felt their dignity was respected when staff provided care to them. The home has a procedure for investigating complaints. Residents said they did not have any concerns but if they did they would be able to tell the providers, who would listen and take action if necessary. The home protects the residents from abuse by ensuring staff are trained to follow the robust procedure which is in place to respond to suspicion or evidence of abuse or neglect. Sufficient numbers of staff are on duty throughout the day and night to be able to meet the needs of the residents. Financial procedures within the home also ensure that residents’ interests are protected. Heathcote D55 S62289 Heathcote V229048 170605 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Heathcote D55 S62289 Heathcote V229048 170605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Heathcote D55 S62289 Heathcote V229048 170605 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3. Standard 6 is not applicable as the home does not provide intermediate care. New residents move into the home having had their needs assessed and been assured that these needs will be met. EVIDENCE: A file of a new resident was reviewed and contained documentary evidence of a pre-admission assessment. The assessment was thorough and involved the service user and family. It formed the basis on which a care plan could be made. Residents spoken with had prior knowledge of the home before they were admitted. Heathcote D55 S62289 Heathcote V229048 170605 Stage 4.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10. Shortfalls in the care planning system mean that staff are not provided with sufficient information to ensure that they meet the personal needs of the residents fully. However the health needs of the residents are well met with evidence of good support from community health professionals. The procedures for managing medication do not fully meet the guidance of the Royal Pharmaceutical Society, which could place residents at risk. Residents felt that staff were kind and caring, treated them with respect and upheld their right to privacy. EVIDENCE: Two care files were reviewed. They contained basic care plans, which did not give much detail as to how care needs were to be met. There was no evidence that residents and/or their chosen representative were involved in the development and review of the care plans. The plans were not evaluated on a monthly basis. Heathcote D55 S62289 Heathcote V229048 170605 Stage 4.doc Version 1.30 Page 10 Residents said that they were treated with kindness and their right to privacy was upheld. Throughout the inspection residents were seen to be supported with respect and sensitivity. Relevant assessments such as moving and handling, nutrition and risk of falls were held on file. Where assessments identified a need for specialist equipment or services this was provided. Details of contact with health care professional such as GP, district nurse, optician and chiropodist were recorded. One resident confirmed he/she was able to choose a GP and was able to continue with the dentist, chiropodist and opticians of choice in the town. The registered manager confirmed that the home had good links with local GPs and the district nursing service. The medication policy was reviewed and it gave clear information about the administration of medicines, self-medication and homely remedies to be used. One resident was self-medicating and there was documentary evidence that the GP had agreed to this. Three members of staff were trained to administer medication. Each resident had a medication administration chart (MAR), which recorded all medicines taken on a regular basis. They did not include a list of medicines taken as and when necessary, although such medicines were kept for several residents. A recommendation has been made that all medicines prescribed for each resident must be included on their MAR. Heathcote D55 S62289 Heathcote V229048 170605 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed during this inspection. EVIDENCE: Heathcote D55 S62289 Heathcote V229048 170605 Stage 4.doc Version 1.30 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18. A written complaints procedure leaves residents in no doubt that steps will be taken to deal with any complaint or concern they may have. Staff’s knowledge and understanding of Adult Protection issues provides a safe environment in which residents are protected from abuse. EVIDENCE: Residents spoken with said that they had no complaints to make but felt that if they did they would be happy to speak with the registered providers about their concerns. There had been no complaints made since the last inspection. The complaints procedure clearly states how complaints would be dealt with and gave timescales. The home had a robust policy and procedure to respond to suspicion or evidence of abuse or neglect. Through discussion staff demonstrated knowledge of the Department of Health guidance “No Secrets” and local protection of vulnerable adults procedures. Heathcote D55 S62289 Heathcote V229048 170605 Stage 4.doc Version 1.30 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22 & 25 Recent investment has significantly improved the appearance of this home creating a comfortable and generally safe environment for those living there and visiting. However some areas of the home need to be assessed to minimise risks to residents. EVIDENCE: Since becoming the Registered Providers of Heathcote Mr and Mrs Charig have undertaken a programme of routine maintenance. The grounds were tidy, attractive and accessible by the residents and their visitors. As two of the bedrooms became empty they had been redecorated. However a ground floor bedroom has a steep permanent ramp in the doorway to cover a previous step into the room. This was a potential hazard to the occupant of the room. An extensive programme for the replacement of windows had been completed and the home met the requirements of the fire authority in this regard. The loft insulation had also been replaced. Domestic style lighting was provided throughout. The house was kept at a pleasant temperature.
Heathcote D55 S62289 Heathcote V229048 170605 Stage 4.doc Version 1.30 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 The number and skills of staff members on duty adequately meet residents’ needs. Shortfalls in the recruitment procedure do not fully protect residents from risk. A detailed programme of training supports staff members to provide an effective and safe service. EVIDENCE: Duty rotas were reviewed and indicated that a minimum of two care staff were on duty between the hours of 8.30am and 10pm. Mr and Mrs Charig live on site and provide on-call cover at night. Extra staff are rostered to be on duty on a Tuesday, Thursday and Friday morning when various social activities are arranged. Staff duties include domestic tasks, catering and personal care. Three staff files were seen and generally contained the relevant statutory information with the exception of written references for one member of staff. The Registered Providers are both keen that staff have access to suitable training, which would ensure that residents are given a good service. Within the last six months the following training had taken place: • Moving and handling • Fire safety • Adult Abuse • Dementia Care in the Care Home
Heathcote D55 S62289 Heathcote V229048 170605 Stage 4.doc Version 1.30 Page 15 A programme for the rest of the year was available for staff to see. Staff spoken with said that they had found the training was relevant to the care they gave and was enjoyable to do. Residents said that they found the staff knowledgeable and competent in their work. Heathcote D55 S62289 Heathcote V229048 170605 Stage 4.doc Version 1.30 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35 & 38. The manager has a development plan and vision for the home, which has not yet been effectively communicated to residents, staff and relatives. The residents’ financial interests are safeguarded by the home’s robust financial procedures. The health and safety of the residents and staff are generally protected by the policies and procedures followed at Heathcote. EVIDENCE: The manager has a quality assurance and quality monitoring system he intends to use. It will include an external agency undertaking an audit of the home every six months. Mr Charig also intends to undertake quarterly audits for: • Care • Catering • Housekeeping • General Administration
Heathcote D55 S62289 Heathcote V229048 170605 Stage 4.doc Version 1.30 Page 17 The effectiveness of the quality assurance will be fully assessed at the next inspection. Residents confirmed that they either deal with their own finances or have appointed a responsible representative to do so. This is frequently another family member. The home does hold ‘pocket money’ for some service users at their request. All monetary transactions were recorded and were seen to be up to date and accurate. Records showed that all staff had received recent training in fire safety, food hygiene, infection control and manual handling. Staff spoken with confirmed this. Substances hazardous to health were seen to be stored securely. The fire safety records seen were complete and up to date with the exception of a fire risk assessment of the home. Heathcote D55 S62289 Heathcote V229048 170605 Stage 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 3 x x 1 x x 3 x STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 2 x 3 x x 2 Heathcote D55 S62289 Heathcote V229048 170605 Stage 4.doc Version 1.30 Page 19 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1)(2) Requirement The registered person must ensure that each plan of care is drawn up with the involvement of the resident and/or their chosen representative and be keept under review. Each care plan must give the detail of action which needs to be taken by care staff to ensure that all aspects of the health, personal cand social care needs of the resident are met. All parts of the home must be free from hazards and a risk assessment must be undertaken on the step/ramp into the green room and appropriate action taken to minimise the risk of falls and trips. Timescale for action 17/09/05 2. OP7 15(1) 17/09/05 3. OP22 13(4) 17/09/05 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 OP9 Good Practice Recommendations All prescibed medications for each resident should be entered on their medication administration record.
D55 S62289 Heathcote V229048 170605 Stage 4.doc Version 1.30 Page 20 Heathcote 2. 3. 4. OP29 OP33 OP38 Two written references should be kept on file for all members of staff. The quality assurance and quality monitoring system at Heathcote should be commenced. A fire risk assessment should be undertaken for the home. Heathcote D55 S62289 Heathcote V229048 170605 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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