Inspection on 08/11/05 for Heathcote

This inspection was carried out on 8th November 2005.

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

The inspector 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

Heathcote 09/07/07

Heathcote 05/07/06

Heathcote 17/06/05

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

CARE HOMES FOR OLDER PEOPLE Heathcote 6 Cecil Road Swanage Dorset BH19 1JJ Lead Inspector Gloria Ashwell Announced Inspection 8th November 2005 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Heathcote DS0000062289.V262931.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Heathcote DS0000062289.V262931.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Heathcote Address 6 Cecil Road Swanage Dorset BH19 1JJ 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) 01929 423778 Mr Mark Charig Mrs Lisa Heather Charig Mr Mark Charig Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10) of places Heathcote DS0000062289.V262931.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th June 2005 Brief Description of the Service: Heathcote is an older style property, situated in a quiet residential road close to Swanage town centre where there are a number of shops, restaurants and other facilities including public transport buses. The home has a large garden to the rear and smaller garden with off road parking at the front of the home; additional unrestricted parking is available on the road. Resident’s accommodation is on the ground and first floors; the owners private accommodation is on the second floor. Access between the first and second floor is by a central stairway and passenger lift from the ground floor. Communal areas include a lounge and an adjoining dining room with patio doors providing access to the rear garden. The home has a laundry equipped with a washing machine and tumble drier. The home is registered to Mr and Mrs Charig; Mr Charig is the registered manager. Heathcote is registered to provide personal care for 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 routinely provide night care staff although the owners live on the premises and consider themselves to be on call throughout the night. Arrangements can be made for residents to receive the services of a visiting chiropodist and hairdresser. Heathcote DS0000062289.V262931.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was one of the two statutory inspections required in accordance with the Care Standards Act 2000. Since the last inspection 3 additional visits have been carried out by the Commission in response to initial concerns raised by health and social care professionals engaged in ‘Adult Protection’ procedures. Following the most recent of these visits, in September 2005 an Enforcement Notice was issued, preventing the home from admitting any new residents; at the time of inspection 6 residents were accommodated. As a result of these actions this inspection was announced, having been arranged with Mr & Mrs Charig during the previous week. The inspection was carried out by 2 persons; Gloria Ashwell (Regulation Inspector) and Sue Barber (Regulation Manager). The inspectors spoke with Mr & Mrs Charig, care staff, 4 residents, the visiting relatives of 4 residents and a visiting General Practitioner. They observed staff interaction with residents and the carrying out of routine tasks in the home. The inspectors arrived at 10.30, departed for a hour long lunch break at 13.00 and concluded the inspection at 16.30; the duration of the inspection was 5 hours. Before departing the home the inspectors issued an Immediate Requirement in respect of recruitment procedures and ‘short dated’ requirements regarding employment records of staff and risk assessment for dangers associated with unrestricted upper floor windows. Additional information used to inform the inspection process included a letter provided to the home by the satisfied relative of a resident. Standards assessed and found met during the previous inspection were not reassessed during this inspection. As a result of the improvements noted during this inspection the restriction on new admissions was lifted on condition that the Commission be notified of each proposed new admission. What the service does well: Heathcote DS0000062289.V262931.R01.S.doc Version 5.0 Page 6 The home provides good care to residents who are mainly of low and medium levels of dependency, and frequently experience mild degrees of dementia. Meals are appetising and of good quantity and quality. The premises are comfortable and homely, with a communal use lounge and adjoining dining room. Staff are kind and helpful to residents. Residents are treated with respect, their privacy is protected and staff understand and meet their needs. Residents feel safe and well cared for and the home provides a range of social and recreational activities. What has improved since the last inspection? What they could do better: Staff recruitment, employment and aspects of training must be urgently improved to ensure that residents are not placed at risk of harm by potentially unsuitable and inexperienced staff. The home must introduce assessment systems to minimise risks of accident and should review the current practice of not routinely providing wakeful night staff. It is the intention of the registered providers to in due course re-register the home to provide care for residents suffering from dementia; at present there are a number of residents with this condition and formal application must be made to the Commission to vary the current category of person the home is registered to accommodate to reflect the needs of the residents. For subsequent admissions, variations on a ‘case by case’ basis should be made. Heathcote DS0000062289.V262931.R01.S.doc Version 5.0 Page 7 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 DS0000062289.V262931.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heathcote DS0000062289.V262931.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4 (Standard 3 was assessed and found met at the last inspection) The home does not provide intermediate care so Standard 6 does not apply. The home is at present accommodating some residents who have needs the home is not registered to meet; in consequence the home may not be adequately equipped (by staff training, policies/procedures etc.) and may not be properly meeting all needs of these persons. EVIDENCE: The home at present accommodates at least 3 residents whom Mr & Mrs Charig believe have dementia. Heathcote is registered to accommodate persons over 65 years of age in the category OP; Heathcote is not registered to accommodate persons with dementia. For Mr & Mrs Charig to continue to care for these persons in Heathcote they must without delay apply to the Commission for a variation to the registered category of the home, providing sufficient evidence to support the application. Heathcote DS0000062289.V262931.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Staff have written information necessary to ensure the provision of correct care to each resident. The home has not adequately implemented policies or procedures for the protection of residents prone to falling or other accident so residents may be at risk of harm. Medicine storage, handling and recording systems have been recently altered to ensure that residents receive medicines as prescribed. Residents and their relatives and friends feel they are treated with respect and kindness by staff of the home. EVIDENCE: For each resident there is a written plan of care, based on assessed needs. For the improvement of these records it is recommended that the monthly reviews be recorded in accordance with systematic evaluation of the care plan. Heathcote DS0000062289.V262931.R01.S.doc Version 5.0 Page 11 The home records details of all accidents and has developed but not implemented a formal policy and procedure for the management of accidents to ensure that risks are identified and minimised. Medication administration records in recent use did not all reliably confirm that residents had received medicines as prescribed; to improve this circumstance the home has now introduced use of a ‘monitored dosage system’ (MDS). Records now in use for the MDS indicate that medicines have been accurately administered. Discussion with residents, a number of visiting relatives and a visiting doctor indicated that staff are kind, polite and suitably knowledgeable regarding the needs of the residents, and properly promote their privacy, dignity and wellbeing. Heathcote DS0000062289.V262931.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The quality of daily life in the home is good with residents assisted to maintain as much independence as possible enabling them to pursue their preferred lifestyle. Social and leisure activities are varied and suited to the preference and ability of each resident. Residents are encouraged to maintain contact with the local community and visits by their friends and relatives are welcomed by the home. Residents are encouraged and assisted to exercise choice and control over their lives. Meals are appetising and of good quantity and quality. Most residents take meals in the dining room; some receive them in their bedrooms. EVIDENCE: The inspectors spoke to 4 residents; all expressed satisfaction with the home, including the range of activities, meal provision, staff and premises. Heathcote DS0000062289.V262931.R01.S.doc Version 5.0 Page 13 During the morning of inspection the weekly physical fitness session took place in the main lounge led by a visiting therapist; those residents who participated enjoyed the event. Visitors are welcome at any time and residents said they can choose what time they rise and go to bed, and where they spend their time – in their bedrooms or the communal rooms. Residents select meals in advance, from a planned menu. Heathcote DS0000062289.V262931.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 were assessed and found met at the last inspection EVIDENCE: Heathcote DS0000062289.V262931.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20, 22, 24, 25 & 26 (Standard 19 was assessed and found met at the last The home is attractive, comfortable and well maintained but has not been formally assessed by an Occupational Therapist to ensure it is suitable to meet the various needs of residents. A call system is installed in all resident’s bedrooms and bathrooms enabling them to summon prompt assistance as required. Resident’s bedrooms are suitably decorated and furnished and there is a pleasant lounge with an adjoining dining room and well-maintained gardens, mainly to the rear of the home. The home is light, airy and maintained at a high standard of cleanliness. Heathcote DS0000062289.V262931.R01.S.doc Version 5.0 Page 16 EVIDENCE: Rooms are suitably decorated and appropriately furnished and the home has a comfortable and relaxed atmosphere throughout. It is recommended that the suitability of the premises be formally assessed by an occupational therapist. A call system is installed in all resident’s bedrooms and bathrooms enabling them to summon prompt assistance as required. Residents are confident of receiving a prompt response to calls; one said that staff “come very quickly”. Resident’s bedrooms contain a variety of personal belongings; most residents provide items of their own furniture and one resident has a private telephone installed. Heathcote DS0000062289.V262931.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 By day the home employs enough staff to meet the needs of residents and to ensure their safety and comfort, but at night the home does not provide waking staff unless particular residents who require the attentions of staff at night make extra payments for this provision. The home’s recruitment systems do not adequately protect residents from the risks of potentially unsuitable staff being employed. In this regard Immediate and short-dated requirements were issued during the inspection. The home must improve training opportunities to ensure that staff receive appropriate training and are competent to carry out their jobs. EVIDENCE: The home does not routinely provide any wakeful night staff and reliance is placed upon residents by use of the call bell system themselves summoning assistance from the owners who reside in their private premises on the top floor of the home. At present one resident requires regular staff attention throughout the night; this resident pays the entire fees of a night care assistant, who therefore does not attend to the needs of any other residents. Heathcote DS0000062289.V262931.R01.S.doc Version 5.0 Page 18 This system is not satisfactory because it places responsibility on residents summoning assistance, which they may be unable to do in the event of health or other emergency. It is required that the needs of each resident are fully assessed in writing and reviewed at least every month, with records kept of all occasions when night assistance is required by residents (with the exception of the resident separately provided with a wakeful night carer). These records must thereafter be used by the home in determining staffing levels, in accordance with the guidance of the ‘Residential Forum: care staffing’ document. While the registered providers were recently on holiday and away from the home, not all staff working in the home were suitably experienced and trained. During the recent 16-day absence from the home of registered providers Mr & Mrs Charig a recently employed member of staff was frequently on duty but had no experience of care work and had received no relevant training for the work. Additionally, some staff were working a high number of hours; one care worker, on duty during both day and night shifts, worked in excess of 92 hours in one 7 day period. From examination of records and discussion with Mr & Mrs Charig there was evidence that new members of staff had recently commenced work in the home prior to the home receiving written references. For a number of staff the home does not hold sufficient information, including details of past employment, health and personal circumstances and for some persons the home holds no records, including those for CRB disclosure and POVA check. It is recommended that the home operates in accordance with the General Social Care Council ‘Codes of Practice’ (www.gscc.org.uk) and provides to each staff member a copy of the Code; to assist this process the inspectors showed Mr Charig the document with details for obtaining copies. Individual staff members have completed distance learning in various subjects including Health & Safety, Protection of Vulnerable Adults, Control of Infection and Emergency Aid. 1 care worker holds a National Vocational Qualification in care; the home employs 8 other care staff and intends to arrange for 2 of them to train for this award; it is recommended that at least 50 of the care staff are trained to NVQ standard. Usually new staff undertake induction training, in accordance with TOPSS standards; however, there was no record of any training having been provided to a recently employed care worker. Questions were asked of a recently employed staff member by one of the inspectors; a number of incorrect responses were given and corrected by Mrs Charig. Heathcote DS0000062289.V262931.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 & 38 (Standards 31 & 35 were found met at the last inspection) The home arranges periodic external audit to ensure that residents remain satisfied with all aspects of the home. Systems of equipment maintenance and safety checking are in place that ensure the protection of service users and staff, but must be improved by the inclusion of assessment of risks of accidental falling from upper floor windows with unrestricted opening capacity. EVIDENCE: Periodic analysis of the opinions of residents and their friends and relatives is undertaken on behalf of the home by an external consultancy, to ensure the maintenance of good satisfaction levels. Heathcote DS0000062289.V262931.R01.S.doc Version 5.0 Page 20 The home has recorded a fire safety risk assessment of the premises, provides staff with fire safety training, holds periodic fire drills and tests/checks fire safety equipment in accordance with the standards set by Dorset Fire & Rescue Service. To further improve fire safety standards it is recommended that the names of all staff participating in drills be recorded on each occasion. Mr Charig said that the electrical installation was inspected and considered safe during August 2003 and is to be re-inspected after 5 years. The inspectors were shown written evidence of safety of the gas installation (dated 21 October 2005) and the passenger lift (1 June 2005). An external consultancy has recorded ‘health and safety risk assessment of the premises’; it is required that the home obtain and scrutinise a copy of this document to ensure that all risks have been identified and are being properly managed. Radiators are fitted with guards to overcome risks of burns and hot water outlets in resident areas (hot water taps on wash hand basins and baths) are fitted with regulators to overcome risks of accidental scalding. Mr Charig periodically checks the temperature of stored water to ensure the management of risks of Legionella contamination; it is recommended that records be kept of these checks. A number of windows in resident areas on the first floor of Heathcote were observed to be of unrestricted opening capacity. Mr Charig stated that risk assessment had not been recorded for risks of accidental falling from the windows; a short-dated requirement was issued during the inspection to rectify this omission. Heathcote DS0000062289.V262931.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X 3 X 2 X X X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X 2 Heathcote DS0000062289.V262931.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? NO 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 OP4 Regulation 43 Requirement The home must not accommodate persons external to the category for which it is registered. For those persons already in the home who are external to the category OP the home must make application to the Commission for variation to the registration. This requirement is repeated from two ‘additional visit’ letters; the timescale of 10/10/05 was not met. The home must implement written policies and procedures for the management of accidents and minimisation of identified risks. The home must provide night staffing in accordance with the assessed needs of residents, and in consideration of records of residents night requirements. All staff must receive training appropriate to the work they are to perform and records must be kept of this training. There must be evidence that the home operates a robust DS0000062289.V262931.R01.S.doc Timescale for action 01/01/06 2. OP8 13 01/01/06 3. OP27 18 01/01/06 4. OP28 18 08/11/05 5. OP29 19 & Sch 2 08/11/05 Heathcote Version 5.0 Page 23 6 7. 8. OP29 OP30 OP38 19 & Sch 2 18(1) 13 9. OP38 13 recruitment system; new staff must not commence work in the home without evidence of written references, personal identification and health information, employment history, suitable CRB disclosure and POVA check. Records held for staff currently employed must be improved to the necessary standard. There must be recorded evidence of the induction training of all new staff. The home must obtain and scrutinise the recorded health and safety risk assessment of the premises to ensure that all risks have been identified and are being properly managed. Risk assessment must be recorded for all upper floor windows with unrestricted opening capacity, and there must be sound evidence of appropriate action(s) having been taken to manage any identified risks of accidental falling. 01/01/06 01/01/06 01/02/06 01/12/05 Heathcote DS0000062289.V262931.R01.S.doc Version 5.0 Page 24 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 2 3 4 Refer to Standard OP7 OP8 OP22 OP28 Good Practice Recommendations Monthly reviews should be recorded in accordance with systematic evaluation of each resident’s care plan. Periodic audit should be carried out and recorded regarding all accidents, to identify and minimise any patterns/tends e.g. time, place, person, activity. The suitability of the premises should be formally assessed by an Occupational Therapist. The home must keep the number of hours worked by each member of staff under review, to ensure that no person/s work an excessively high number of hours, thereby possibly placing themselves and the residents at risk of harm, by their tiredness. At least 50 of the care staff should be trained to NVQ standard. The home should operate in accordance with the General Social Care Council ‘Codes of Practice’ and provide to each staff member a copy of the Code. The names of all staff participating in fire drills should on each occasion be recorded. Records should be kept of all checks of water temperature for the control of Legionella. 5 6 7 8 OP28 OP29 OP38 OP38 Heathcote DS0000062289.V262931.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Poole Office 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 © 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 Heathcote DS0000062289.V262931.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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