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Inspection on 05/07/07 for Heather House Nursing Home

Also see our care home review for Heather House Nursing Home for more information

This inspection was carried out on 5th July 2007.

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.

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?

The home has made significant progress to ensure that the requirements made at the last inspection were met. The manager stated that the system of recording has improved especially in relation to incidences involving residents with challenging behaviour.

What the care home could do better:

Whilst the requirements issued at the last inspection had been met the manager must ensure that the following concerns set out below are addressed. These concerns include: To ensure that there are adequate numbers of care staff working at the home at all times. Equipments (Bedrails) applied on residents beds must be appropriate and within safety guidelines to minimise/prevent injury to residents. Residents would be better protected if residents and /or their representatives are involved in planning their care and to confirm consent by signing the care plans.Generic risk assessments of the home including hazardous areas in the kitchen must be undertaken to ensure that residents, staff and visitors are protected from potential harm. Residents would be better protected if the medication were securely stored. The home must review the medicine policy and ensure that it is robust enough to prevent drug errors and enforce accountability. It is recommended that the home employ cleaners to work on weekends to enable the residents to benefit from a cleaner environment.

CARE HOMES FOR OLDER PEOPLE Heather House Nursing Home Bannerdown Road Batheaston Bath Bath & N E Somerset BA1 7PL Lead Inspector Grace Agu Key Unannounced Inspection 5th July 2007 09:30 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 Heather House Nursing Home DS0000020361.V337883.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 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. Heather House Nursing Home DS0000020361.V337883.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heather House Nursing Home Address Bannerdown Road Batheaston Bath Bath & N E Somerset BA1 7PL 08453 455741 01225 859210 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) Mrs Sally Roberts Ms Lorna Flick Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Heather House Nursing Home DS0000020361.V337883.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. May accommodate 36 Persons aged 50 years and over Staffing Notice dated 10/10/2001 and as amended on 31/03/2003 applies. Manager must be a RN on parts 1 or 12 of the NMC register Date of last inspection 8th August 2006 Brief Description of the Service: Heather House is registered as a care home with nursing for 36 older persons. The home is situated in Bath Easton, which facilitates ready access to Bath. The home itself can be accessed by car or bus. There is easy access to local shops and social venues. The home is a converted older property, providing a mix of single, companion and en-suite rooms. Care is offered over two floors, with communal space in three areas on the ground floor. There is a passenger lift providing access to all resident areas. Heather House is part of the Blanchworth Care Group. Heather House Nursing Home DS0000020361.V337883.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced site visit as part of a key inspection that was undertaken over nine hours to review the requirements made at the last inspection and also to review the care practice to ensure that it is in line with the legislation and that best practice is followed at the home At the last inspection four requirements were made in regard to different areas of service provision to ensure that the residents are protected and that the quality of service provided is what they expect and deserve. It was pleasing to note that all the requirements had been met. As a part of this inspection two immediate requirements were issued in relation to working below the statutory staffing notice and using equipment that could cause potential harm to the residents and staff members. In response to the immediate requirement regarding current staffing level the provider stated that following a meeting with the Commission for Social Care Inspection staffing notice is no longer relevant with current legislation. The immediate requirement is therefore withdrawn. A tour of the building was undertaken and a number of records were viewed. Six residents, six staff members and was spoken with on the day. What the service does well: Generally, the Home was found fairly clean, warm and free from offensive odours. The environment is well maintained with good décor giving the residents an informal pleasant atmosphere and a sense of homeliness and security. Staff were noted interacting with residents in a dignified and sensitive manner. Residents were noted accessing different areas of the home without restrictions. Residents and staff have a good relationship, evidence from the visitors book suggest that families, friends and representatives are encouraged to visit the Home to ensure that residents maintain contact with their loved ones. The home provides regular activities programme for the residents to ensure regular stimulation and a record kept of individual resident participation. Heather House Nursing Home DS0000020361.V337883.R01.S.doc Version 5.2 Page 6 Appropriate care plans are provided after assessment and are reviewed as required; other health professionals are consulted and are involved to ensure that any health problems identified are addressed. One medical professional met on the day stated that they are satisfied with the care provided for the residents and that the manager and staff work very hard to keep the standard of care very high. Residents spoken with made positive comments about the staff. One resident felt that the staff are good, “they treat me well”. Another resident stated, “Staff are very good and kind”. All trained nurses working at the home had their Personal Identification Numbers (PIN) checked by the Nursing and Midwifery Council before commencement of employment to ensure residents are protected. Two satisfactory references and Criminal Records Bureau clearance are obtained before a new staff member commences employment to ensure residents are adequately protected. Aids and equipment are provided in sufficient quantity to assist care staff in meeting the needs of service users. What has improved since the last inspection? What they could do better: Whilst the requirements issued at the last inspection had been met the manager must ensure that the following concerns set out below are addressed. These concerns include: To ensure that there are adequate numbers of care staff working at the home at all times. Equipments (Bedrails) applied on residents beds must be appropriate and within safety guidelines to minimise/prevent injury to residents. Residents would be better protected if residents and /or their representatives are involved in planning their care and to confirm consent by signing the care plans. Heather House Nursing Home DS0000020361.V337883.R01.S.doc Version 5.2 Page 7 Generic risk assessments of the home including hazardous areas in the kitchen must be undertaken to ensure that residents, staff and visitors are protected from potential harm. Residents would be better protected if the medication were securely stored. The home must review the medicine policy and ensure that it is robust enough to prevent drug errors and enforce accountability. It is recommended that the home employ cleaners to work on weekends to enable the residents to benefit from a cleaner environment. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Heather House Nursing Home DS0000020361.V337883.R01.S.doc Version 5.2 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 Heather House Nursing Home DS0000020361.V337883.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,3,4,5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The process of admission of prospective residents is comprehensive, detailed and well planed to enable the resident to make a positive choice of moving to the home with the assurance that their needs will be met. EVIDENCE: The home has a Service Users’ Guide that is given to prospective residents and their relatives or representatives when they visit the home to enable them to make an informed choice about moving to the home. The care file of a recently admitted resident showed that the resident was assessed before being admitted to the home to ensure that the home is able to meet their needs Some of the information noted in the care file included, Activities of Daily Living, and other relevant information. Heather House Nursing Home DS0000020361.V337883.R01.S.doc Version 5.2 Page 10 Prospective residents and or their relatives are offered one-month trial period to enable them feel comfortable and to make a decision whether to stay. The residents are also provided with a written contract with information relating to their room fees to be paid and any additional cost and including the terms and conditions of their stay at the home. Heather House Nursing Home DS0000020361.V337883.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home offers support to residents throughout their lives and towards the end, it also protects residents by reviewing their health needs, however it fails to protect the residents through lack of documented involvement in their care planning; drug recording and administration. EVIDENCE: Three care records were reviewed and it was noted that each care file contained detailed admission assessment of the needs of the resident. All three care files of the care files contained detailed care plan information about how staff are to meet the physical and psychological needs of the resident and are regularly evaluated and reviewed on a monthly basis. The homes Annual Quality Assurance Assessment (AQAA) confirms that residents have access to their care plan if they so wish. Heather House Nursing Home DS0000020361.V337883.R01.S.doc Version 5.2 Page 12 In addition to the care plan the manager stated that checklists are completed on a daily basis documenting the hands on care given to each resident. Staff members are required to sign this form after each intervention and any necessary changes are reported to the nurses who also document it into the nursing notes. However no evidence was seen to show that residents or their advocates have been involved in the care planning process. It is required that residents and /or their representatives are consulted whilst care plans are developed to ensure that the individual’s health and welfare needs are adequately met. On the day of inspection the local General Practitioner visited to review residents’ health care and advise staff about the actions to be taken should any emergency occur. Other health professionals visiting the home include opticians, dietician, district nurses and chiropodist. Review of the training matrix, the home manager and three staff members currently holds an up to date First aid Certificate to ensure that emergency treatment is given to residents staff and visitors when needed. The procedures for the receipt, storage and administration and disposal of medication in the home were reviewed. Ten residents medication administration record sheets were reviewed. Records seen from the drug trolley in relation to handling and administering medication was satisfactory. There was a photograph of the resident maintained with each record. The medication was stored in a locked trolley and in a locked cupboard. A new drug fridge was noted following a requirement from last inspection, the temperature recordings are monitored and recorded daily and those viewed were within satisfactory limits. However the inspector was concerned about two Regulation 37 notifications sent to the Commission in relation to drug error to a resident and a missing box (27 tablets) of a resident night medication. The manager stated that latter was reported to the police and the head office and that the outcome had not been determined. Furthermore it was disappointing to note that some residents’ medication was left on worktop in the treatment room. This practice is unsafe gives room to drug mismanagement. Whilst the home has a medication policy it must be reviewed to ensure that it is robust enough and that it is being adhered to by staff members responsible for administering medication to protect the residents and their medication. Heather House Nursing Home DS0000020361.V337883.R01.S.doc Version 5.2 Page 13 The facilities noted in the home and the conduct of staff support the policies of maintaining privacy and dignity at the home. For example the double rooms have curtains used to respect the residents privacy whilst assisting them with personal care. All the residents spoken with confirmed that staff treated them with respect, they were able to get up and retire when they wanted and staff knock on the bedroom doors and waited for answer before going in. The home has a policy and procedure in the event of death of a resident. Terminally ill residents are cared for in a dignified manner. Residents, representatives are able to stay with the individual if required. Heather House Nursing Home DS0000020361.V337883.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides meaningful activities for residents, enables them to maintain contact with the local community, families and friends and ensures that the residents enjoy good meals at their chosen times. EVIDENCE: Residents, relatives and staff spoken with confirmed that the home actively supports the residents to maintain contact with their families, representatives and friends. One resident spoken with stated that friends visit anytime and regularly. Two other relative met at the home confirmed that they are able to visit at any time and that there are no restrictions. The home designates a carer to provide activities 30 hours a week five days a week and 10 hours a week on care. The individual offers a variety of weekly and monthly activities to ensure that residents are regularly stimulated. Heather House Nursing Home DS0000020361.V337883.R01.S.doc Version 5.2 Page 15 These activities include games, cake making, bingo, ball games and other activities suitable to the residents. One resident stated that she likes her own company and prefers not to go downstairs for activities organised by the home. One to one interaction is offered to all residents who prefer to stay in their rooms and also those who are unable to participate in the activities There is a record of all activities undertaken in the individual care records. Residents interviewed stated that they have a choice of when to get up and when to retire and have not been pressurised by staff to change their routines. Personal items and furniture were noted in residents’ rooms and a list of personal belongings were noted in residents’ care files. Residents who do not have regular contact with relatives or family or friends are offered an opportunity for advocacy. There is a four-week menu plan. The main meal of the day is also displayed on the board. Staff told the inspector that residents make a choice the day before but can chose an alternative if the were not happy with the meal of the day. The dining tables were nicely presented with individual place settings. Food provided for lunch on the day of inspection includes turkey casserole Swede and Carrot and banofie pie for pudding. The food looked nutritious and staff were noted either supervising feeding or assisting residents who were having difficulties with feeding themselves. This service was provided in a dignified manner. The meal was not hurried Residents spoken with stated that they enjoyed their meals. The kitchen was inspected and was found to be clean, the fridge and freezer temperatures were noted to were in date, residents likes and dislikes were noted displayed in the kitchen to enable the chef and staff to provide the individual residents with their preferred meals. It was agreed that the risk assessments for hazardous areas of the kitchen that was not available for inspection on the day, these should be forwarded to the Commission for review. The chef and the kitchen assistant met on the day have updated certificate in basic food hygiene. The manager stated that the present chef was leaving on the day of inspection and that another cook is due to start work the following day. Heather House Nursing Home DS0000020361.V337883.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are enabled to complain and are protected from harm and abuse through robust policies and procedures and safe practices. EVIDENCE: The home has a complaint procedure, which is displayed at the reception. This document contains information about the Commission for Social Care inspection to enable the residents and or the relatives to contact the Commission if their complaint was not satisfactorily resolved by the home There is also a Whistle Blowing Policy to enable staff to report any bad practices without fear of reprisal. Residents spoke with stated that they would talk to the manager if they had any concerns. One resident stated they felt safe at the home. The complaints book recorded one complaint since the last inspection in relation to lack of water and attitude of a staff member, the complaints was satisfactorily resolved actions taken and outcomes were fully recorded. Heather House Nursing Home DS0000020361.V337883.R01.S.doc Version 5.2 Page 17 The home has policy and procedure on the Protection of Vulnerable Adults from abuse from Blanchworth Care. The home follows the Bath and North East Somerset Council guidance on issues concerning protection of vulnerable adults from abuse. Staff members spoken with confirmed that they had attended training on abuse. The staff files of recently recruited staff members contained Criminal Record Bureau (CRB) Checks and two satisfactory references before commencement of employment. The home checks the personal identification numbers of all registered nurses with the Nursing and Midwifery Council (NMC) before commencement of employment and periodically. Heather House Nursing Home DS0000020361.V337883.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20,21,22,24,25,26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents enjoy a hygienic and pleasant home with a good standard of accommodation, however the home fails to provide them with a safe clean and cluster free environment. EVIDENCE: Heather House is an older property converted and adapted to care for older people. It provides care over two floors. No changes had occurred in relation to the home’s suitability for its stated purpose. The home was found welcoming and free from unpleasant odours. Residents were found sitting in the communal areas and appeared very relaxed in the homely environment. Heather House Nursing Home DS0000020361.V337883.R01.S.doc Version 5.2 Page 19 The smaller lounge designated as a quiet area was noted untidy and was filled with different unwanted equipment. This provided limited access to residents and their visitors. The home must find appropriate storage for unwanted items to ensure that the residents who chose to use the lounge feel safe to do so. All the bedrooms viewed were personalised, colour co-ordinated and furnished. Each bedroom had small items such as pictures photographs and other personal belongings to beautify the rooms and remind residents of their past memories. Double bedroom is provided with screen to ensure privacy for personal care Residents spoken with said they liked their rooms. There is a lift access to all the floors of the home; all the corridors are fitted with handrails on both sides to assist with mobility. Most of the rooms have en-suite facilities and the communal toilets and bathrooms have grab rails and various manuals handling equipment to assist staff with meeting the resident’s needs. However the shower room and the sink were noted untidy and dirty. This was discussed with domestic staff and also with the home manager at feedback. The laundry area was noted to be clean and tidy with good flooring and ventilation, there are two washing machine with sluicing facilities and two dryers to enable the home to provide better laundry services for all the residents. The shed mentioned in the last inspection report has been removed in line with requirement notice issue. Heather House Nursing Home DS0000020361.V337883.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 26,27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recruitment procedure of the home offers protection to the residents. However the home fails to comply with statutory staffing notice to meet the residents needs. EVIDENCE: A random review of the rota showed that the home had one care staff less between 8am and 2pm and 2pm and 8pm based on the number of residents, the dependency level according to the staffing notice issued under Care Standard Act 2000. The manager told the inspector that the working with one staff less during the day was putting pressure on the care staff and that the needs of the residents are not satisfactorly met due to high dependency level of current residents. Another example was observation made during lunch time. A very dependent individual on a recliner chair was left unattended in the main lounge with the meal on the table beside the person whilst waiting to be fed. Two care staff were assissting residents with their meal in the dining area. Heather House Nursing Home DS0000020361.V337883.R01.S.doc Version 5.2 Page 21 At a discussion with a health professional met on the day, the individual told the inspector that the ‘home could do with more staff’. An immediate requirement notice was issued to correct this. However this has been withdrawn following a meeting between the provider and the Commission inn relation to staffing notice. It was agreed that at present staffing notice is no more relevant to current legislation. The manager must ensure that adequate numbers of care staff are working at the home at all times to ensure that the residents needs are adequately met. This is following an observation made at lunch time on the day. The home has a robust recruitment procedure to ensure that suitable staff are employed to meet the residents needs. Records of recently recruited staff members contained two satisfactory references, Criminal Record Bureau (CRB) disclosures and relevant qualification to ensure that the residents are protected. The home also has completed a satisfactory induction programme for new staff members. All staff spoken with confirmed that they have attended various training to include, manual handling update, dementia, First Aid and Protection of vulnerable Adults from abuse. Staff have achieved National Vocational Qualification (NVQ) at level 2 and some care staff confirmed that they are currently undertaking NVQ at level 2. Review of the trainig matrix of staff confirmed the above training. One staff member spoken with stated that staff work as a team to ensure that the residents needs are met. Staff meet regularly to discuss ways to improve care, the last meeting was 12/02/07. Heather House Nursing Home DS0000020361.V337883.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36,37,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents enjoy a well managed home, however the home fails to protect them by lack of generic risk assessments and unsafe health and safety equipments. EVIDENCE: The registered manager, Ms Lorna flick met at this inspection was very welcoming and showed clear understanding of the inspection process. The registered manager is a first level nurse and has attended many courses to include wound management, infection control communication and First aid. Heather House Nursing Home DS0000020361.V337883.R01.S.doc Version 5.2 Page 23 The residents and staff spoken with made positive comments about the manager and her ability to manage the home. One resident stated manager is good ,she comes to see us regulaly, One staff member stated “Lorna” is approachable, she will listen. The manager stated at a discussion that the home has an open door policy and residents and their families take advantage of this to discuss any of their concerns at any time. The manager stated that she is aware that improvements needed to be made at the home in terms of the overall care of the residents and has communicated this through staff meetings. The last recorded staff meeting was on 12/2/07. The manager feels supported by the Director of Care and has supevision to enable her to perform the duties effectively. Records of staff supervision evidenced that the home has commenced staff supervision to enable them to review their care practices and have support where there are shortfalls as required at the last inspection. The fire log book was noted up to date. Staff have attended fire awareness training and fire drills. However there was no evidence that generic risk assessments of different areas of the home were undertaken including potential hazardous areas in the kitchen. Food safety risk assessment was seen. The maintainace book was up to date. The home employs a maintenance person twice a week. All maintainance work are recorded including when the task is completed. Record of accident to residents were clearly written and showed a high recorded number of accidents since the last inspection. The manager stated that the staff meeting on 30/05/07 focused on review of risk assessments and care plans to minimise accidents to residents in line with change in need. Safeguards in relation to health and safety were reviewed and it was noted that the gas, electricity and sevice records for moving and handling equipments had were not up to date to offer protection to the residents. The manager contacted the head office and the inspector was informed that these checks had been carried out and that the ccertficates would be forwarded to the Commission for verification. These documents were received before this report was completed. Heather House Nursing Home DS0000020361.V337883.R01.S.doc Version 5.2 Page 24 Furthermore bed rails of two bed bound residents were found unsuitable and lose. This unsafe practice could potentially cause harm to the residents and staff. An immediate requirement notice was issued for these to be replaced or repaired for the individuals’ protection and safety.The provider’s response to this requirement notice was within the time scale. A satisfactory explanation and action plan has been received by the Commission. This will be the focus of the next inspection. Record of accident to residents were clearly written and reviewed and risk assessment along with care plans reviewed in line with change in need. The manager was very clear about how the home reviews the quality of its services. They include the monthly visits by the provider, monthly care plan reviews and regular tour of the building to discuss any concerns with the residents and their representatives. Annual quality assurance questionnaire is sent to residents, relatives and health professionals, the result is colated and published. Areas of concern are addressed. The home has policies in relation to various aspects of the services provided at the home to include health and safety, medication ,accidents and Protection of Vulnerable Adults from Abuse. Residents records and other relevant information are stored securely in a locked cabinets. Heather House Nursing Home DS0000020361.V337883.R01.S.doc Version 5.2 Page 25 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 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 2 X 2 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 3 2 Heather House Nursing Home DS0000020361.V337883.R01.S.doc Version 5.2 Page 26 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. 2. 3. Standard OP27 OP22 OP7 Regulation 18(1) 23 15 Requirement Ensure that adequate numbers of staff are available at all times to meet residents’ needs. Ensure that appropriate and safe bed rails are applied on identified residents’ beds. Care plans must be developed with the resident and /or their relative and ensure consent is obtained. Review the medicine policy and include tighter measures to prevent drug error and promote accountability. Ensure that all medication is securely stored. Ensure that all parts of the home are kept clean at all times. Ensure that generic risk assessments of all areas (including the kitchen) are undertaken. Timescale for action 12/07/07 12/07/07 30/08/07 4. OP9 13 (2) 05/08/07 5 6 OP26 OP38 23 23 05/08/07 05/08/07 Heather House Nursing Home DS0000020361.V337883.R01.S.doc Version 5.2 Page 27 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 OP26 Good Practice Recommendations It is recommended the home employs staff to work on weekends to provide cleaner environment for the residence Heather House Nursing Home DS0000020361.V337883.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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