Inspection on 11/05/07 for Heatherbank

This inspection was carried out on 11th May 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Heatherbank 11/05/06

Heatherbank 28/11/05

Heatherbank 06/04/05

Heatherbank 09/12/04

Heatherbank 30/07/04

Similar services:

Spinney (The)

Queen Elizabeth House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Heatherbank 7-9 Cavendish Road Sutton Surrey SM2 5EY Lead Inspector Peter Stanley Key Unannounced Inspection 11th May 2007 9:30am 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 Heatherbank DS0000007168.V338466.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. Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heatherbank Address 7-9 Cavendish Road Sutton Surrey SM2 5EY 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) 020 8642 2930 020 8770 7278 Mr Adrian Hawkins Mrs Hazel Hawkins Mrs Hazel Hawkins Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th May 2006 Brief Description of the Service: Heatherbank is a registered care home for 23 older people. It is situated near Sutton Town Centre and is owned by Mr and Mrs Hawkins. Accommodation for users is available on the ground and first floors. There are 21 single and 2 double rooms. Two of the single rooms and one of the double rooms have en suite facilities. Some of the bedrooms are below ten square metres others are much larger. Communal areas include a lounge with an adjoining dining room. There is also a kitchen and an adjoining room which smokers use. A stair lift is provided. There is a garden area to the rear, but this is not easily accessible for service users. The home offers both long term and respite care. It does not have the facilities to offer intermediate care. Heatherbank DS0000007168.V338466.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 inspection of the home that took about six hours. The home’s registered manager and provider, Mrs Hazel Hawkins, assisted with the inspection, with some assistance from the other registered provider, Mr Adrian Hawkins. The current number of totals residents 17. The home has had three new long-term admissions over the last 12 months, and has had a number of short-term respite admissions. The registered providers are currently in negotiations with the freeholder’s representatives regarding the extension of the home’s lease. This is seen as crucial in ensuring the home’s longer-term future. The inspector spoke to a large number of residents during the course of this inspection, and case-tracked three recent admissions to the home. He also spoke to staff members on duty, and observed staff’s interactions with residents. The inspector examined documentation including residents’ care plans, risk assessments, daily logs, medication records, staff supervision and training records, policies and procedures, staff rotas and records relating to incidents, accidents and complaints. The inspector carried out a full inspection of the premises and completed checks relating to health and safety. Following a sizeable number of unmet requirements from the last key inspection, there have been follow-up random inspections on 30.10.06 and 6.03.07. Reference will be made in the report to these findings. Generally, the home has been addressing its shortcomings and has improved its performance over the last year. Of 15 requirements issued at the previous inspection on 11.05.06, 9 requirements had been met by the time of the last random inspection on 6.03.07. Of these 6 requirements, 2 have now been met and 1 partly met. From this inspection there are 3 new requirements (6 in total) and 3 recommendations. Many positive comments were expressed by residents regarding the home and the care provided by staff, and residents generally presented as being well settled and satisfied with their environment. Questionnaires returned by the relatives of two residents also expressed satisfaction with the home and the care provided. Staff members on duty expressed positive views about the home and the support they receive. One concern, however, remains, regarding the apparent lack of stimulation and activities at the home. This view was again expressed by some residents, and is also evidenced by the inspector’s observations during his visits. Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 6 What the service does well: Prospective residents are being provided with all the information they require to enable an informed choice as to where they would like to live.. The home is able to demonstrate that it is appropriately assessing the needs of prospective residents, and that the range of needs presented by residents is being appropriately met. Prospective residents, their relatives and friends, are able to visit to assess the suitability of the home. The health care needs of residents are being fully met. Residents are being protected by the home’s medication policy, procedures and training. Residents feel that that they are being treated with respect and that their right to privacy is being maintained. Residents are assisted to maintain contact with family and friends, and links with the local community are encouraged. Residents are able to exercise some choice and control in their day-to-day routines, and to receive appropriate support from staff in helping to facilitate this. Residents receive a wholesome, appealing and nutritious diet in pleasant surroundings, and at times convenient to them. Residents and their relatives/friends are able to raise any concerns they may have, and to know that these will be taken seriously and addressed. Residents’ legal rights are being protected. Service users are living in a safe, well-maintained environment, with access to safe, sufficient and comfortable facilities. Sufficient aids and adaptations are in place to safely meet the needs of service users. Service users’ rooms are safe, comfortable and pleasantly decorated, reflecting service users’ personal identities, and being suited to their individual needs. Residents are being safeguarded by satisfactory recruitment policy and procedures. Criminal records checks are now being completed before the recruitment of any new staff. Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 7 Generally, the home is being well managed, and in a way that demonstrates that it is being run in the best interests of residents. The management approach is evidenced to be open and enabling, and conducive to creating a positive and inclusive atmosphere in the home. Generally, the inspector is satisfied that the health, safety and welfare of residents and staff are being appropriately promoted and protected. What has improved since the last inspection? What they could do better: While residents are being provided with a range of opportunities for recreational and social activity, more could be done to promote their participation in day-to-day activities. While the home’s policies and procedures are helping to ensure that service users are being safeguarded from abuse, their protection also requires that statutory training in adult protection be provided for all care staff. The home presents as clean, pleasant and hygienic. Staff training in infection control is, however, required, if standards are to be maintained. Please contact the provider for advice of actions taken in response to this Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 8 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. Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 9 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 Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 10 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 to 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are being provided with all the information they require to enable an informed choice as to where they would like to live.. The home is able to demonstrate that it is appropriately assessing the needs of prospective residents, and that the range of needs presented by residents is being appropriately met. Prospective residents, their relatives and friends, are able to visit to assess the suitability of the home. EVIDENCE: Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 11 The home has a comprehensive Statement of Purpose, and Service User Guide, a copy of which is issued to each service user. These documents have been reviewed and updated, in September 2006. While the majority of service users are referred by social services, the home has some privately funded service users. Prior to admission, prospective residents are invited to visit the home and to meet residents and staff. The prospective resident and his/her relatives are fully involved in the process leading up to an admission, and are given the opportunity to fully assess the suitability of the home. The home does not provide intermediate care. There have been 3 new admissions for long-stay care within the last 12 months, and 1 admission since the last inspection. The Standex system of preassessment and care planning is used by the home. The home also provides respite care for short stays. The inspector has examined files for these admissions and found that the necessary pre-admission information had been obtained and assessments completed. The inspector was pleased to find evidence of improvement in certain areas, notably in regard to service users’ care plans now being reviewed on a regular basis. The inspector spoke to a large number of residents during the inspection, and received generally positive feedback regarding the care and support being provided. Residents indicated that staff are considerate and caring and are meeting their individual care needs. Assessments and care plans looked at by the inspector indicated that the home has the capacity to meet the assessed needs of service users presenting varying degrees of cognitive and physical dependency. The home is now ensuring that staff are being regularly supervised, this being evidenced in the inspection of staff records. Feedback from the manager and staff, and inspection of staff records, also indicates that staff are generally being provided with the appropriate induction, training and guidance with which to meet the needs of older people. A three-way contract, involving the home, the referring agency, and the resident, is drawn up for new admissions involving social services. For private admissions, the home draws up its own statement of terms and conditions with the prospective resident. Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 12 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 7 to 11 Residents are having their health, personal and social care needs set out in an individual plan of care, and reviewed on a regular basis. The health care needs of residents are being fully met. Residents are being protected by the home’s medication policy, procedures and training. Residents feel that that they are being treated with respect and that their right to privacy is being maintained. EVIDENCE: Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 13 Care plans are being compiled on the basis of the initial assessment prior to admission, on admission and during residency. Three residents have been admitted to the home within the last 12 months. These include a photograph of the individual and detail the person’s individual needs and how the home aims to meet these. The inspector has sampled residents’ files, both on this inspection and on the previous random inspection, and evidenced that care plans are now being reviewed and updated on a regular two-monthly basis. The inspector recommends that the home moves towards more regular review, and that care plans are reviewed on at least a monthly basis. This is in accordance with good practice, as detailed in standard 7.4. The health care needs of residents are evidenced as being appropriately met. Residents’ care plans and daily notes evidence that visits from health care professionals are taking place, and that health care needs and medical advice are being recorded. The inspector was advised that ten residents are registered with the home’s local GP practice, this now being the maximum number permitted, and five residents with another GP practice. Two other residents are registered with their own GP. Community nurses and other health care professionals visit the home as and when required. Three residents currently receive visits from a district nurse. One resident, who has had a history of depression, receives occasional visits from a CPN. A community-based dentist and dental hygienist visit the home six-monthly, and an optician visits to undertake eye-tests on a yearly basis. The manager advised that the home is presently trying to secure the services of an NHS chiropodist. A private chiropodist who has had a long association with the home has now retired. Though she is still visiting occasionally this is a restricted and temporary arrangement. The home has a medication policy in place, and uses the Monitored Discharge system for administering medication. All medications are kept within a locked cabinet in the staff area adjacent to the lounge. One resident is currently taking controlled drugs, these being stored in a separate and secure lockable safe. The inspector was advised that no residents are currently taking their own medication. All medicines are prescribed on an individual basis, and administered by trained staff, all staff having undertaken accredited medication training. A list of staff trained to administer medication is maintained. The home has had a recent pharmacy inspection, on 31.03.07, no concerns having been identified. The inspector spoke to a large number of residents during the inspection. Views expressed indicated that’ residents privacy is being respected, with staff being perceived as caring and respectful. Residents are able to see visitors in their own rooms if they wish. The inspector observed residents being treated Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 14 with respect and kindness by staff. All residents have a lockable space in their bedrooms for storing personal possessions and valuables. Personal care is given in residents’ own rooms. Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 15 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 to 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While residents are being provided with a range of opportunities for recreational and social activity, more could be done to promote their participation in day-to-day activities. Residents are assisted to maintain contact with family and friends, and links with the local community are encouraged. Residents are able to exercise some choice and control in their day-to-day routines, and to receive appropriate support from staff in helping to facilitate this. Residents receive a wholesome, appealing and nutritious diet in pleasant surroundings, and at times convenient to them. EVIDENCE: Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 16 Activities offered have included, and occasional visits from a group of volunteers called ‘Non such Orbit’ who provide entertainment including singsongs and bingo sessions. Other activities offered include craft therapy evenings, reminiscence sessions, exercise sessions, and quizzes. There is a DVD player, with a selection of DVDs for showing to residents. A number of games and books are available, and a mobile library visits the home on a monthly basis. The inspector has previously expressed concern that some residents at the home present as being under-stimulated and bored. The inspector spoke to a number of residents sitting in the lounge. While residents seemed generally satisfied, the inspector did not observe any interaction by staff to engage residents or involve them in a game or activity. The television was on, to which few of the residents were paying any attention. Organised activities include fortnightly visits from a volunteer to engage residents in activities such as music and movement, and quizzes. A church visitor visits each week and spends time engaging with residents in conversation, while a group of volunteers called ‘Non such Orbit’ visit occasionally and provide entertainment including singsongs and bingo sessions. There are also occasional visits by paid musical entertainers, providing live entertainment. Whilst the home has been making attempts to develop its activity programme, more involvement by volunteers would be helpful in providing more regular informal contact and activity with residents. More could also be done to encourage staff to interact with residents and initiate activities. The home does not organise any outings itself but encourages relatives to visit and take residents out if they wish. There is access to a day centre in the community. and some residents are registered with Dial-a –Ride. Residents are encouraged to maintain contact with their friends and relatives and to develop links with the local community. The home has a hairdresser, who visits twice a week. She was present on the day of inspection, several of the residents having had their hair done. Views expressed by residents indicate that visitors are made welcome at the home, and that they are encouraged to maintaining their contact with friends and relatives wherever possible. Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 17 The inspector canvassed views regarding the ability of residents to exercise autonomy and choice. Views expressed indicated that residents are generally satisfied with the way that the home is being run, that they are being consulted regarding issues that affect them, and that they feel able to exercise choice and make decisions regarding their daily lives. Residents are not, however, having regular service users’ meetings, just two having been held within the last year. These meetings provide the opportunity for residents to be informed and consulted regarding issues that affect their day-to-day lives and should be held on at least a two-monthly basis. A requirement applies. Views expressed by residents indicate that they are able to exercise choice in their daily routines. Staff are seen to be caring and enabling in their attitudes whilst providing the necessary care and support in a way that meets individual needs and preferences. The manager has advised that residents are encouraged to retain as much control over their lives as they are able. The home’s proprietors do not wish to be involved in managing any finances. Where residents are unable to manage their finances power of attorney rests with a family member, or a solicitor. Menus are provided over a four-week period, and include a wide-ranging choice of dishes. The menus, and an inspection of the kitchen and food storage areas, evidenced a varied choice of food with fresh vegetables and fruit being made regularly available. Residents expressed a high level of satisfaction with the food that is offered, and the meals served at lunchtime were found to be both nutritious and appetising. Individual tastes and dietary needs are being monitored and catered for. Residents are able to choose their meals the day before with a record of their choice being kept. The dining room presents as a pleasant area in which to have meals. Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 18 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): 16 to 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives/friends are able to raise any concerns they may have, and to know that these will be taken seriously and addressed. Residents’ legal rights are being protected. While residents are evidenced to be living in a safe environment, their protection will not be fully assured until all staff undertake statutory training in adult protection. EVIDENCE: The home has an appropriate complaints policy and procedure in place, a summary of which is included in the Service User Guide (Standard 16). A copy of the complaints policy is kept in the entrance hall, together with a complaints record sheet. No complaints have been logged since the last inspection. The home aims to protect residents’ legal rights by involving family and friends in respect of their care plans, benefits and monies, and in discussing any Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 19 issues at reviews. All residents are registered to vote, and are supported where necessary to vote, usually by postal vote, or by attending the polling station. Views expressed to the inspector indicates that residents feel safe and secure in this home, and that staff are generally perceived as being caring and considerate. No adult protection allegations or concerns have been recorded since the last inspection. The home has an adult protection procedure. This outlines the home’s procedures in regard to any suspicion or allegation of abuse. The home also has a copy of the London Borough of Sutton adult protection policy and procedures. Staff at the home have previously received training from a qualified trainer in adult abuse. There are, however, a number of staff who are still awaiting places for the LB Sutton’s Vulnerable Adult training. This is a long-standing requirement dating back to 6.4.05, which has now been partly met. Mrs Hawkins has confirmed that 5 of the 14 care staff have completed this training and that places are being sought from the LB Sutton for other staff to attend. Mrs Hawkins indicated that there have been difficulties obtaining places and has evidenced the cancellation of two recent courses for which staff had been scheduled to attend. All training will need to be evidenced with certificates. Whilst this requirement remains partially met it will be repeated but will not result on this occasion with a reduced quality judgement. The registered manager was advised to follow this up (in writing) as a priority with the LB Sutton social services training section. Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 20 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 to 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are living in a safe, well-maintained environment, with access to safe, sufficient and comfortable facilities. Sufficient aids and adaptations are in place to safely meet the needs of service users. Service users’ rooms are safe, comfortable and pleasantly decorated, reflecting service users’ personal identities, and being suited to their individual needs. The home presents as clean, pleasant and hygienic. Staff training in infection control is, however, required, if standards are to be maintained. Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 21 EVIDENCE: The inspector completed an inspection of the premises. The home presents as being well maintained and decorated, and as providing a pleasant, safe and comfortable environment. A maintenance and development programme is in place, regarding the renewal of the fabric and decoration of the home. This includes ongoing redecoration and re-carpeting of residents’ bedrooms, and of the home’s communal areas. The home has been re-carpeted in the reception and communal areas and along the corridors, with re-carpeting of the main staircase to follow. Rooms 11, 22 and room 23 have recently been re-carpeted and redecorated. The inspector was advised that the kitchen is due to be redecorated. The home is basically well maintained, with an ongoing programme of external decoration to the front and back of the home having taken place over the last three to four years. The communal areas in the home present as being adequately furnished and equipped, providing comfort and a homely atmosphere for the home’s residents. Furnishings and lighting are domestic in style. Views expressed to the inspector indicated that residents are settled in their environment and are satisfied with their surroundings and the facilities provided. The home has sufficient bathroom and toilet facilities, which includes two Acer baths, one walk-in and one fixed bath. All of the home’s bathrooms have had a bath seat installed. All of the home’s toilets have raised seats and liquid soap dispensers. The first floor bathroom has been recently re-decorated and new linoleum put down. There is a pleasant, but not easily accessible, garden at the rear of the property. The home’s proprietors, Mr and Mrs Hawkins, have previously advised that, due to budgetary constraints, there are no current plans to renovate and upgrade the garden area. It is, however, to be hoped that this may be achievable in the longer term. There are, however, plans to build a conservatory at the rear of the home. Views expressed by residents indicate that they feel settled and generally satisfied with their home environment and with the facilities provided, and that their needs are being adequately met. The home presents as safe, with sufficient aids and adaptations in place. It was last risk assessed by an occupational therapist, in November 2004, and found to provide a sufficient range of equipment and adaptations appropriate to meeting the needs of the home’s physically frail and disabled residents. Views expressed indicated that residents are happy with their rooms, and that these are meeting their individual needs. The rooms seen by the inspector Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 22 presented as being adequately furnished and pleasantly decorated, a number of rooms having been re-carpeted and redecorated over the last two years. All rooms have a lockable space. Residents’ rooms reflect their individual tastes and identities, and include personal photos and mementoes. Residents are able to bring personal possessions and items of furniture with them to the home. All rooms have appropriate door locks, which can be opened from the outside if necessary. Magnetic door guards (to enable self-closing) have been fitted to a number of bedroom doors where it is the resident’s wish to keep their door open. However, one bedroom (Room 22) was observed to have its door propped open, the inspector being advised by a care worker that this was the resident’s wish. A requirement, for a magnetic door guard to be fitted, applies. The inspector found the premises to be clean, hygienic and free from any offensive odours. A smoke extractor has been installed in the area between the living room and the hallway where residents are presently able to smoke if they wish. However, from 1 July, the home is to adopt a no smoking policy, which will mean that smoking will no longer be permitted in any of the communal areas. The home received an inspection from Environmental Health on 21/02/07. No concerns were identified. However, for standards of hygiene to be maintained, there is a need for all staff to receive on-site training in infection control. This requirement has still to be met. Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 23 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): 27 to 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has the numbers and skill mix of staff sufficient to meet residents’ needs and ensure their safety. The staff complement will, however, need to be increased from 2 to 3 should there be any increase in the number of residents from the present level. Residents are being safeguarded by satisfactory recruitment policy and procedures. Criminal records checks are now being completed before the recruitment of any new staff. While, generally, staff are being provided with the necessary induction and training with which to perform their work duties competently, and safely meet the needs of residents, their protection requires that all staff complete statutory adult protection and infection control training. EVIDENCE: Generally, the home was evidenced to have the numbers and skill mix of staff sufficient to safely meet the needs presented by the home’s residents. The Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 24 inspector checked the staff rota. A minimum of two staff is presently being provided at all times, day and night (both waking staff). There are currently a number of vacancies, the home being registered for 23 residents. The inspector advised the manager that any increase in the present number of residents from the present level of 17 would necessitate an increase in the staffing complement to 3 staff throughout the day. The Registered Manager, who is a trained nurse, and her husband also work within the home. They are supernumerary and their hours are detailed on the duty rota in response to a previous requirement. There are currently 12 care staff and a cleaner. The home has recently lost its cook, this role being presently being carried out by Mr Hawkins, who is a trained chef. Since the last key inspection, one new member of staff has been recruited. The inspector has examined the staff file and found that all the necessary recruitment and identity checks have been completed together with the necessary criminal records checks (CRB and POVA). There is evidence on staff files of staff having relevant qualifications, and there is ongoing identification of training needs. The home currently has 3 care staff who have NVQ Level 3 and 6 staff with NVQ Level 2 or equivalent. Two other staff are due to register for studies leading to an NVQ2. This meets the target of at least 50 of care staff with an NVQ2. An induction programme is in place for all new staff. A Certificate in Care Practice has been developed for one staff member who has been employed through the Mencap Pathways scheme. There is ongoing training in health and safety, first aid, medication, manual handling and fire prevention. Most staff have completed training in dementia. The inspector has previously identified a need for on-site training in infection control. Mrs Hawkins has evidenced that she has attended Advanced Infection Control training on 21 February 2007. A date has been arranged, in May 2007, for some staff to attend Sutton’s infection control training. All staff must attend this training, and other dates will need to be obtained. This must be followed up as a priority. The registered manager was unable to evidence a programme of ongoing training for staff. The inspector identified the need for an up-to-date staff training and development programme to be put in place to evidence the training that has been planned for the current year 2007-08. A requirement applies. Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 25 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 to 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally, the home is being well managed, and in a way that demonstrates that it is being run in the best interests of residents. The management approach is evidenced to be open and enabling, and conducive to creating a positive and inclusive atmosphere in the home. With regular, one-to-one supervision now being provided, residents can be assured that staff will be appropriately supported in meeting their needs. Generally, the inspector is satisfied that the health, safety and welfare of residents and staff are being appropriately promoted and protected. Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 26 EVIDENCE: Mrs Hawkins is a trained nurse. Both she and Mr Hawkins have many years experience in working with this client group, and Mrs Hawkins has recently completed studies and obtained the Registered Managers Award (January 2007). From the evidence of this inspection, and the feedback received from both residents and staff, the home is generally being managed in a competent, caring and open way. Residents spoken to by the inspector expressed their satisfaction with the dayto-day management of the home and with the care being provided by staff. From the feedback received, the registered providers are perceived to be open and supportive in their approach, and to be providing a pleasant, homely environment in which to live. The inspector observed residents being treated with consideration and respect by the manager and staff. Following a requirement from the previous key inspection, it was evidenced that quality assurance surveys have been completed with residents and relatives, and that the use of questionnaires has been extended to visiting professionals, volunteers and other stakeholders. A QA Development Plan for the home has now been put in place for 2006-07. This is, however, quite short (a single page) and must, for 2007-08, be developed into a more comprehensive and structured report. The inspector has advised accessing Development Plans from other homes to provide an indication of how to approach this task. A recommendation applies. The manager has confirmed that residents are encouraged to retain as much control over their lives as they are able. Where an individual is unable to manage their finances, power of attorney rests with a family member or a solicitor. The home’s proprietors do not wish to be involved in managing any finances, but, with the expressed wish of one service user, act as an appointee, with a record being kept of all receipts and outgoings. Mrs Hawkins assured the inspector that with the exception of one staff member (who is at college) all staff are now being provided with regular two-monthly supervision. The inspector has examined staff files, on this and the previous (random) inspection (on 6.03.07), and evidenced that two-monthly supervision has been taking place over the last six months. However, given previous concerns regarding the irregularity of supervision, this improvement must be sustained and will be closely monitored on future inspections. The home has yet to submit a set of accounts for the year 2004/05, and for the years 2005/06 and 2006/07. The inspector has been made aware by the Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 27 home’s providers that there has been a long-tem problem in obtaining tax returns due to a tax investigation by the Inland Revenue. This has apparently delayed preparation of the home’s audited accounts for these three tax years. Mr and Mrs Hawkins have previously advised the inspector that there has been further contact with the accountants and that a meeting had been arranged to resolve outstanding queries dating back to the tax year 2003-04. This has been evidenced with a letter from the accountancy firm. Mr and Mrs Hawkins have also advised that, following the resolution of these queries, accounts for the years 2003-04 and 2004-05 should be prepared in the coming months, with preparation of accounts for the subsequent tax years of 2005-06 and 2006-07 to follow in the longer term once these have been completed. Records required by regulation for the protection of residents, and for the effective and efficient running of the business, are generally being maintained to a satisfactory standard. A requirement from the last inspection has been partly met. A checklist of policies and procedures, which lists all policies and procedures, has been drawn up. Policies and procedures are being reviewed and updated as required. A copy of the checklist still needs, however, to be included on each staff file. This needs to evidence that staff have read and understood each policy that has been developed and updated. A written policy and procedure covering emergency situations is in place. This refers to ‘the need to inform the service user’s nearest relative or representative at the earliest opportunity when an emergency arises’. The inspector examined certificates relating to health and safety. Up to date servicing certificates are in place for electrical wiring and installation, gas servicing, portable electrical appliances, fire safety, hoist maintenance and the testing of call systems, together with certificates for Legionella and environmental health. Regular weekly hot water checks are being completed, together with daily fridge/freezer and oven temperature checks. The home’s fire alarms were evidenced to be receiving regular weekly checks, and there were regular recorded checks for hot water and fridge/freezers. Monthly checks are being recorded for the home’s emergency call systems and emergency lighting. The stannah stair lift was last serviced on 5/1/07. A requirement from the last key inspection, for the home’s health and safety risk assessments to be reviewed and updated, has now been completed. The home has been unable to access fire safety training from the fire authority, this training no longer being available. The registered provider, Mr Hawkins, provided an assurance that the home is providing all necessary training and support to staff in fire safety including the appropriate use of fire equipment and fire evacuation procedures. There are weekly tests of fire alarms and fire drills are being held on a regular basis. The most recent fire drill took place on 30.3.07, with staff being provided with information (documented) relating to Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 28 fire evacuation procedures. The inspector was advised that the home’s fire risk assessment has been updated, on 14.5.07. Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 29 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 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 2 3 3 3 3 Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes 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 OP18 Regulation 18(1)(c) Requirement Adult protection. The registered providers must ensure that all care staff have accessed and completed Suttons Vulnerable Adult and Adult Protection training. This is to ensure that staff know the procedures to be followed should any incident of abuse arise, and that residents are being appropriately protected from abuse. Requirement partly met, 5 out of 14 staff so far completed training. Extension of time-scale agreed. 2 OP26 13(4)(c), 13(6)18(1 )(a) & (c) Accredited on-site training in infection control must be provided for all staff. Extension of time-scale agreed. 3 OP30 18(1)(a) & (c) Staff training. A staff training and development Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 31 Timescale for action 30/09/07 30/09/07 30/09/07 programme must be put in place to evidence the training that has been planned for the current year 2007-08. A copy of this must be forwarded to the CSCI. This is necessary in assuring residents, their relatives, and other parties, of the home’s competency in safely meeting residents’ needs. 4 OP32 12(2) & (5) Service user meetings. Service user meetings must be held on at least a two-monthly basis. These meetings provide the opportunity for residents to be informed and consulted regarding issues that affect their day-to-day lives. 5 OP34 25(1)(2,a) The registered providers must 25(3a,b,c) submit a set of accounts for the year 2004/05 to the CSCI, in order to demonstrate the home’s financial viability. Extension of time-scale agreed. 6 OP37 12(1)(a), 18(1)(a) A copy of the home’s policies and procedures checklist should be included in each staff file. This should evidence that staff have read and understood each policy developed and updated. Health and safety. A magnetic door guard must be fitted to the door of Room 22, so as (which is being kept open in accordance with the resident’s wishes). This is required in the interests Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 32 30/09/07 30/09/07 30/09/07 7 OP38 13(4)(a) & (c) 30/06/07 of the resident’s safety, to ensure that the door closes in the event of fire. 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 Refer to Standard OP7 OP12 Good Practice Recommendations Residents’ care plans should be reviewed on at least a monthly basis (7.4). Consideration should be given to extending the use of volunteers to visit and befriend service users, and to engage in recreational activities. The next annual Development Plan, for 2007-08, should be developed into a more comprehensive and structured report. The inspector advises accessing Development Plans from other homes to provide an indication of how to approach this task. 3 OP33 Heatherbank DS0000007168.V338466.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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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