Inspection on 22/08/07 for Heatherbrook Nursing Home

This inspection was carried out on 22nd August 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

Heatherbrook Nursing Home 21/10/06

Heatherbrook Nursing Home 25/02/06

Heatherbrook Nursing Home 23/08/05

Heatherbrook Nursing Home 23/03/05

Heatherbrook Nursing Home 06/09/04

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

CARE HOMES FOR OLDER PEOPLE Heatherbrook Nursing Home 80 Como Street Romford Essex RM7 7DT Lead Inspector Ms Gwen Lording Unannounced Inspection 22nd August 2007 10:00 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 Heatherbrook Nursing Home DS0000015594.V349086.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. Heatherbrook Nursing Home DS0000015594.V349086.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heatherbrook Nursing Home Address 80 Como Street Romford Essex RM7 7DT 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) 01708 737 961 01708 737 962 manager.heatherbrook@careuk.com manager.burroughs@careuk.com Care UK Community Partnerships Ltd Alison Jane Graham Care Home 45 Category(ies) of Dementia (45) registration, with number of places Heatherbrook Nursing Home DS0000015594.V349086.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 45 21st October 2006 Date of last inspection Brief Description of the Service: Heatherbrook is a purpose built home registered to provide nursing care to 45 older people with dementia. Care UK Community Partnerships Limited, a company that operates similar homes across the country, operates the home. The home is situated in a residential area of Romford and is in walking distance of local shops and public transport links. Residents are accommodated on two floors, Bluebell on the ground floor and Hylands on the first floor. A passenger lift is available. All rooms are single occupancy and have en-suite facilities. The current scale of charges is from £520.00 to £650.00 per week. There are additional costs for items such as hairdressing, toiletries, chiropody and newspapers. Information is made available to prospective residents and their relatives via a Service Users Guide, which is available prior to admission. A copy of the most recent inspection report is also made available. Heatherbrook Nursing Home DS0000015594.V349086.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, which started at 10am and took place over seven hours. The inspection was undertaken by the lead inspector, Gwen Lording. The manager and deputy manager were available throughout the visit to aid the inspection process. This was a key inspection in the inspection programme for 2007/ 2008. Discussion took place with the manager; deputy manager; several members of nursing and care staff; kitchen, laundry and maintenance staff; the activities co-ordinator; and the home’s administrator. The inspector spoke to residents where possible; however due to their care needs it was not possible to fully obtain their views. Visiting relatives and friends were spoken to and asked to give their views on the service and the standards of care in the home. Nursing and care staff were asked about the care that residents receive, and were also observed carrying out their duties. A tour of the premises, including the laundry and main kitchen was undertaken. The files of several residents on each unit were case tracked, together with the examination of other staff and home records. This included medication administration; activity programmes; training records; maintenance records; complaints and staff recruitment procedures and files. Information was also taken from an Annual Quality Assurance Assessment (AQAA), which was completed by the manager. This is a new self-assessment process, which all providers are required to complete once a year. Additional information relevant to this inspection was also obtained from monthly Regulation 26 monitoring reports and Regulation 37, notification of events. As part of the inspection process the views of several community health care professionals who provide a service to the home were sought and are commented on in this report. Relatives and staff were asked how people living in the home wished to be referred to. The majority expressed a wish for the term resident to be used, as it is their home. This is reflected accordingly in the report. The Inspector would like to thank the residents, staff and visitors for their input during the inspection. What the service does well: Heatherbrook Nursing Home DS0000015594.V349086.R01.S.doc Version 5.2 Page 6 As part of the inspection, contact was made by phone with community health and social care professionals who visit the home, this included the tissue viability nurse and funding authorities. They commented very positively on their involvement with the home and expressed no concerns about the care being provided; and that any advice given was well received and actioned accordingly. During the inspection staff were seen to be providing good personal care and all residents appeared clean, well groomed and appropriately dressed. There is a relaxed atmosphere throughout the home and residents appeared unhurried and are given sufficient time and support in their everyday activities. Discussion with relatives indicated that they are happy with the care being provided. Comments from relatives included: “Nothing is too much trouble for them (the staff), my husband is very well looked after” “The carers are very kind. I can visit at any time – it’s not a problem even if I come at eight in the morning” There is a well-established system in place for undertaking multidisciplinary reviews of residents care. The home works collaboratively with health care professionals and local community health services to provide an increased quality of health care for all residents. What has improved since the last inspection? What they could do better: Whilst there have been some improvements to the environment the registered persons must ensure that all parts of the home are well maintained. This is with reference to the carpets in the lounges of both units and the floor covering in the dining room on Bluebell. These must be replaced as a matter of priority. Heatherbrook Nursing Home DS0000015594.V349086.R01.S.doc Version 5.2 Page 7 With the recent introduction of the Mental Capacity Act 2005, it is essential that all staff working in the home receive adequate and appropriate training in this important area and the impact it will have upon the delivery of care to vulnerable people. The registered persons must review the use of the child safety gates and consider alternative ways of managing any identified risks around the safety of individual residents. 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. Heatherbrook Nursing Home DS0000015594.V349086.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 Heatherbrook Nursing Home DS0000015594.V349086.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): Standards 3 & 4 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. A pre-admission assessment is undertaken for all prospective residents. Care plans are drawn up from the information in this assessment ensuring that the needs of the residents are identified, understood and met. The home does not offer intermediate care. EVIDENCE: Individual records are kept for each resident and a number of files were examined on each unit. All records inspected have assessment information recorded and the information had been used to continue assessment following admission to the home and develop care plans. The records showed that residents, where possible and their relatives/ representatives are involved in Heatherbrook Nursing Home DS0000015594.V349086.R01.S.doc Version 5.2 Page 10 the assessment process. Where appropriate, information provided by the placing authority was also included. The manager was provided with a copy of the Commission’s ‘Policy and Guidance on Provision of Fees Information by Care Home’s. This sets out what information care home providers need to include in the Service User Guide regarding fees and terms and conditions, and is in a format that is easy to understand. Heatherbrook Nursing Home DS0000015594.V349086.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): Standards 7, 8, 9, 10 & 11 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. Residents’ health, personal and social care needs are set out in individual care plans and provide staff with the information they need to satisfactorily identify and meet residents’ needs. There are clear medication policies and procedures for staff to follow, so as to ensure that residents are safeguarded with regard to medication. Service users can be assured that at the time of their death, they and their families will be treated with sensitivity and respect. EVIDENCE: Individual care plans were available for each resident and a total of ten residents were case tracked, five on each unit, and their care plans and related documentation inspected. The home uses a computerised care planning system Saturn, and in addition each resident has a separate file containing some hand Heatherbrook Nursing Home DS0000015594.V349086.R01.S.doc Version 5.2 Page 12 written records, and items of correspondence. All staff receive training and demonstrated confidence and competence in its use when assisting the inspector to access residents care plans. Care plans were generally very comprehensive and detailed health, personal and social care needs. There was evidence that care plans were being reviewed at least monthly and updated to reflect changing needs. However, the care plan of one resident had not been updated following a review of the frequency of blood sugar monitoring. Whilst staff were able to give a good verbal account of the change in care needs, it is important that any such changes are accurately reflected in written care plans. As far as possible, residents’ and/ or their relatives are involved in the drawing up of their care plan. The documentation/ health records relating to wound management; management of diabetes; control of infection and a recently admitted resident were examined. The records for these residents were found to be detailed and being adequately maintained. Care planning included the management and understanding of the cognitive and affective features presented by people living with dementia. Details such as the use of visual prompts and maintaining independence were clearly recorded. Risk assessments are routinely undertaken on admission around nutrition, manual handling, continence, risk of falls and pressure sore prevention; and are being reviewed on a regular basis. Records are maintained of nutrition, including weight loss or gain with appropriate action being taken where necessary. A number of monitoring charts were examined including blood sugar monitoring, turning charts and fluid intake/ output monitoring charts. The majority of these were found to be in good order. However, a small number of fluid charts were being completed retrospectively by care staff. For example, at 12.00 hours on the day of the inspection the last recorded entry on one chart was 06.00 hours, and at 15.00 hours the last recorded entry on another chart was 11.00 hours. It is essential that all monitoring charts are maintained accurately and up to date. Files evidenced involvement from GP’s; tissue viability nurse; optical, dental and chiropody services. The manager has set up multidisciplinary care reviews for all residents in the home. These reviews include the GP, practice nurse from the surgery, pharmacist, and consultant psychiatrist. This initiative has enabled the home to work collaboratively with health care professionals and local community health services to provide an increased quality of health care for residents. There has been some development of care plans around ‘End of Life’ wishes and needs. The inspector was able to evidence information in some care plans where discussions had taken place with family members around end of life care Heatherbrook Nursing Home DS0000015594.V349086.R01.S.doc Version 5.2 Page 13 needs. The manager is aware that further development is needed in this important area. However, from discussions with staff and viewing cards/ letters received from relatives, it was apparent that staff dealt with a person’s dying and death in a sensitive and understanding manner, both for the individual and relatives. One relative had written: “Thank you for your kind words and comfort.” Staff in the home routinely support relatives following the death of a resident through sympathy cards, floral tributes and support for staff to attend funerals. Staff talked about and were observed to treat residents in a respectful and sensitive manner. They understood the need to promote dignity through practices such as the way they addressed residents and were observed knocking o bedroom and bathroom doors before entering. They were seen to be very gentle when undertaking moving and handling tasks and offered explanation and reassurance throughout. An audit was undertaken for the handling and recording of medicines within the home and a sample of Medication Administration Record (MAR) charts were examined. There are clear medication policies and procedures for staff to follow. Discussions with staff and the review of medication records show that staff are following the policies and procedures, so as to ensure that residents are safeguarded with regard to their medication. Medication audits are undertaken on a regular basis by the manager. The home receives a pharmacy service from a local independent pharmacist and he is seen as a very important part of the care team. He attends the multidisciplinary reviews; has a good knowledge of the medication needs of the residents and liaises with the GP around individual needs. In addition he visits the home on a monthly basis to gives advice and training to nursing staff. The residents have high dependency needs in relation to their dementia and it was not possible to fully obtain the views of residents spoken during the inspection. However, residents were seen to be clean, well groomed, relaxed in their environment and interacted well with staff. The inspector was able to speak with a number of visiting relatives. All spoke very positively about the care and support to residents in the home. Comments from relatives included: “Nothing is too much trouble for them, my husband is very well looked after” “My mum has been here for about two years. I would not want her to be cared for anywhere else. The staff always keep me informed”. Heatherbrook Nursing Home DS0000015594.V349086.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): Standards 12, 13, 14 & 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Whilst there is a general programme of activities available, consideration needs to be given to planning a more varied and stimulating choice of activities, which are suitable for all residents. The activity programme is currently being reviewed. This will hopefully be reflected in the provision of an imaginative and varied programme, which is in accordance with individual’s capabilities and their changing needs. EVIDENCE: A new activities co-ordinator has been appointed and has been in post for only three weeks. She works from 8am-4pm five days a week and previously worked in the home as a carer. She is currently reviewing the activity programme and has already introduced a number of new initiatives such as ‘Interactive Breakfast’. She sits with a small number of residents at the breakfast table and supports/ enables them to be meaningfully involved in the meal. For example pouring themselves a cup of tea, adding milk sugar, buttering toast etc. Such initiatives are important in enabling people living with dementia to retain a level of independence and be involved in everyday Heatherbrook Nursing Home DS0000015594.V349086.R01.S.doc Version 5.2 Page 15 activities of daily living. All residents now have an activities record, which is part of the computerised care planning system and the activities co-ordinator inputs information onto the system. Throughout the visit the inspector observed staff allowing time for residents to express their wishes and supporting individuals to make choices in their everyday lives, wherever possible. For example choosing a drink and where they wished to sit and eat their meal. Visiting time are flexible and relatives/ friends are encouraged to visit. Relatives spoken to commented that they felt very welcomed by staff and were encouraged to visit at any time. The inspector was able to observe part of the lunchtime meal being served on both Hyland and Bluebell. Staff were seen to offer assistance where necessary and this was done discreetly and individually. Pureed meals were presented in an attractive and appealing manner and residents who required assistance were not hurried. Meals are mainly served in the dining rooms, though some residents choose to eat in their rooms. There is a planned menu but the home’s experience is that residents’ have difficulty in choosing from the menu, so choices are encouraged at the point of serving for most people. On Hylands tables were not routinely laid with clothes, napkins, condiments, cutlery or glasses. However, on Bluebell tables were well laid prior to residents sitting down for the meal and setting was more congenial A visit was made to the kitchen and the inspector was able to discuss the storage and preparation of food with the cook. She was fully aware of those residents requiring special therapeutic diets and demonstrated a good knowledge and understanding of the importance of well balanced and well presented meals. There is a four weekly menu cycle, which is changed seasonally. A cooked breakfast is available on alternate days and fresh fruit is provided daily and is available on request. The use of full cream milk, butter and cream is used wherever possible to supplement the diets of those residents with reduced food intake/ diminished appetite. Nutritional milkshakes/ smoothies are also prepared for those residents who are experiencing weight loss. Heatherbrook Nursing Home DS0000015594.V349086.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): Standards 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The manager and staff make every effort to sort out any problems and concerns. Residents and their relatives can be confident that their complaints and concerns will be listened to, taken seriously and acted upon. All staff working in the home have received training in safeguarding adults to ensure that there is a proper response to any suspicion or allegation of abuse. However, the manager must ensure that any risks identified around the safety of individual residents is dealt with through effective risk management rather than the inappropriate use of equipment. EVIDENCE: The home has a written complaints policy and procedure for dealing with complaints, and staff spoken to were aware of the complaint procedure and how to deal with complaints or concerns made to them. The complaints log was inspected and indicated complaints received, details of investigation, action taken to resolve and the outcome for the complainant. The manager was clear that that any complaints received by the home would be responded to in writing and in accordance with the home’s complaint procedure and stated timescales. Relatives are also able to record any concerns/ comments/ compliments in a book that is kept in the reception area and the manager views this on a daily basis. This means that she can address issues of concern Heatherbrook Nursing Home DS0000015594.V349086.R01.S.doc Version 5.2 Page 17 quickly and take action to resolve such concerns to the satisfaction of the complainant. Those relatives spoken to were aware of how to complain and to whom. They said that any concerns are dealt with immediately by the manager and staff so that issues do not escalate and become major concerns or complaints. All staff working in the home have received training in safeguarding adults and this is included in induction training for all new staff. This was evidenced on staff files and the training schedule. Those staff spoken to were conversant with the action to be taken if they had concerns about the safety and welfare of residents or if they witnessed any suspected abuse. During the inspection it was observed that child safety gates were in place across the bedroom doorways of a number of residents. There were a total of ten gates fitted to bedroom doorways on Hylands Unit and three on Bluebell Unit. In discussion with staff it would seem that relatives had requested that this be put in place as they had concerns as to the safety of their relatives when they were not visiting. Their concerns were around other more confused residents wandering into the bedrooms and taking items from the room; or disturbing residents who needed to be nursed in bed, due to increasing frailty. Risk assessments had been undertaken and although there were signed consent letters from relatives for the use of the gates, there was no evidence as to the reason for this. In discussion with the manager it is acknowledged that the use of the gates is not intended as a physical restraint, as it is not to prevent the residents from leaving their own rooms. However, it is not an acceptable method of managing risks identified around the safety of individual residents and must be dealt with through effective risk management strategies rather than the inappropriate use of equipment. Staff who are supervising and observing other residents should be managing any risk appropriately. All environments should be supportive and enabling. The use of such a gate is also detrimental in the event of fire, or another resident could climb over the gate and this could lead to a possible accident. Whilst it is important to work closely with relatives, this must always be in the interest of residents. The manager is required to review the use of these gates and consider alternative ways of managing this risk. This could include re-arranging accommodation and the use of lounge areas, so that residents who are frail are in one part of the unit, or redeploying staff/ reviewing staffing levels so as to ensure the safety of all the residents. Heatherbrook Nursing Home DS0000015594.V349086.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): Standards 19, 20, 23, 24 & 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home is clean, generally well maintained, decorated and furnished to a satisfactory standard, with the exception of carpets in some of the communal areas. However, the general environment must be improved so as to meet the specialist needs of people living with dementia, through improved signage, décor and use of communal areas. EVIDENCE: The building was toured by the inspector, accompanied by the manager, at the start of the visit, and all areas were visited again later during the day. Some bedrooms were seen either by invitation of the resident, whilst others were seen because the doors were open or being cleaned. All of the bedrooms Heatherbrook Nursing Home DS0000015594.V349086.R01.S.doc Version 5.2 Page 19 seen were personalised and were reflective of the occupant’s interests, culture and religion. There were no offensive odours and the home was clean and tidy. The standard of the décor, furnishings and fittings are generally being maintained to a good standard with the exception of the carpets in the lounge/dining rooms on both units, and the floor covering in the dining room on Bluebell. The carpets in these areas were heavily stained, dirty and “sticky” when being walked on. The manager stated that they are having difficulty keeping these carpets clean despite regular and repeated shampooing. It is a requirement that carpets in both these areas are replaced as a matter of priority. The floor covering in the dining area on Bluebell is also badly worn and with large areas of white stains. This flooring must also be replaced. There is an ongoing programme of refurbishment and re-decoration. A maintenance person is employed and there is an effective system in place for staff to report items requiring attention or repair. The external grounds and secluded gardens are secure and being well maintained The laundry area was visited and this was found to be clean, with soiled articles, clothing and foul linen being stored appropriately, pending washing. The laundress was aware of health and safety regulations with regard to handling and storage of chemicals. Personal Protective Equipment (PPE) such as clothing, gloves, masks and goggles were available and in use. Hand washing facilities are prominently sited and staff were observed to be practising an adequate standard of hand hygiene. The manager has received information and is fully aware of the recent legislation regarding smoking in care homes, which came into effect on the 1st July 2007 There was some signage and décor however, this was not adequate to the needs of residents living with dementia and this needs to be developed further. Toilets had some signage and the doors had been painted a different colour. However, this had not been continued through to en suite facilities to aid identification. One of the assisted bathrooms/ toilets on Hylands was being used as a storage room for wheelchairs and other sundry items of equipment and therefore not available or accessible to residents wishing to use it. As the ability of people living with dementia to communicate with words decreases, the use of non-verbal cues and the environment are important in enabling them to cope better with daily life and aids to orientation. The home is registered to accommodate people with dementia. Therefore the general environment on both floors floor must reflect good practice guidance on dementia care within care homes. Consideration must be given to utilising the existing design and layout of this unit to meet the specialist needs of people living with dementia. For example, Heatherbrook Nursing Home DS0000015594.V349086.R01.S.doc Version 5.2 Page 20 through the use of visual cues such as colour and signage. Staff must be aware of factors such as noise. On the day of the inspection several residents on Hylands were sat in the lounge with the television on, the sound turned off and music being played elsewhere in the lounge. More pictures and items of interest must be provided in the corridors, lounges and dining rooms. These can be used as points of discussion/ interaction with residents living with dementia. The physical environment has an enormous impact on how the strengths and skills of people living with dementia are supported or not. Changes mentioned above, if implemented, can help to support people living with dementia, and help to maximise independence and minimise confusion. Heatherbrook Nursing Home DS0000015594.V349086.R01.S.doc Version 5.2 Page 21 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): Standards 27, 28, 29 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Staffing levels are satisfactory and there are sufficient staff on duty to meet the individual assessed needs of the residents. Residents benefit from a committed staff team who have the skills and training to meet their needs. The procedures for the recruitment of staff are robust and provide safeguards for people living in the home. EVIDENCE: Staff rotas were inspected and the staffing levels and skill mix of qualified nurses and care staff, on both units of the home, was sufficient to meet the assessed nursing and personal care needs of the residents. The home has a relatively stable workforce and there is minimal use of bank staff to cover any shortfalls due to sickness, annual leave and vacant posts. Effective team working was observed and evidenced throughout the inspection, and staff interacted well, both with each other and the residents. A record is maintained of staff training and records showed that staff have undertaken training in essential areas such as manual handling, food hygiene, health and safety, fire safety and infection control. In addition the Heatherbrook Nursing Home DS0000015594.V349086.R01.S.doc Version 5.2 Page 22 organisation has a computerised staff training system for induction and mandatory training. This is a laptop (EL Box) which is accessible 24hours a day for all staff. Compliance figures evidenced a high take up from staff, with the majority of staff achieving pass rates of 100 . All staff working in the home have undertaken training in dementia care and managing challenging behaviour. A discussion took place with the manager around the recently introduced Mental Capacity Act 2005, and the impact it will have upon the delivery of care to vulnerable people. It is essential that all staff working in the home receive adequate and appropriate training in this important area. The manager stated that she has already identified a source of training for this topic. The AQAA completed by the manager stated that approximately 49 of staff are qualified to National Vocational Qualification (NVQ) level 2 or above. Registration for other care staff is ongoing. The files of the three most recently employed staff were inspected and these were found to be in good order with necessary references, Criminal Records Bureau (CRB) disclosures, and application forms duly completed. Care UK Limited; as an organisation, employs a workforce from diverse cultures and backgrounds. It was apparent that the ethnicity of the majority of the staff team is not generally reflective of that of the resident group. However, in discussion with the manager and staff they were able to demonstrate an awareness of the importance of understanding and appropriately meeting the needs of all residents, wherever possible around equality and diversity issues. It is important that the manager continues to reinforce this awareness through staff training and supervision. Specific training regarding equality and diversity has been sourced by the manager and will be accessed by all staff over the next year. This will ensure that the spiritual, cultural, sexual and any other diverse need of residents at Heatherbrook is met through meaningful ‘person centred’ care. Heatherbrook Nursing Home DS0000015594.V349086.R01.S.doc Version 5.2 Page 23 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): Standards 31, 32, 33, 35, 36 & 38 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The manager of the home is a well qualified and experienced person and residents benefit as the home is run in their best interests. Monitoring visits are undertaken regularly by the responsible individual to monitor and report on the quality of service being provided in the home. EVIDENCE: The manager has the qualifications and experience to manage the home and is able to demonstrate a clear understanding of the needs of the residents. Ms Graham is very resident focused and works continuously to improve the service and provide an increased quality of life for residents with the support of Heatherbrook Nursing Home DS0000015594.V349086.R01.S.doc Version 5.2 Page 24 a strong team, and in partnership with the family of residents and professionals. All staff spoken to throughout the visit, both care and departmental staff, spoke very positively about how well supported and valued they felt by the manager. The home has a deputy manager who is also a qualified and experienced person. Two days a week he is supernumerary to staffing levels and this allows him to work with staff on the units to undertake training and work on care planning. From viewing staff records and talking to staff it was evident that staff receive regular supervision, which includes observational and peer supervision. Staff meetings are held regularly and are minuted. Relatives meeting are held every three months and the manager is making arrangements for the local Dementia Outreach Service to attend one of these meetings to discuss issues around dementia and for relatives to have a better understanding of this illness. The manager completes a monthly management report and this includes information on accidents/ incidents, complaints, incidence of pressure sores and infection rates. The home benefits from the quality assurance procedures of the registered organisation, Care UK. A representative of the registered organisation undertakes monthly Regulation 26 monitoring visits to monitor and report on the quality of the service being provided in the home. A copy of the report is sent to the Commission. Currently the manager does not act as an appointed agent for any resident. Residents’ financial affairs are managed by their relatives/ representatives. The home has responsibility for the personal allowances of several residents. Through discussion with the home’s administrator and records inspected, there was evidence to show that residents’ financial interests are safeguarded. Secure facilities are provided for the safekeeping of money and valuables held on behalf of residents’. A wide range of records were looked at including fire safety; emergency lighting; lift maintenance; recording of water temperatures and accident/ incident reports. These records were found to be in good order, up to date and accurate. Heatherbrook Nursing Home DS0000015594.V349086.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 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 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 2 2 X 3 X 3 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 2 Heatherbrook Nursing Home DS0000015594.V349086.R01.S.doc Version 5.2 Page 26 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 OP19 Regulation 16 Requirement The registered persons must ensure that all parts of the home are well maintained. This is with reference to the carpets in the lounges of both units and the floor covering in the dining room on Bluebell. (Timescale of 31/01/07 not met) The registered providers must ensure that where a record of food/ fluid is indicated, that these recordings must be accurately maintained and up to date. The registered persons must review the use of the child safety gates and consider alternative ways of managing any identified risks around the safety of individual residents. The registered providers must ensure that the existing layout and design of both units reflects good practice guidance on dementia care within care homes, to ensure that the environment meets the specialist needs of the residents. DS0000015594.V349086.R01.S.doc Timescale for action 07/10/07 2. OP8 12 22/08/07 3. OP18 OP38 13 4(a)(c) 6 30/11/07 4. OP19 23 30/11/07 Heatherbrook Nursing Home 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. Refer to Standard Good Practice Recommendations Heatherbrook Nursing Home DS0000015594.V349086.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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. Extracts may not be used or reproduced without the express permission of CSCI Heatherbrook Nursing Home DS0000015594.V349086.R01.S.doc Version 5.2 Page 29 - 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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