Inspection on 25/02/06 for Heatherbrook Nursing Home

This inspection was carried out on 25th February 2006.

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 22/08/07

Heatherbrook Nursing Home 21/10/06

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 Georgia Chimbani Unannounced Inspection 25th February 2006 12:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Heatherbrook Nursing Home DS0000015594.V284285.R01.S.doc Version 5.1 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.V284285.R01.S.doc Version 5.1 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 www.careuk.com Care UK Community Partnerships Limited Miss Emma Louise Bryer Care Home 45 Category(ies) of Dementia - over 65 years of age (45) registration, with number of places Heatherbrook Nursing Home DS0000015594.V284285.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Date of last inspection Minimum Staffing Notice To include one named person under 65 years of age 23rd August 2005 Brief Description of the Service: Heatherbrook is a purpose built home in a residential area of Romford. It is in walking distance of local shops and public transport links. The home provides 24 hour nursing care for 45 older people with dementia. Service users 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. Heatherbrook Nursing Home DS0000015594.V284285.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on a Saturday afternoon and lasted a duration of 4 hours and 15 minutes. Present at this unannounced inspection were the 2 Registered General Nurses on duty, both co-operated fully with the inspection process until the manager, Ms Emma Bryer arrived at the home. The inspector made unsuccessful attempts to interview service users. Feedback received from two relatives visiting at the time of the inspection was very positive. One relative was very lavish in their praise of the quality of care offered at the home. They stated they would highly recommend the home and described it as “a 10 star hotel.” When asked about the quality of the food they said they were “blown away by the [quality of] food.” It is the inspector’s opinion that home has benefited from the manager’s dedicated and professional management approach. At the time of the inspection the home had 2 vacancies. 11 requirements were made at the last inspection. 8 requirements were met and 3 are restated, with a new timescale for compliance. Restated requirements relate to staff training and the completion of an analysis of the quality assurance questionnaires sent to service users, relatives and health professionals to gain their views on the operation of the home. Further information about unmet requirements can be found in the relevant standard. None the less, repeated requirements impact upon the welfare and safety of service users. Failure to comply by the revised timescale will lead to the Commission for Social Care Inspection considering enforcement action to secure compliance. A further 2 requirements are made following this inspection bringing the total number of requirements made to 7. What the service does well: What has improved since the last inspection? Recordkeeping of care plans has improved considerably and any changes are immediately noted. Service users with pressure ulcers are also monitored closely and their records are kept up to date. Bedding provided to service Heatherbrook Nursing Home DS0000015594.V284285.R01.S.doc Version 5.1 Page 6 users is of a satisfactory quality and offensive odours have been eliminated from the home. The majority of staff have received training in infection control. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Heatherbrook Nursing Home DS0000015594.V284285.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heatherbrook Nursing Home DS0000015594.V284285.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 0 EVIDENCE: The key standards relating to this section were inspected at the last inspection. Heatherbrook Nursing Home DS0000015594.V284285.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 and 10 The current standard of care planning documentation ensures that service user’s needs are identified and appropriately met. Medication practices in the home are commendable and ensure the health and safety of service users is maintained. More must be done to demonstrate the home’s commitment to upholding the dignity of service users. EVIDENCE: At the previous inspection two requirements were made relating to recording on care plans. At this inspection the inspector was shown care plan documentation of several service users by the manager. The home does not hold paper records but stores all service user information such as care plans electronically. All staff have access to the electronic records but their level of access varies depending on their position. Sample care plans examined indicated that monthly reviews were carried out with clear actions for staff on how they could meet the needs of service users. Records of a service user with a pressure ulcer revealed that their wound was assessed regularly and their records were reviewed accordingly. Another service user’s records reflected Heatherbrook Nursing Home DS0000015594.V284285.R01.S.doc Version 5.1 Page 10 changes in their dietary intake and there was evidence of a referral and the subsequent response from a speech and language therapist. An inspection of the medication storage areas and records on the first floor revealed a high standard of recordkeeping. Where a service user had not taken their medication on a particular date records showed the reason. Up to date records were seen of medical administration record sheets and the controlled drugs register. Records of temperatures of the room where medication is stored were also available for inspection. The majority of service users living in the home have varying levels of dementia. The inspector attempted to interview several service users but due to their cognitive impairment little information could be obtained. Information shown to the inspector by the manager revealed that positive feedback had been received from a funeral service on the care given to a service user by the home following their death. Observations made by the inspector at the time of the inspection indicated that service users were well dressed and were addressed appropriately by staff. The inspector noted that during lunchtime a member of staff was sitting with two service users at a table and assisting them both with feeding. Upstairs another member of staff was feeding a service user with their plate placed on a chair rather than a table. The position of the member of staff in relation to the service user they were feeding indicated that they had a better vantage point of the television rather than the service user they were feeding. The registered persons must ensure that staff work in a way that treats service users with respect and upholds their dignity. Heatherbrook Nursing Home DS0000015594.V284285.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 14 There was a lack of written evidence in relation to group activities provided in the home. The home has to be able to evidence from records that all activities provided are recorded to show that they have the ability to meet the social needs of service users. Flexible visiting times ensure that service users are able to maintain links with their family, friends and local community. Service users’ ability to make choices about their life promotes their independence and makes them feel valued. EVIDENCE: At the previous inspection the registered persons were required to improve the activities within the home. A discussion with the manager revealed that there were a variety of group and individual activities offered at the home. The inspector was shown records of activities undertaken with individual service users, but there were no records of group activities or entertainers that were stated to be brought into the home on a regular. The manager advised that this information would be recorded in the activity coordinator’s diary that was not available for inspection. Any record relating to the operation of the home should be held in the home. Heatherbrook Nursing Home DS0000015594.V284285.R01.S.doc Version 5.1 Page 12 The inspector was able to observe relatives visiting at various times during the day. Interviews with some visiting relatives confirmed that there were no restrictions on visits to the home. Evidence was available to confirm that service users were able to make choices about their daily lives. The inspector observed that a service user had chosen to stay in bed in the afternoon as they were tired and wanted to rest. Heatherbrook Nursing Home DS0000015594.V284285.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 0 EVIDENCE: The key standards relating to this section were inspected at the last inspection. Heatherbrook Nursing Home DS0000015594.V284285.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 and 26 Improvements to the living environment ensure a safe and comfortable environment for all service users. EVIDENCE: Following the previous inspection 3 requirements were made relating to the environment of the home. Service user rooms inspected revealed clean and appropriate bedding and no offensive odours were detected in rooms identified at the last inspection. The inspector noted that despite a requirement at the previous inspection the extractor fans in the en-suite facilities of service user rooms were not working. The manager advised that these had been repaired and were all in working order however they had recently been disconnected as a safety precaution following a fire in a home owned by the same organisation. Heatherbrook Nursing Home DS0000015594.V284285.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 and 30 Recruitment practices at the home must be improved to ensure that staff that have undergone the required level of checks to care for service users. There has been some, but not sufficient progress in training of staff and this can compromise the safety of service users. EVIDENCE: Discussions with the manager revealed that the home has recruited approximately 18 staff following the last inspection. A random sample of 4 files was inspected. All files contained a Criminal Records Bureau (CRB) check and evidence of identification. One file did not contain a recent photograph of the member of staff. This is required. Two members of staff were noted to be nonEuropean union citizens but there was no evidence of their eligibility to work. References were available on all files but for one member of staff these were from their parish priest and a colleague/friend and not from their previous employer. Another file contained references that were on a standard form issued by the home but were not verifiable, as there was no official letterhead or stamp from the referee. The registered persons must ensure that all files contain a recent photograph of the member of staff and evidence of eligibility to work. References must be sought from previous employers and the manager must satisfy themselves as to the authenticity of the references. Heatherbrook Nursing Home DS0000015594.V284285.R01.S.doc Version 5.1 Page 16 At the previous inspection 4 requirements were made relating to staff training in fire, first aid, infection control and activities for people with dementia. The manager informed that a new activities co-ordinator had been recruited just before Christmas and they were booked on a 3-day training course in March. This requirement was still within the timescales set at the last inspection. Confirmation is required by the Commission that this training has been achieved by the activities co-ordinator. The inspector was shown evidence that approximately 40 staff had received training in infection control. The requirement for all new staff to attend a fire drill was still outstanding. Records indicated that of approximately 18 new staff only 6 had been present at a fire drill in the last few months. The inspector was reassured to note that despite this shortcoming, most staff had received fire safety training in the last 6 months. This requirement is restated. The manager informed the inspector that 12 staff had attended a basic first aid course but documentation confirming this was not available for inspection. In the absence of documentary evidence this requirement is restated. All staff must attend basic first aid training. Heatherbrook Nursing Home DS0000015594.V284285.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 and 36 The home must carryout an analysis of the quality assurance questionnaires returned to the home. This analysis should form part of the Service Users Guide to give any new service users a view of what service the home can provide. Financial practices in the home protect service users from financial abuse. EVIDENCE: A discussion with the manager revealed that questionnaires were sent out to relatives monthly and more recently quarterly to seek their views on the quality of the service. Following further discussion it was agreed that an annual quality assurance process would probably serve the needs of the service and stakeholders better as quarterly was too frequent. The registered person must ensure that a quality assurance analysis of the information returned from service users, their relatives and visiting professionals is made. A copy of the Heatherbrook Nursing Home DS0000015594.V284285.R01.S.doc Version 5.1 Page 18 analysis of the findings must be made available to service users as part of the Service Users Guide and a copy sent to the CSCI. The home holds small amounts of money for service users for incidental expenses such as hairdressing, chiropody and toiletries. The manager advised that the insurance requirements of the home require this amount not to exceed £200 per service user. The inspector examined the records of one service user and found the records to be accurate and up to date. The amount of money tallied with the records of expenditure. Expenditure such as chiropody did not have a receipt however the inspector was able to verify this expenditure with records made by the Chiropodist on the day of their visit. At the previous inspection a requirement was made for all nursing staff to have formal written supervision. Discussion with a nursing member of staff indicated that they received supervision monthly and had received supervision recently. Records made available to the inspector by the manager indicated that some but not all nursing staff had received regular supervision. Detailed records of supervision for both nursing and care staff were not available as the manager advised that these were confidential and were kept by the member of staff and not the manager. The manager was able to show the inspector a blank format that is used to record the supervision process. This includes all the aspects detailed under standard 36 of the national minimum standards for older people. The home has to be able to evidence that all nursing and care staff working in the home receive 6 formal, written supervision sessions within any one rolling year (the past requirement made was that supervision sessions should commence by September 2005). It is recommended that the manager keep a supervision planning record and when a formal written supervision session has been completed that both the supervisor and the supervisee sign and date the tracking sheet to evidence that this has taken place. Heatherbrook Nursing Home DS0000015594.V284285.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X 3 3 3 STAFFING Standard No Score 27 X 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 3 X X Heatherbrook Nursing Home DS0000015594.V284285.R01.S.doc Version 5.1 Page 20 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 OP10 Regulation 12(4)(a) Requirement The registered persons must ensure that staff work in a way that treats service users with respect and upholds their dignity. The registered persons must ensure that all files contain a recent photograph of the member of staff and evidence of eligibility to work. References must be sought from previous employers and the manager must satisfy themselves as to the authenticity of the references. The 12 recently employed staff must attend a drill. The registered persons must ensure that all staff attend a basic first aid course. [Previous timescale of 30/1/06 not met.] Provide written confirmation that the activity co-ordinator has undertaken training in providing activities for people with Dementia. Provide a copy of the Quality DS0000015594.V284285.R01.S.doc Timescale for action 25/05/06 2 OP29 19 Schedule 4 para 6 25/05/06 4. 5. OP30 OP30 18(1)(c) (i) 13(2c) 25/05/06 25/04/06 6. OP30 18(1)(c) (i) 25/04/06 7. OP33 24 25/07/06 Page 21 Heatherbrook Nursing Home Version 5.1 Assurance analysis to the Commission. A copy of the analysis must form part of the Service Users Guide and be reviewed annually. 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 OP12 OP36 Good Practice Recommendations Records relating to group activities and entertainers that are being brought into the home should be held in the home and be available for inspection. It is recommended that the manager keep a supervision planning record and when a formal written supervision session has been completed that both the supervisor and the supervisee sign and date the tracking record to evidence that this has taken place. Heatherbrook Nursing Home DS0000015594.V284285.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Heatherbrook Nursing Home DS0000015594.V284285.R01.S.doc Version 5.1 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!