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Inspection on 29/04/05 for Heatherdene Nursing Home

Also see our care home review for Heatherdene Nursing Home for more information

This inspection was carried out on 29th April 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents and visitors spoke highly of the home and particularly about the staff working in the home saying `staff are very kind` `extremely kind and helpful, `welcoming pleasant and cheery`. The quality and standard of the food and entertainment was also complimented. All residents have a full assessment prior to their admission and every effort is made to ensure the move into the home is a smooth transition and the care needs of the resident can be met from arrival. The care needs of residents are fully assessed following admission and care is planned and clearly documented. Heatherdene nursing home provides a home like environment where visiting is encouraged with some visitors spending long periods of time in the home.

What has improved since the last inspection?

The home has made good progress towards meeting the requirements made at the last inspection. The plans of care have been improved and now fully record any pressure sore or risk of pressure sore development. Records also record the appropriate nursing care to be provided in such circumstances. The activities and entertainment in the home has been improved with individual social needs being assessed and responded to. Health and safety issues in the home are being responded to with clear procedures being followed.

What the care home could do better:

Systems need to be adopted to ensure that the resident or their representative are involved in the planning of the residents care and that this is documented. Although Heatherdene nursing home has 2 separate communal areas these are small and need to be improved along with the disabled access to the gardens. Although staff training is improving further training needs to be established to ensure staff have the skills to fully meet all the needs of the residents in the home.

CARE HOMES FOR OLDER PEOPLE Heatherdene Nursing Home The Highlands Bexhill on Sea East Sussex TN39 5HL Lead Inspector Melanie Freeman Unannounced 29 April 2005 10:00 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 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. Heatherdene Nursing Home H59-H10 S47280 Heatherdene V223188 290405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Heatherdene Nursing Home Address The Highlands Bexhill on Sea East Sussex TN39 5HL 01424 224518 01424 212800 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Zeenat Nanji & Dr Tasneem Osman Mr Stianand Baichoo Care Home with Nursing 23 Category(ies) of Old age, not falling within any other category registration, with number (OP) 23 of places Heatherdene Nursing Home H59-H10 S47280 Heatherdene V223188 290405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users to be accommodated is 23. 2. That the care home provides general nursing care to older people over the age of 65. 3. That rooms 5 and 15 are the only rooms used as shared rooms. 4. That the communal space is improved to meet the pre commission Health Authority standard by June 2005. 5. That the bathing facilities are improved by June 2005. Date of last inspection 1 February 2005 Brief Description of the Service: Heatherdene is registered to provide nursing care for older people and accommodates both privately and those service users who are funded by social services.Heatherdene was originally a family home and has been greatly extended and adapted to its present use over the last 20 years.The home has 21 bedrooms 2 of which can be used for sharing and 6 of the single rooms have en-suite facilities. Heatherdene Nursing Home is situated on the outskirts of Bexhill on Sea, in a private residential road in an elevated position facing towards the sea, with attractive gardens on all sides.Heatherdene is owned by a family partnership that also owns and manages another care home in East Sussex. Heatherdene Nursing Home H59-H10 S47280 Heatherdene V223188 290405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out between the hours of 10.00 and 15.30. The registered manager was on duty and was able to contribute to the inspection process and received the inspector’s feedback. The inspector was able to spend time with residents in communal areas and in their own rooms she also met with 4 visitors and a trainer who was carrying out one of the mangers assessments. Staff were spoken to and observed as they worked. The inspector ate a meal that was prepared for residents and was able to observe that afternoon’s entertainment provided by a visiting magician. It was clear that the home had made good progress in meeting the requirements made at the last inspection. What the service does well: What has improved since the last inspection? The home has made good progress towards meeting the requirements made at the last inspection. The plans of care have been improved and now fully record any pressure sore or risk of pressure sore development. Records also record the appropriate nursing care to be provided in such circumstances. The activities and entertainment in the home has been improved with individual social needs being assessed and responded to. Health and safety issues in the home are being responded to with clear procedures being followed. Heatherdene Nursing Home H59-H10 S47280 Heatherdene V223188 290405 Stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Heatherdene Nursing Home H59-H10 S47280 Heatherdene V223188 290405 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Heatherdene Nursing Home H59-H10 S47280 Heatherdene V223188 290405 Stage 4.doc Version 1.20 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 standard(s) 1,2,3 and 6 The inspector found that the home provides prospective and existing service users, with a good level of information on the services and facilities provided. Pre-admission procedures are good and help ensure that service users are appropriately placed in a service that is suitable to meet their needs and one that they choose to live in. EVIDENCE: On arrival at Heatherdene Nursing Home the inspector confirmed that a statement of purpose and service users guide was on display in the front entrance. This contains full information and a copy of the service users guide is given to prospective service users and is available in all bedrooms. The inspector was able to see signed copies of terms and conditions of residency provided to service users and held within individual files. Full assessments are undertaken by the home manager prior to any service user being admitted to the home and these are retained within the care documentation. The inspector spoke to the wife of a newly admitted service users and she confirmed that she had visited the home and had been provided with useful information before the admission of her husband was agreed. Intermediate or rehabilitative care is not provided at Heatherdene nursing home. Heatherdene Nursing Home H59-H10 S47280 Heatherdene V223188 290405 Stage 4.doc Version 1.20 Page 9 Heatherdene Nursing Home H59-H10 S47280 Heatherdene V223188 290405 Stage 4.doc Version 1.20 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 and 10 The home was found to be meeting service users health and general needs and accessed additional community support when needed. The inspector judged that service users privacy and dignity rights were upheld. EVIDENCE: The care documentation of 2 service users were inspected in depth and these demonstrated that full assessments are completed and these are used to inform the plans of care generated. Although the plans of care were full and provided clear guidance to care staff they are pre printed and they are not always fully accurate. The care documentation reviewed demonstrated a regular review of care, it did not however record the service users or their representatives involvement in the planning of care. A recognised pressure sore assessment tool is used to identify service users at risk of pressure sore development and appropriate equipment was seen in response to this risk. Service users representatives confirmed that they believed that the home was meeting the health care needs of service users. The care documentation maintains clear records demonstrating community health care involvement in service users care needs. During the inspection the inspector observed that staff were moving service users in a safe and competent manner with the use of appropriate equipment. Heatherdene Nursing Home H59-H10 S47280 Heatherdene V223188 290405 Stage 4.doc Version 1.20 Page 11 Service users and visitors spoken to said that staff were courteous and that they gave choices to service users on how and where they spent their day. Service users spoken to confirmed that they had an opportunity to vote in the general election. Heatherdene Nursing Home H59-H10 S47280 Heatherdene V223188 290405 Stage 4.doc Version 1.20 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15 The activities and the provision of meals are managed well by the manager and his staff, ensuring that quality in these areas is good and that choice and variation is available. EVIDENCE: In general conversation 1 service user said that she was ‘happy in the home’ and enjoyed the afternoon entertainment that included ‘bingo, films and a visiting magician’. On the day of this unannounced inspection the magician provided entertainment in the afternoon that was greatly enjoyed by the service users who attended. Social assessments are being recorded in the care documentation. All service users spoken to complemented the food and the meal eaten by the inspector was satisfactory. Service users also confirmed that choices at meal times are available. Heatherdene Nursing Home H59-H10 S47280 Heatherdene V223188 290405 Stage 4.doc Version 1.20 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 standard(s) 18 Procedures and training in the home ensure that adult protection issues are managed appropriately. EVIDENCE: The home has a detailed adult protection procedure and has the local guidelines available in the office area. Staff have received training on adult protection issues within the year. The home has co-operated fully with the Adult Protection team who received an alert in respect of a service user admitted from Heatherdene nursing home. The investigation has now been concluded and the home has responded to findings by changing some procedures and practice in the home. The investigation did not identify any neglect in the home. Heatherdene Nursing Home H59-H10 S47280 Heatherdene V223188 290405 Stage 4.doc Version 1.20 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 standard(s) 19,22,24 and 25 The home provides service users with a comfortable environment that is well decorated and home like. Individual rooms are equipped to meet service users needs. Disabled wheelchair access to the garden is not provided. EVIDENCE: Heatherdene nursing home is a converted family home and has retained a homely looking environment. A tour of the home confirmed that a good standard of decoration is maintained throughout along with a good standard of cleanliness. The communal areas are well used and these are to be improved to meet the national minimum standards as agreed with the registered owners when they purchased the home. The CSCI are awaiting confirmation of when this matter is to be progressed. There is a patio area and attractive gardens. The gardens do not provide a pathway for wheelchairs and 1 service user said he would like to get out in the garden more. It was noted that all rooms had appropriate furniture with radiators guarded and all hot water controlled to a safe temperature. Heatherdene Nursing Home H59-H10 S47280 Heatherdene V223188 290405 Stage 4.doc Version 1.20 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28 and 30 Staffing arrangements and numbers were satisfactory to meet the needs of service users. Staff training is developing but does not fully demonstrate that staff are trained to do their jobs. EVIDENCE: At the time of this inspection 21 services users were living in the home. The staffing arrangements have been reviewed since the last inspection and the inspector noted that the staffing provision was adequate and the needs of the service users were being met. In addition to the care staff appropriate kitchen and catering staff are employed. During the inspection service users and visitors commented positively about the staff attitude saying ‘staff are very kind’ ‘extremely kind and helpful, ‘welcoming pleasant and cheery’. An agency staff confirmed to the inspector that she liked working at Heatherdene and felt she received good support from the registered nurses in the home, who are readily available and work along side the care staff. The home is progressing staff training with induction training being clearly documented in staff records. Foundation training and NVQ training for care staff at level 2 has still to be fully established. Heatherdene Nursing Home H59-H10 S47280 Heatherdene V223188 290405 Stage 4.doc Version 1.20 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33 and 38 The registered manager promotes a positive inclusive environment where staff and service users are happy to consult with him. The systems for seeking service users views needs to be built on in order to review aspects of the home’s performance. Procedures followed in the home ensure the welfare of staff and service users. EVIDENCE: On the day of inspection the registered manager was working in the home and it was clear from interaction observed with staff and service users that he has an excellent rapport with both, responding to service user wishes sympathetically. Systems for quality monitoring are in place and include service users questionnaires on the care and facilities in the home. Service users/relatives meetings are not held and the results from the questionnaires are not published. Health and safety concerns raised the last inspection were responded to quickly and all radiators are now guarded. Safe working practices are Heatherdene Nursing Home H59-H10 S47280 Heatherdene V223188 290405 Stage 4.doc Version 1.20 Page 17 promoted and relevant staff training was seen to be documented along with appropriate policies and procedures. Heatherdene Nursing Home H59-H10 S47280 Heatherdene V223188 290405 Stage 4.doc Version 1.20 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x 2 x 3 3 x STAFFING Standard No Score 27 3 28 1 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x 2 x x x x 3 Heatherdene Nursing Home H59-H10 S47280 Heatherdene V223188 290405 Stage 4.doc Version 1.20 Page 19 yes Are there any outstanding requirements from the last inspection? 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 7 Regulation 15(1) Requirement That plans of care are written with the involvement of service users or their representatives and pre written care plans are always adapted to reflect the individual care needs. That access to the garden for disabled service users is improved. That training is established to meet the NTO work force training targets and that more care staff are trained to NVQ level 2. That effective quality assurance and quality monitoring systems are fully implemented. Timescale for action 1.6.05 2. 3. 22 30 23(2)(a 18(1)(c 1.7.05 1.8.05 4. 33 24 1.7.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 22 Good Practice Recommendations That an assessment of the premises and facilities should be undertaken by a qualified Occupational Therapist, to advise on the suitability of disability equipment and environmental adaptations. H59-H10 S47280 Heatherdene V223188 290405 Stage 4.doc Version 1.20 Page 20 Heatherdene Nursing Home Heatherdene Nursing Home H59-H10 S47280 Heatherdene V223188 290405 Stage 4.doc Version 1.20 Page 21 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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. 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