CARE HOME ADULTS 18-65
Heatherington House 5 London Road Kettering Northants NN16 0EF Lead Inspector
Keith Williamson Unannounced Inspection 4th December 2006 09:00 Heatherington House DS0000067633.V312558.R01.S.doc Version 5.2 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 Heatherington House DS0000067633.V312558.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 Adults 18-65. 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. Heatherington House DS0000067633.V312558.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Heatherington House Address 5 London Road Kettering Northants NN16 0EF 01536 411064 01536 411065 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) kingston@consensushealthcare.org Consensus Support Services Limited Miss Lisa Marie Bellamy Care Home 8 Category(ies) of Learning disability (8), Mental disorder, registration, with number excluding learning disability or dementia (3) of places Heatherington House DS0000067633.V312558.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No person falling within category MD, Mental Disorder excluding Learning Disability or Dementia, may be admitted to Heatherington House unless that person falls within category LD, Learning Disability ie. Dual Disability The maximum number of persons accommodated within Heatherington House is 8 27-02-06 2. Date of last inspection Brief Description of the Service: Heatherington House is one of five registered homes in Kettering owned and run by the registered providers, Consensus Support Services Limited. These homes are collectively known as Gretton Homes, with the central office being located in Gretton House in the village of Gretton. Heatherington House continues to provide personal care for residents with Prader-Willi Syndrome. The registration category for Heatherington House is learning disability (LD), to include up to a maximum of three residents who may in addition have a past or present mental disorder (MD). The age range of residents at the time of inspection is within the category of Younger Adults, with eight male residents in residence at the time of inspection. As with the other Gretton Homes Houses, Heatherington House takes residents from all over the country as the staff team are experienced in working with residents with Prader-Willi Syndrome. Heatherington House is close to the centre of Kettering and therefore the residents benefit from the proximity of community resources, such as the nearby swimming pool, shopping centre, etc. Heatherington House, in common with all other Gretton Homes, enjoys the benefit of its own transport for residents. This enables residents to benefit from access to a wider variety of resources located elsewhere in the county. Heatherington House is now a non-smoking home. Heatherington House DS0000067633.V312558.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of the inspections undertaken by the Commission for Social Care Inspection (csci) is upon outcomes for service users and their views of the service provided. The primary method of Inspection used was ‘case tracking’ which involves selecting clients and tracking the care they received through looking at their records, talking with them where possible, and looking at their accommodation. This inspection took place over one weekday, commencing at 9.00am took five hours to complete, and was assisted by the Deputy Divisional Manager. An opportunity was taken to look around the home, view records, policies and care plans and to talk to the residents and staff. All residents were seen during the inspection and any comments made to the inspector on their impressions of the home, are included in this report. A number of questionnaires forwarded by the commission for social care inspection, to the residents in the home, their relatives or other interested professionals, have been returned, and any comments have been included as part of this report. There are no privately funded service users at the home, and the cost of each placement falls between £1429.40 and £1810.33 per week. Comments to the Inspector from residents included: “I chose to come here, to lose weight – its too strict at times but I enjoy being here”. “I enjoy going to the woodwork project, it’s a long drive but I quite enjoy that as well”. “We are going out to the library today, then we go for a drink”. “I am going to see my girlfriend tonight, the staff help me get there”. “I enjoy going swimming, but not the gym”. What the service does well:
Residents’ needs are assessed prior to moving into the home. Care plans are negotiated with residents, and the sample of plans were signed by the residents. Heatherington House DS0000067633.V312558.R01.S.doc Version 5.2 Page 6 Decision-making and autonomy is promoted through effective care planning, and pointers are given to staff how to promote resident choice. Care plans are held in the office along with other sensitive information being appropriately secured. Risk assessments are in place, which details how care is to be delivered, this promotes the health and welfare of both service users and staff. Personal development is recognised in each residents individual care plan and weekly timetable. Some of the current residents benefit from further education and independence courses, others from paid employment. All residents have individual weekly timetables in place; recognition is given to individuals continuing to use facilities familiar to them. Daily routines are reflective of individual resident lifestyles, and are designed to suit the residents’ needs. Meals and mealtimes are strictly controlled, and these restrictions are well documented in the contract and plan of care. Meals are produced to suit the individual residents dietary requirements. Personal support is offered on a flexible basis, care plans reflect what abilities residents have; and there is a strong emphasis on residents working toward independence. The monitoring of residents healthcare is regularly undertaken. Residents are supported to manage their own healthcare, but no resident has yet commenced self-medicating. Medication is administered appropriately by the staff. The manager has the necessary complaints procedure and policies in place. Staff spoken with demonstrated a good awareness of both the complaints and adult protection policies and procedures were operated. There have been no complaints recorded since the last inspection of this service, and none forwarded to the commission for social care inspection. The environment of the home is warm and friendly. The decor of the home is of a very high standard, with a plan for re-decoration and replacement of the furniture and chairs to the main lounge. A security camera has been installed to cover the car park area to the rear of the home; this has increased security in an isolated area of the home. Bedrooms are all single occupancy are individually decorated, personalised and include a range of personal electrical equipment. Residents also benefit from having individual bedroom keys. The public areas of the home provide a homely comfortable atmosphere. The staff turnover at the home is low and this provides residents with continuity and consistency of care. A number of the staff group have completed National Vocational Qualifications at levels two and three, some have undertaken the Learning Disability Training (ldaf) course. Job descriptions are in place for all staff members to clarify their understanding of the various roles and responsibilities.
Heatherington House DS0000067633.V312558.R01.S.doc Version 5.2 Page 7 A thorough recruitment procedure is followed with references and criminal record bureau clearances being obtained prior to new staff working with residents. Staff are provided with a comprehensive induction and training programme. Residents felt that their opinions were listened to, valued and acted upon and that they had trust and confidence in the staff group as a whole. Residents confirmed they were involved in the quality assurance of the home by participating in questionnaires issued by the manager. The system for safekeeping of residents’ moneys monies was inspected and found to be secure. A selection of records including fire and accident were inspected. Fire safety was well maintained with weekly fire tests and regular drills carried out. A good approach is taken to ensuring safe working practices. What has improved since the last inspection? 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. Heatherington House DS0000067633.V312558.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heatherington House DS0000067633.V312558.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 & 5. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. The admission process is detailed and effective resulting in accurate information for prospective residents and staff. EVIDENCE: Residents’ needs are assessed prior to moving into the home. The manager compiles information using the health and social care assessments, and in some cases previous knowledge of the resident; providing an information base from which comprehensive and detailed care plans and risk assessments are then produced. The case tracked residents files were viewed; completed signed contracts are in place. Contracts specify any restrictions placed on residents in the home. Heatherington House DS0000067633.V312558.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. Residents are looked after well in respect of their individual personal care needs, areas of risk are assessed appropriately. EVIDENCE: The care plans and records of three residents were viewed. The care plans contained information as to how the care needs of the residents are to be met. Care plans are negotiated with residents, and the sample of plans were signed by the residents. Decision-making and autonomy is promoted through effective care planning, and pointers are given to staff how to promote resident choice. Care plans are held in the office along with other sensitive information being appropriately secured. Residents’ participation in the home continues with regular resident meetings and questionnaires being circulated to the residents and wider circle of relatives and professionals involved with the home.
Heatherington House DS0000067633.V312558.R01.S.doc Version 5.2 Page 11 Risk assessments are in place, which details how care is to be delivered, this promotes the health and welfare of both service users and staff. The staff record day to day events in an ongoing record, these were seen on individual resident files, and those sampled are completed appropriately. Heatherington House DS0000067633.V312558.R01.S.doc Version 5.2 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17. Quality in this outcome area is excellent. This judgement has been made using the available evidence including a visit to the service. Residents experience an appropriate and fulfilling lifestyle. EVIDENCE: Personal development is recognised in each residents individual care plan and weekly timetable. Some of the current residents benefit from further education and independence courses, others from paid employment. All residents have individual weekly timetables in place; recognition is given to individuals continuing to use facilities familiar to them, even though this involves staff in extended travel. All weekly timetables are personalised and negotiated with the residents prior to commencement, and covers leisure activities and personal development. Daily routines are reflective of individual resident lifestyles, and are designed to suit the residents’ needs. Heatherington House DS0000067633.V312558.R01.S.doc Version 5.2 Page 13 Meals and mealtimes are strictly controlled, and these restrictions are well documented in the contract and plan of care. Meals are produced to suit the individual residents dietary requirements. Residents spoken with indicated, “I enjoy going to the woodwork project, it’s a long drive but I quite enjoy that as well” “We are going out to the library today, then we go for a drink”. “I enjoy going swimming, but not the gym”. Heatherington House DS0000067633.V312558.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 & 21. Quality in this outcome area is excellent. This judgement has been made using the available evidence including a visit to the service. Resident’s health and personal care needs are met on an individual basis. EVIDENCE: Personal support is offered on a flexible basis, care plans reflect what abilities residents have; and there is a strong emphasis on residents working toward independence, evidence is in place to suggest these plans are reviewed and updated regularly. The monitoring of residents healthcare is regularly undertaken, and visits from specialist medical staff and General Practitioners is undertaken flexibly and recorded individually. Residents are supported to manage their own healthcare. Medication is administered appropriately, the staff when spoken with, showed a good awareness of administration techniques. Medication is stored securely, the medication administration records (marr charts) being up to date, signed appropriately and having no omissions. The final wishes of residents are recorded appropriately in each of the residents’ plans of care.
Heatherington House DS0000067633.V312558.R01.S.doc Version 5.2 Page 15 Residents spoken with indicated, “I chose to come here, to lose weight – its too strict at times but I enjoy being here”. “I am going to see my girlfriend tonight, the staff help me get there”. Heatherington House DS0000067633.V312558.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. Residents are protected by the policies and procedures regarding complaints and adult protection, produced by the home. EVIDENCE: The manager has the necessary complaints procedure and policies in place. Staff spoken with demonstrated a good awareness of both the complaints and adult protection policies and procedures were operated. There have been no complaints recorded since the last inspection of this service, and none forwarded to the commission for social care inspection. Detailed examination of the adult protection policy indicated that sufficient information is contained in the document for staff members’ guidance on how to prevent abuse in the home. The manager stated that adult protection issues were was openly discussed at resident and staff meetings. Heatherington House DS0000067633.V312558.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 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, 26, 28 & 30. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. Residents live in a homely, comfortable and clean environment. EVIDENCE: The environment of the home is warm and friendly. The decor of the home is of a very high standard, with a plan for re-decoration and replacement of the furniture and chairs to the main lounge. A security camera has been installed to cover the car park area to the rear of the home; this has increased security in an isolated area of the home. Bedrooms are all single occupancy are individually decorated, personalised and include a range of personal electrical equipment. Residents also benefit from having individual bedroom keys, thus affording the choice of private time alone. The public areas of the home provide a homely comfortable atmosphere, with numerous public areas giving residents an excellent scope of utilising the space available, with a flexible approach to time spent in the home. Heatherington House DS0000067633.V312558.R01.S.doc Version 5.2 Page 18 Staff showed a good awareness of cross contamination issues, with laundry facilities being appropriately sited and domestic in nature. Heatherington House DS0000067633.V312558.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. The manager employs a well-trained, competent and supportive staff group who continue to promote and protect the well being of residents in their care. EVIDENCE: The staff turnover at the home is low and this provides residents with continuity and consistency of care. A number of the staff group have completed National Vocational Qualifications at levels two and three, some have undertaken the Learning Disability Training (ldaf) course. A sample of staff rotas showed that appropriate numbers of staff are on duty on all shifts including a sleeping in night “companion”. Staff confirmed staffing levels are adjusted according to residents needs and to take account of residents’ activities or periods of greater need. Job descriptions are in place for all staff members to clarify their understanding of the various roles and responsibilities. The staff group also demonstrated that they worked as a close-knit team protecting the well being of their residents. Heatherington House DS0000067633.V312558.R01.S.doc Version 5.2 Page 20 A thorough recruitment procedure is followed with references and criminal record bureau clearances being obtained prior to new staff working with residents. The main files are held securely in the Managers’ office, with copies of all documents also being held centrally at the company main offices. Staff are provided with comprehensive training and the training plan showed that this included induction, core training, updates and specialist training such as dealing with challenging behaviour. Staff are encouraged to undertake National Vocational Qualifications and currently 100 of the regular staff group have completed their training, in level 2 some in level 3 and the The staff member spoken with confirmed that she received supervision and support from the manager. Heatherington House DS0000067633.V312558.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 & 42. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. The Management of the Home is effective, accessible and responsive to the needs of both the residents and staff. EVIDENCE: Staff members spoken with felt that the management team were accessible and approachable, and willing to discuss any issues and guide practice. The manager was viewed as very supportive to the staff team. Residents felt the staff group were approachable, and commented that they had almost daily contact with them. Residents felt that their opinions were listened to, valued and acted upon and that they had trust and confidence in the staff group as a whole. Residents confirmed they were involved in the quality assurance of the home by participating in questionnaires issued by the manager. The system for safekeeping of residents’ moneys monies was inspected and found to be secure.
Heatherington House DS0000067633.V312558.R01.S.doc Version 5.2 Page 22 A selection of records including fire and accident were inspected. Fire safety was well maintained with weekly fire tests and regular drills carried out. Staff confirmed that they assisted in the completion of these routine tests. A good approach is taken to ensuring safe working practices. Staff confirmed they receive regular updated training in this area. Records were safely and securely held, though the recording of daily records by support staff names residents in other resident’s records. This practice is not in line the current guidance of the Data Protection Act, and must be amended to ensure compliance with that Act of Parliament. . Heatherington House DS0000067633.V312558.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 4 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 3 3 X 3 X 3 3 X Heatherington House DS0000067633.V312558.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 Heatherington House DS0000067633.V312558.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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