Inspection on 27/07/07 for Heathers, The

This inspection was carried out on 27th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Heathers, The 13/10/06

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Heathers, The The Heathers 35 Farnaby Road Shortlands Bromley Kent BR1 4BL Lead Inspector Wendy Owen Unannounced Inspection 27th July 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 Heathers, The DS0000067267.V339174.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. Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heathers, The Address The Heathers 35 Farnaby Road Shortlands Bromley Kent BR1 4BL 020 8460 6555 020 8697 6979 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) The Heathers Residential Care Home Ltd Mrs Heather Hall Care Home 12 Category(ies) of Old age, not falling within any other category registration, with number (12) of places Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th October 2006 Brief Description of the Service: The Heathers is two adjoining, older style converted and extended semidetached houses located in a quiet residential area of the London Borough of Bromley. It is within a short walking distance of local shops and public transport. The home is on three levels with service users accommodated on all three floors, accessed by a lift. All bedrooms have single occupancy with some benefiting from en-suite facilities. Each floor has a kitchenette and there is a lounge and dining room on the ground and first floor. There is limited off street parking to the front of the house, which has an attractive, well-maintained garden to the rear. A veranda provides extra outside space for residents wishing to spend time in the open air. The home is under new ownership and management with the staff team remaining in post to provide continuity of care to residents. Information is provided in the form of a Service Users Guide and Statement of Purpose both of which are in written format. Details of the terms and conditions of residency are included in this information. Fees range from £500.20-£520.00 (for en-suite rooms) Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection included viewing the information sent to the Commission, written surveys received from relatives and residents and an unannounced visit. The visit took place over a day and a half and included a tour of the building, observation of practice and verbal feedback from 4 residents and 1 relative. Records were viewed and the inspector also had discussions with the manager and two care staff. Eleven residents were in the home on day of the visit. What the service does well: The Heathers provides a good standard of care to the people living in the home making them feel valued and giving an overall sense of well-being. One relative wrote that the home provides: “ an excellent level of care and support to maintain X’s quality of life.” One resident told the inspector of the way in which she came to live in the home, first of all coming for respite and liking it so much that she wanted to stay. Another resident wrote that they had been coming into the home for several years on respite before living here permanently. It has a “Home from home feel” wrote one relative, whilst another resident wrote: “From the very first day I knew it was the home for me.” Prior to admission residents are assessed to ensure the home can meet their needs and individuals are encouraged to visit the home before making any decisions. Written information is provided to residents and relatives in the form of a Statement of Purpose and Service Users Guide. Once the decisions has been made and residents come to live at The Heathers, a care plan with supporting risk assessments is developed to ensure staff have the information they need to provide the care and support. The home ensures the healthcare needs of residents are met with relatives being informed of any concerns and medication practices ensuring the safety and promoting the health of the residents. Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 6 “I most appreciate being accompanied on my hospital visits by a member of staff.” Wrote one individual. The home also encourages residents to make decisions and choose how to spend their day balancing risks with encouraging independence. “Sometimes I don’t feel like doing things-the staff are very good, allowing me complete freedom but encouraging me when I need it.” said one individual. Residents are able to raise any concerns or issues with the manager and staff knowing that they will be listened to and their concerns acted upon. The food is of a satisfactory standard, although one resident said “I feel I could eat more for the evening meal….” Staff understand the needs of the residents with a very stable workforce using very few agency staff. A relative said of staff: “there is a range of experience across the staff. There is very little staff turnover so the knowledge of each individuals needs is maintained.” Whilst another wrote “The Heathers has some outstanding staff and I am very happy with X’s care.” Staff feel well supported by the manager and are comfortable in raising concerns. The physical environment is comfortable and homely decorated in a domestic style with residents’ own rooms personalised. Of the cleanliness relatives and residents felt it was “spotless” What has improved since the last inspection? Since the last inspection the manager has improved the information provided to staff regarding the residents’ needs. The care plans and risk assessments provide good information many areas of the residents identified needs. The way in which the home ensures the residents’ safety in respect of those that self-administer medication has also been reviewed. The complaints procedure has been amended to reflect the current Provider and management of the home and a complaints book is also in place to ensure all complaints are logged. Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 7 The last inspection required the home to monitor and record residents weights to ensure nutritional needs are met. At this inspection there were good records in place. Staff are also being provided with first aid training to deal with emergencies in the home. What they could do better: The Statement of Purpose, Service Users Guide and the complaints procedures must be provided in various formats to ensure residents are able to understand the information provided. Care plans have improved since the last inspection. However, they would benefit from being more formally reviewed with the resident and, if desired, the family. The staff must ensure there are accurate records of the health checks and visits made by health professionals to ensure residents’ continued health. The medication procedures must be amended to reflect good practice in medication practices and records of receipt, administration and disposal must be maintained to ensure the safety and well-being of those living in the home. The home is comfortable and reasonably maintained. However, access for those with mobility needs or disabilities must be improved to ensure residents are able to move freely throughout the home safely. One relative did say that a “ramp is required from the dining area/lounge to the patio area as people with visual impairment cannot always see the door edge/strip. Training for those staff who are new to the home must be more structured and meet the Skills Sector Council Common Induction Standards. More specific training must also be provided to ensure staff are able to meet individual needs. There were some concerns over the way in which the health and safety of the home is met. Two areas had not had the required checks or examinations and fire drills and instruction are not meeting the requirements of the Fire Service. There is little evidence of staff being formally supervised to ensure staff are able to provide a consistent quality of care. Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 8 There is little evidence of a review of the service being undertaken and involvement of residents in the running of the home. This would ensure the home is run in the best interests of the residents. A more robust system is in place for ensuring the personal finances are protected. 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. Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Some information is available to those using the service explaining what to expect if they choose to live in the home. The assessment process ensures that the home admits those individuals whose care needs they are able to meet and that staff have the information to provide the individual care required. EVIDENCE: Information for prospective residents and their family is provided in the form of a Statement of Purpose and Service Users Guide. It is comprehensive, although there is also some information missing. For example: details of the Provider. The document is written in small font and is not suitable for those residents who have sight problems, of which the AQAA states there are five in the home. The Statement of Purpose also contained details of the contract. (please see comments below) (See requirement) Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 11 Since the last inspection two residents have been admitted, one of which was an “emergency placement” whilst the other was more managed. In this instance the residents’ family viewed the home on behalf of their relative who was coming from another home, a distance away. In the case of the first resident, who was admitted privately for a period of convalescence, the manager who is a RGN, had undertaken an assessment at the hospital. In the second admission the Local Authority were involved in the placement, the manager had obtained the Care Manager’s assessment and undertaken an assessment herself. When the inspector spoke to the resident who was in the home for “convalescence” he told the inspector that, even though he had only been in the home for one day, he felt comfortable with staff and that they were able to assist him with his needs. He had been given information and told about routines in a relaxed manner. The second resident said that staff cared for her well but she expressed unhappiness at the lack of activities. (See comments in the relevant standards). One other resident who has been in the home for some time said “From the very first day I knew it was the home for me.” All spoken to had only positive comments regarding the care staff and manage and were satisfied that their needs were being met. The Provider has also produced a contract that contains much of the information required to enable people to make a decision as to whether or not the home is suitable for them. It would be beneficial to ensure “reasonable” notice by both sides (re trial period) is clarified to ensure there is some protection to the home and the resident. (See recommendation). The resident who had been admitted for respite care had a copy of the respite agreement in their personal file, whilst in the second case there was no evidence of the agreement between the home and themselves or the local authority placement agreement. There was no evidence of the funding arrangements and who was responsible for payment of the fees. (See requirement) Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All residents have care plans developed together with other information to ensure staff are able to support them in their day to day lives with minimum risks. Their healthcare needs are met through satisfactory medication practices and access to healthcare personnel to ensure their continued health and wellbeing EVIDENCE: It was evident from the written and verbal feedback received from relatives and residents that the home provides a good standard of care to those people living there. A number of residents and relatives wrote of how staff encourage independence, respecting the fact that there are risks involved which they wish to take. One wrote that, the “staff are there if I need their help”. This is also a principle advocated in the Statement of Purpose. One relative said despite their father having a stroke the home was excellent at “ensuring he was able to continue with his independent lifestyle rather than focussing on the risks all the Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 13 time.” They respected his rights to live the life he choose with him able to decide upon the risks involved and whether he was prepared to take the risks. Another relative wrote that The Heathers provides “an excellent level of care and support to maintain X’s quality of life.” On visiting the residents the inspector noted that they were well presented and well groomed with clothes befitting the weather. Records viewed in respect of three residents showed that all of them had a care plan detailing the care required together with an assessment of living providing further information for staff. Discussions with the residents in question showed that the care plans, generally reflected the care and support required, although gaps were evident in social and financial needs and, in some cases more information was required in some of the identified needs. For example where the individual is a diabetic the District Nurse and staff role should be evident, particularly in respect of checking blood sugar levels and the link between the DN administering insulin and the resident taking meals. (See recommendation) It was also positive to note that an integral part of the care plan included the residents’ preferred routines for the day. It was clear from discussion that residents are able to shower or bath whichever is their preference and that this is not restricted to once a week. The inspector noted a number of different aids to daily living including zimmer frames and wheelchairs which had been provided to individual residents as well as grab rails and handrails. It would be beneficial to evidence how the home is maintaining the equipment used. (See recommendation) Despite the attempts by the manager to implement a keyworker system this has not been adopted. It is worth persevering to enable the relationships to build and this would benefit improvements in the reviewing process. To date reviews have been completed in-house with the manager reviewing the care plans. There is little evidence of residents, relatives or other interested parties, such as Care Managers being involved. (See requirement) It was also clear from feedback that residents and relatives felt their health needs are being met. Two residents wrote that their health needs are generally met, whilst six said they are always met. All the relatives’ feedback confirmed that the are kept up to date with anything affecting the resident, with one relative writing that it was: “A rare occurrence (anything happening) but I am always consulted even about less major issues.” Whilst the feedback confirms the medical needs are being met, it is difficult from the records specific to these recordings to note GP and other involvement, as it is not accurately recorded and you would have to trawl through daily records to find the appropriate information. However, there is Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 14 good evidence of the residents being weighed regularly with records showing weights remaining fairly static or increasing. (See recommendation) Risk assessments, although basic, were in place for falls, moving and handling, nutrition and pressure care. Observations made whilst touring the home during the early morning routines showed staff knocking on doors before entering, chatting away with residents and ensuring doors remained closed during this time. Those residents spoken to confirmed that during these times staff respected their privacy and felt that their dignity was respected. An audit of the medication procedures and practices showed that records were generally completed well. There were some gaps in the recording of allergies, short-term medication received and variable doses need to record how many i.e. 1 or 2. One person self- administers medication and records showed this, although the records do not show how much medication has been handed over each time and there are no records of the manager checking for non-compliance. The inspector checked that the medication was kept secure in a lockable space in their rooms. All other medication was kept secure in a medication trolley or locked cupboard and there is a list of signatures of staff authorised to administer medication. The manager must ensure the initials of the previous manager are removed. There are controlled drugs in use at present. There are homely remedies in stock with a policy dated 04/06. This requires updating to meet the needs of the current group, especially with the individual with diabetes. The record of disposal book could not be located over the two days of the visit and therefore records of medication disposed could not be checked. The home has a contract with a pharmacy for supply of their prescribed medication and an audit dated 11/9/06 showed the systems to be satisfactory. The medication policy and procedures are comprehensive, although some areas require amending such as bulk supply of prescription only medications. A number of staff have received training in the safe handling of medication as part of a distance learning course or training from the pharmacist. (See requirement) Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Routines in the home are flexible with residents choosing how to spend their days. However, there is limited activity and stimulation and this may impact on the overall well-being of the individual. The quality of the food is satisfactory with meals that are varied, healthy and nutritious. EVIDENCE: Residents are encouraged to live the life that they chose and staff are keen to promote independence as much as possible. Previous comments detailed above show how this was viewed as an important part of one resident’s life where staff respected his right to take risks. Residents spoken to told the inspector how they were able to choose when to get up and got to bed as well as deciding how they wished to spend their days. One resident said “we are not forced to go to bed when staff say”. Another resident said the only routines were mealtimes and activities going on, otherwise they choose how they wish to spend their days. For most, this is choosing their own company, only meeting others at mealtimes or when there Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 16 is an activity or the hairdresser visits. Many read the daily newspapers or magazines that are delivered, have regular library visits or talking books, listen to the radio or watching TV. It is quite an insular life and since the activities are limited they generally meet at mealtimes. This life does not suit everyone with one lady telling the inspector that it is “boring” living here. Whilst another wrote “Sometimes I don’t feel like doing things - the staff are very good, allowing me complete freedom but encouraging me when I need it.” It is also evident that where staff spend their time undertaking personal care, laundry, cleaning and the cooking of meals, this tends to be the focus of their working day and interaction with residents is limited to mealtimes, personal care and general comments when they walk by. It is also said that residents choose to spend their days like this but when activities are held they tend to really enjoy them. Providing a stimulating environment and interacting with residents should be seen as part of their overall care needs as this promotes a sense of overall well-being. The way in which this area of life could be improved was discussed with the manager and staff member who were keen to try out different ways. It is clear that they are under the illusion that during the afternoon shift where there are two staff on duty and the manager they believe the home must be covered at all times with two staff and therefore do not attempt to leave the home with residents. This should not be a restriction on the home and, as long as there are systems in place for emergencies, then staff should be encouraged to be flexible and encourage outings. (See requirement) Whilst residents state that the are happy with the informal systems in place to involve them in the running of the home, the lack of quality assurance system and residents or relatives meetings means that the organisation does not have a true reflection of the quality of care and whether the routines of the home are planned around the residents. Visiting is flexible with relatives welcomed into the home made welcome. There is plenty of space in either in residents’ rooms or the communal areas to talk in private and the kitchenette has facilities for making refreshments. Positive relationships are fostered with relatives viewed as an integral part of the individual’s needs. One relative wrote of the staff they always “make nice cup of tea”. Residents are placed on the electoral register and are able to vote either by postal vote or at the local polling station. Residents had variable reports on the quality of the food provided. For many it was healthy and sufficient with plenty of choice. One wrote that the food is exceptional; three always liked food; four said “usually” and one “mostly.” Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 17 “ I am always given a choice if I don’t like something like mushrooms.” For others it was “so-so” and stating it had gone through a poor patch, although was getting a little better. “the food had suffered since Heather left but is has gradually got better.” The menus did not show what the alternatives are, although the manager stated that this is generally an omelette or salad. It would be good practice to have some other alternative available to ensure good choice and to actively involve residents in planning the menu. The Statement of Purpose states, “we have a full-time catering manager/cook preparing and cooking the meal. This is not correct as the night care staff member develops the menus and prepares some of the food that is then cooked by staff during the morning shift. The day staff also prepare the teatime meal. Breakfast is taken in residents’ rooms with lunch and tea-time meals taken in the main dining room with refreshments offered at various times throughout the day. Lunch is, for many, the first opportunity to meet and socialise with the other residents. Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are able to raise any concerns with the manager and staff, knowing that they will be listened and responded to without delay and any issues resolved. Residents feel safe and protected in the home, although procedures and knowledge of how to manage any allegations need improvement by all those involved in safeguarding vulnerable individuals. EVIDENCE: The last inspection identified that the complaints procedure provided details of the previous owner and manager. This has now been reviewed and amendments made to reflect the current situation. This should be made available in other formats such as large print. (See recommendation) A copy is on display in the hallway and provided in the information given to the residents. The manager has also produced a register to ensure complaints are logged. There are few complaints regarding the quality of care provided and the pre-inspection information detailed that there had been no complaints made in the last twelve months. The Commission is not aware of any complaints and nor have there been complaints made to social services. Feedback from residents and relatives showed that they were well aware of who to raise any concerns with and many wrote “never needed to” when asking about complaints. All provided positive comments about the way in Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 19 which the manager enabled residents to discuss any concerns and felt that she was approachable and would have no reservation in discussing issues with her. Adult protection procedures remain in place from the previous provider along with the Inter-Agency Guidelines for Bromley, where - as in this case - there are outer borough placements. The manager must also obtain the authorities adult protection procedures to inform any decisions. Discussions with the manager show that she is not - as yet - fully conversant with the management of allegations, the role the local authority adult protection co-ordinator, or of POVA. There is evidence of some staff being trained in protecting adults from abuse and one staff member had a sound knowledge of how she would deal with such incidents and understanding her role in referring incidents on. It is clear from discussions with residents that they feel safe and secure in the home and feel comfortable with staff. (See requirement) Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Heathers provides a warm, safe and homely place to live. It is adequately maintained and is clean and fresh. EVIDENCE: The Heathers provides a warm, comfortable and homely environment for those living there. It is however becoming a little tired and worn and needs some redecoration or refurbishment in places. The residents’ private rooms are all personalised and have the required furniture. One resident told the inspector that their room had not been redecorated since they had been there and that was a number of years ago. The manager stated that she was going to take the opportunity to decorate some rooms if she could transfer the resident temporarily to the vacant respite rooms. However, there has not been that Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 21 opportunity. Those spoken to generally felt their rooms met their day-to-day needs with many having TV, radio and telephones for their personal use. A visit by the Environmental Health Officer in 06/07 recorded the need to refurbish the kitchen in the next twelve months and when this was being completed fly-screens for the doors should be fitted. Residents have equipment such as mobility aids, and wheelchairs and grab rails etc are fitted throughout the home. Comments made in previous standards show that the equipment used by residents must be monitored for continued safe use. One relative felt that there should be more aids for those who have mobility problems, such as ramp access outside and from the kitchenette to the seating area and to the balcony. The Providers must investigate their access for those with a disability, especially in light of the Disability Discrimination Act. (See requirement and recommendation) There have also been issues, over the last few years, with the water supply. It is hoped this is now resolved. The home also has a more reliable “handyman”, although his time is shared between other projects and therefore The Heathers has limited use of his skills. This should be reviewed because there are a number of areas that require his input. The Providers have purchased a new parker bath and a washing machine with a sluice. However, these are yet to be fitted and the manager could not give a timescale for these to be fitted. Delays in such things can cause frustration and disappointment with staff and should be addressed quickly. The home employs one domestic and when she is on annual leave the care staff attend to these duties. All the feedback regarding the cleanliness was positive with one relative stating it was “spotless”. The home was of a satisfactory standard of cleanliness with no offensive odours. As said previously, a washing machine with a sluice facility is awaiting fitting and since the last inspection the manager has introduced the provision of soluble bags for soiled laundry. The laundry had adequate hand-washing facilities in place. Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff provide a good quality of care to those living in the home. Training continues to improve to ensure they are able to fully meet individuals’ needs. EVIDENCE: The Heather has thirteen permanent staff, four of whom have NVQ 2 and two are completing it at present. One member of staff spoken to has progressed to NVQ 3 and was very enthusiastic about the knowledge it gave her to continue providing good care. She believed that she had benefited immensely from this period of study. There will shortly be two vacancies within the home, and the manager is currently interviewing for these posts. From discussions with staff and the manager it was evident that contracts had not yet been provided to those working in the home despite the Providers having undertaken to do this last year. Staff are not fully aware of their terms and conditions – this is not good practice! (See recommendation) Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 23 On arrival at the home there were three care staff and the manager on duty. The domestic was on annual leave. Normally three care staff are on the morning shift with two in the afternoon and one at night with a member of staff on call in the home. Care staff undertake all care tasks, laundry and cooking tasks and, when the domestic is on annual leave, they also do the cleaning. The inspector is concerned that with staff involved in so many tasks there is not the time to spend quality time with individuals. This was noted on the day where many residents were in their rooms and staff undertaking tasks for the majority of the time, even during the quieter times in the afternoon. The feedback received about the quality of the care staff was positive. Staff support them well and are caring and sensitive to their needs. Some of the feedback also commented on how well the staff balance the risks with respecting the independence of the individuals. “They are there if I need them” said one. “Excellent staff” said another. Over the last few years the home has had a consistent workforce with very few changes and this has always been commented on because it ensures the residents receive a consistent level of care, staff work as a team because they know each other and residents well. The use of agency staff has always been limited, although recent months have seen an increase in the number of shifts required to be covered. Residents spoken to said that this was true mainly due to sickness and staff taking their holidays. However, this was not seen as a concern as the manager ensures the agency staff used have been those used previously, who know the resident well. The manager has improved the amount of training provided to staff over the last twelve months, mainly due to their involvement with the Bromley training consortium. There are still some areas that need to be covered, particularly around infection control and to ensure all staff are first aid trained. This is being addressed by the manager and will be monitored at the next inspection. Once core training has been completed together with the NVQ awards the manager should consider training specific to the needs of the individuals particularly around age related ailments and illnesses, for example: diabetes and visual impairment. It is positive to note that all staff are due to undertake training in deafness awareness to support those residents in the home who have a hearing deficit. (See recommendation) The last inspection required the manager to improve the recruitment procedures to ensure vulnerable residents are protected. Since that time there have been no new staff recruited, although the manager is currently interviewing for the vacant posts. The recruitment checks and documentation required was discussed to ensure she is fully aware of the requirements and this will be checked at the next inspection. As there have been no new staff recruited, induction training has not been required. However, the manager must ensure that she is aware of the regulations required as regards training Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 24 of staff and investigates the skills sector specifications for this training. (See requirements) Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management systems must be improved to ensure there is continuous improvement in the quality of care and ensure systems are monitored to ensure the health and safety of the residents. EVIDENCE: The manager has been in post for a number of months. She has applied to the Commission for registration but this has been delayed due to confusion over the documentation. She is experienced and qualified having previously owned her own residential home and worked as a RGN in the health service. There is Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 26 a need for her to update her knowledge in areas such as adult protection to ensure she is familiar with good practice. (See recommendation) All the feedback shows the manager to be kind, caring and approachable to residents, staff and visitors, building up good relationships. She visits all the residents in their rooms ever morning to chat and discuss issues and also at the end of her working day she “pops in” to say good-bye and check all is well. It has been mentioned in the previous standards that the lack of contract provided by staff and the manager and the unfairness of this to those employed by the Providers. It is positive that the manager now has a computer, and internet access is being planned. However, to access the internet the homes single telephone line would be kept busy, the manager is also unsure how to use the new systems. The Provider should consider having a separate telephone line installed and provide appropriate training for the manager. One relative stated “The new team have put some good systems in place and are planning to update some of the services.” There are informal processes that monitor the quality of care provided. However, there is a need to implement more formal processes, including annual reviews and auditing of the procedures. The manager should also consider introducing residents and relatives meetings to ensure she is clear on what users of the service expect from the service and where improvements could be made. (See requirement) The Providers visit each month and discuss issues with the residents, staff etc and tour the home. However, their report does not provide information on how records have been audited etc. The AQAA (information provided by the home to the Commission) showed that equipment and services have been checked regularly. A sample of these were viewed during the visit and were found (in the main) to be satisfactory. However the gas equipment and plant have not been serviced since August 05 and despite the AQAA stating that the fixed wiring was completed in 11/06 the only certificate of examination was dated 08/01, requiring a further inspection within the five years. The manager has ensured the gas had been serviced by the second day and had arranged for the fixed wiring examinations. These areas impact upon the health and safety of the home and therefore the residents in it. These must be monitored by the Provider and manager to ensure they are checked regularly, without waiting for the gaps to be noted during the inspection. (See requirement) In general the fire checks had been completed, although the number of fire drills undertaken each year are not meeting fire authority Regulations and the Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 27 staff must receive fire training every twelve months at least. (See requirement) With the exception of one resident, the home does not manage residents’ monies. Where monies are held these must be kept separate from the petty cash and receipts retained for all expenditure made by the home on the resident’s behalf. As the resident is able to acknowledge receipt of these items etc. the home should encourage her to sign for these purchases. Where the home makes purchases on behalf of other residents the relative or whoever is managing their monies is invoiced. Once again receipts must be maintained to ensure a clear audit trail. (See requirement ) A sample of policies and procedures were viewed and it was noted there were changes/updates in some. However, as stated in previous standards, some require amending. (See requirements) It was clear from comments made by the manager and staff that formal supervision has not yet taken place, and much of the manager’s time spent on other areas. There is an informal processes that benefit staff and she ensures that there is an open door policy and discussions as a group. However, more formal supervision is required on a one to one basis to ensure practices, personal development and training are addressed. (See requirement) Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 2 18 x 2 2 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 2 2 2 2 Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 29 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 OP1 Regulation 4 Requirement Information provided in the Statement of Purpose, Service Users Guide and complaints procedure must be provided in formats suitable for the residents to understand. Contracts must be available in the home for each resident. This must contain details of the fees and who is responsible for payment of them to ensure this is clear to the person living there. Residents care must be reviewed in consultation with the resident and where possible, a relative and Care Manager. Medication procedures and practices must be improved to ensure residents are safe. The manager must investigate ways in which activities can be provided to ensure residents are stimulated. The manager must look at ways in which they involve residents in the running of the home to ensure they are able to make decisions on the care provided. DS0000067267.V339174.R01.S.doc Timescale for action 01/10/07 2 OP2 5 01/10/07 3 OP7 15 01/10/07 4 5 OP9 13 16 01/09/07 01/11/07 OP12 6 OP14 16 01/11/07 Heathers, The Version 5.2 Page 30 7. OP18 13 The Registered Person must 01/10/07 ensure that the adult protection procedures reflect the changes in the management and Provider. Staff are to be provided with Protection of Vulnerable Adults training. Partly met. The Provider must provide the Commission with an action plan detailing how they intend to make all areas of the home accessible for residents to use safely. The Registered Person must ensure that they undertake the required recruitment checks prior to a new member of staff commencing employment in the home. This is an immediate requirement. No new staff recruited therefore the requirement has remained in place until the next inspection. 01/10/07 8 OP19 23 9. OP29 17 & 19 01/10/07 10 OP30 18 11 OP38 16 01/10/07 The Registered Person must ensure that new members of staff are provided with formal induction training. A record of this training must be maintained. This requirement has not been met. The previous timescale of 1/4/06 & 01/2/07 has expired. There have been no new staff requiring formal induction training and therefore this will be monitored at future inspection. No new staff recruited. This requirement remains in place to be monitored at the next inspection. The Provider must ensure that 01/10/07 systems are monitored to ensure equipment and services used are safe to protect the people living there. DS0000067267.V339174.R01.S.doc Version 5.2 Page 31 Heathers, The 12 OP38 23 The Registered Person must ensure fire drills are undertaken and records maintained as required by the Fire Service. This is a repeated requirement. Timescale of 01/11/06 has expired. The Provider must ensure that a review of service is carried out. This must involve consultation with residents and other interested parties. Staff must be provided with formal supervision to ensure care practices provide a consistent quality of care. The systems in place for managing residents personal monies must be made more robust to ensure individual monies are protected. 01/09/07 13 OP33 24 01/11/07 14 OP36 18 01/10/07 15 OP35 20 01/09/07 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 3 4 5 Refer to Standard OP2 OP7 OP26 OP8 OP23 Good Practice Recommendations The contract should provide more specific details of the notice period during the trial period. Care plans should reflect health, personal, social, financial and spiritual needs identified. Equipment by residents should be regularly maintained with a record of maintenance kept by the home. Staff should record visits by health professionals and all health checks on the records provided by the home’s systems. The Registered Person should provide an action plan for the redecoration of the bedrooms. This should be done in consultation with the residents. Contracts for staff should be provided without any further DS0000067267.V339174.R01.S.doc Version 5.2 Page 32 6 OP27 Heathers, The 7 8 9. 10 OP30 OP31 OP36 OP33 delay. Staff should be provided with training in specific areas that affect individual residents. Manager should update their knowledge of current practices. The policies and procedures should reflect the changes in the service provision. The Provider should develop a quality assurance system to ensure the services meets the needs of those living in the home. Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Heathers, The DS0000067267.V339174.R01.S.doc Version 5.2 Page 34 - 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. 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