Inspection on 23/05/08 for Heatherside House

This inspection was carried out on 23rd May 2008.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heatherside House 19/11/08

Heatherside House 25/06/07

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Heatherside House Dousland Yelverton Devon PL20 6NN Lead Inspector Anita Sutcliffe Unannounced Inspection 23rd May 2008 10:15 Heatherside House DS0000069209.V366351.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 Heatherside House DS0000069209.V366351.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. Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heatherside House Address Dousland Yelverton Devon PL20 6NN 01822 854771 01822 855972 samgomm@lineone.net 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) Sheval Limited Miss Samantha Ann Louise Gomm Care Home 25 Category(ies) of Learning disability (25) registration, with number of places Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning Disability (Code LD) The maximum number of service users who can be accommodated is 25. 25th June 2007 Date of last inspection Brief Description of the Service: Heatherside House, previously known as Pine Tree Lodge, is a care home providing personal care and accommodation for a maximum of twenty-five people with learning disabilities aged 18 and over, some of whom have been in care for decades and are at or approaching older age. The original home has been open since 1984. The current ownership commenced October 2006. There is a manager and 24 hour staffing. Health care is provided through community services. This home is located at the end of a private driveway in the village of Dousland on the edge of Dartmoor. There are local amenities such as shops, pubs and post offices in the local village of Dousland and in the nearby towns of Yelverton and Tavistock. The home is a detached, two storey property, with a single storey extension and large gardens that are well maintained and accessible. Historically the home consisted of three self-contained units with communal facilities, but it has been going through a major, phased refurbishment for over a year. At present people have the use of one dining room and two sitting rooms. Some bed rooms have been refurbished and now have en suite facilities. The Statement of Purpose and Service User Guide are available in the office of the home. The fees charged at the time of writing are £328 to £682. There is an additional charge for personal purchase, clothing, toiletries, trips Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 5 out, hairdressing and chiropody. Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use the service experience poor quality outcomes. We (the Commission) have collected information about the home towards this inspection since the last key inspection, June 2007. The home also sent us their annual quality assurance assessment (AQAA). The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We did four visits to the home, three unannounced and one announced. A representative of the organisation People First accompanied us on the second visit. He, and his support worker, work as ‘Experts by Experience’. They spent three hours meeting people and talking to them about living at Heatherside House. Those findings are found within this report. Our regional Pharmacist Inspector did an unannounced visit to examine how the home manages medication at the home. We looked in detail at the care and support people receive, and the records of two recently deceased people. We spoke with people at the home, two family representatives, key workers/support staff and the manager about their care. We also spoke and met with health and social care professionals with regular contact with the home. They provided factual information and opinion about the service. Due to current concerns about the home we took records from the home to be examined. As part of the visit to the home we looked at all communal areas, some bedrooms and the kitchen and laundry. Throughout the inspection the manager and all staff at the home were helpful and provided assistance. The reader should be aware that there were concerns about standards at the home during the previous ownership and management of the home that was then called Pinetree Lodge. People who use the service may be described within this report as residents, clients or service users. What the service does well: People at the home show confidence and affection to the manager Sam Gomm. They frequently visited the office to see her and a new resident, asked by us if she had made friends since admission, pointed to Miss Gomm. Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 7 A family representative of a person at the home said: “Everything with Sam Gomm and the other staff has been brilliant. My aunt is very, very happy there. She’s probably the chirpiest I’ve ever seen her. She’s really come out of herself”. People looked clean and ‘well presented’ with jewellery, painted nails and groomed hair if this had been their choice. The newly refurbished bed rooms are fresh, clean, full of personal things of importance and nicely furnished. What has improved since the last inspection? What they could do better: The standard of health care management at the home puts people at risk, in particular medicines, poor adherence to professional advice and guidance and poor care planning and delivery. Staff should be better supervised and all aspects of care management better monitored by the manager and provider. Regular unannounced provider visits are not being reported. No actions seem to have been taken to ensure the concerns of health and social care professionals have been addressed. Some staff seem to be ‘going their own way’ unchecked. Many people using the service are set in their ways, and are therefore dependent on others where that dependence may not be necessary. Some aspects of this are encouraged by the home’s routines and staff practice. Handing plated meals to people is one example, rather than them being able to serve themselves. Whilst it is understood that the new home layout will make Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 8 independent living a more realistic proposition, much more work needs to be done by staff to help people leave this learned behaviour. This needs planning which is not currently in place. Staff need training in the conditions of people who live in the home so they can increase their skills and confidence: Learning disability, behaviour that is a challenge to people, continence, autism and diabetes. There are not enough staff to provide person centred and individual care, only enough to complete the necessary daily tasks such as bathing and cooking. Whilst appreciating the difficulties of building works in a home still occupied hazards must be properly dealt with. Old sinks and piles of wood should not be left where people walk. Things must not be stored in places people should be using: the summer-house; the telephone kiosk. The pleasant outdoor spaces should be more useful for people; space they can enjoy and benefit from. The all-pervading odour of urine, covered with disinfectant smell, should be dealt with at the first opportunity. 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. Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 9 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 Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People cannot make an informed choice about the home from the current information provided, but they will only be admitted following a thorough assessment of their needs. EVIDENCE: We looked at the information the home provides to prospective service users and people who currently use the service. We found that although most people at the home are unable to read the information it is only produced in written format; so the Service User’s Guide is of little use in itself to those it is produced for. We also found that information which is important for people to make an informed choice about the home, and which is required to be included, was not. This includes: • • • • Name and address of the registered provider and registered manager. Whether nursing is provided. The number and relevant qualifications of the staff. The number and size of rooms in the care home. DS0000069209.V366351.R01.S.doc Version 5.2 Page 11 Heatherside House • Arrangements made for respecting the privacy and dignity of people who use the service. Where there was recent admission information had been provided verbally and the written form provided to the family. They said they had received the information needed to make the choice on behalf of their relative. We looked at the most recent admission to the home, which had been an emergency. Comprehensive assessment information had been received and the manager had visited the prospective service user in their current home to discuss and record their needs. A visit to Heatherside House had not been possible due to the limited timescale, but the manager says she would always encourage people to visit prior to making the decision to move. We discussed the needs of the new person admitted. We looked at their records, met them, saw their room and discussed their needs with the key worker allocated to them and their family representative. We found (observed) that she had outings away from the home, she said she liked her room, which had been changed at her request and the key worker was able to describe her history, needs and how they were met. We saw that health care checks had been arranged on her arrival. However, there was no written care plan two months from the admission so care had not been formally planned, which it should for care to be properly delivered. However, the outcome for the new admission was good. She said the manager was her new friend. Her family representative, when asked about the home said: “Everything with Sam Gomm and the other staff has been brilliant. My aunt is very, very happy there. She’s probably the chirpiest I’ve ever seen her. She’s really come out of herself”. Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People’s needs and personal goals are poorly met due to inadequate support/care planning and delivery. EVIDENCE: We looked at the care plans of three people who currently use the service and two recently deceased. Changing needs and personal goals should be reflected in the care plan so that staff are aware of how those needs and goals are to be met. We found the person newly admitted did not have a care plan produced by the home, although their needs had been discussed prior to admission and the assessment information in place was informative. We found some care plans had serious omissions in information. Where a community nurse was, for six months, working to improve the dignity and Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 13 wellbeing of one person the care plan had not been changed to reflect this, despite a record to say the plan had been reviewed within that period. Where for another the ‘need’ identifies that incontinence can be at times of distress or boredom, the ‘intervention’ merely directs staff to support the person to wash and change clothes, liaise with other agency staff and report concerns to health care professionals. The ‘goal’ is described as ‘ensuring a high level of continence care’. The plan does not give staff information as to how to prevent ‘distress or boredom’ or refer to a section of the plan where this is described. A section of the same plan on activities/ social interaction, although recording some activities the person enjoys, does not detail how staff are to provide the support to achieve them. Where staff are to ‘ensure any spiritual wishes are acted on immediately if the person expresses the desire to attend church’, we are told the person, now deceased, could in no way express those needs and so the plan could in no way be achieved. We found that plans, although containing some good detail, were mostly of either little benefit or positively detrimental to the wellbeing of the person using the service. Although the manager records that care plans are reviewed she had not noted some were six months out of date. However, she is encouraging people to make choices and be more involved in planning their care and has already taken steps to get information about ‘personal care planning’ and how that might be used in the home. We looked at how people are helped to make decisions about their lives. The Expert by Experience who assisted the inspection found: ‘Lots of residents have been there a long time and are set in their ways with learned behaviour. All the staff have been there for a long time, making them not easy to change’. Changing people’s expectations and helping them to realise they can make choices, requires planning and consistency in staff approach. We found no evidence through care planning to suggest this is happening and although staff talked of offering choices there were lots of assumptions made, one example being: “She always wants wheetabix”. However, people can choose, for example, when they go to bed and how to decorate their room. Where the person’s needs are more complex (many at the home) their opportunity to make decisions is reduced as staff have limited ability, time or understanding in how to do this. Heath care professionals felt this led to a: “Basic level of neglect”. We looked at how service users manage their finances. We found that now they have their own bank accounts so their money does not go into an account relating to the business. Some keep their own money. For others it is kept securely at the home with records kept of transactions. Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 14 We looked at how risk is assessed and managed for people. Each aspect of a person’s care plan, such as Continence Management, is assigned a risk rating of red, amber or green. Again, however, where necessary this does not transfer to a plan on how to reduce risk. Where one person had a bad fall the associated risk had not been reconsidered in their plan of care. Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Lifestyle at Heatherside House could be much improved. EVIDENCE: The manager says she has increased the number of activities available to people. There is a sensory room, but this was not seen in use. We saw people returning from day centre, where five attend regularly. One spoke of having a sherry at a club the evening before, another of enjoying bingo, another of playing skittles and a trip out. There have been holidays for most people and some days out for others. There is a list of what activities will be provided by an activities worker, but she was not seen throughout the four days of visits, although due to be there she was late or did not turn up. None of the people who use the service mentioned that she comes in during the week to do activities with them. Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 16 We looked at whether activities are age, peer and culturally appropriate. Heatherside House accommodates people of very variable age and their rooms do reflect this; one was playing a game on a laptop computer and then she looked at her holiday photos whilst music played on compact disc player. Another just sat and watch television all day. There is regular input at the home from a local church group giving people the opportunity to follow the Christian faith. One person who uses the service said: “It’s lovely here,” adding that she goes out on trips and enjoys skittles. People have their rooms cleaned for them. They receive their meal already plated, when finished they leave their plates on the table. One person, quite able to remove her own nail varnish, was waiting for staff to do it. Where one helps the manager in the office and one likes to help in the kitchen this is the exception. The Expert by Experience who assisted in the inspection noted that: “The staff do a lot of things for the residents, but there was little evidence they did things with residents. There is no support to help them to do things for themselves”. The approach to daily routines is institutional and opportunities to learn skills are missed. It felt very impersonal that the manager and staff called people ‘clients’ which describes them as a group not individuals. People and staff do not always interact socially when they have the opportunity. It was noted that there was no “cit-chat” at lunch. The Expert by Experience said: “It was like in a library”. He added that the home was not very inviting as it seemed that most people just stayed in their rooms apart from meal times. He would not like to live there. Staff were not seen relaxing to spend time with people although they appeared friendly to them when seen offering assistance. We spoke to two family of people who use the service. They said they are kept informed and always welcomed at the home. However, many of the people do not have contact with family or friends who are not resident at the home. We found the pay phone was not available to people because the room it is in is used as a store. We were told people can use an office phone, but this requires asking and removes independence and choice. We found limited pleasant outdoor space available for people. Whilst there is a large and well kept lawn there is nothing of interest on it, and no shade, the summer house being used for storage. People sat by the front door near the parked cars instead. People were not using the well kept and tended vegetable garden, good as additional food for the home, but a place people could enjoy and possibly learn new skills. Instead, we saw people walking on the drive, past piles of building materials and rubbish, including a discarded sink unit. This also posed a hazard. The road to the home has large ‘pot holes’ and is therefore dangerous to walk on, a restriction to independence and opportunity. The central court yard had a wood pile in it, again ugly and a Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 17 hazard. People are ‘coping’ with the outside space available to them, not enjoying it. We saw that the manager and staff have tried to encourage a more varied diet at the home. When surveys were unsuccessful she tried informal discussion about likes and dislikes. More unusual foods (such as chicken kiev) have been introduced into the menu for people to try. This needs to be continued, as the menu is fairly limited, restricting choice, nutritional content and people’s experience of new foods. We looked at the foods available in the home. It was generally uninspiring and of limited variety and quality. We saw fruit going dry (in a bowl at the back of the kitchen) packet puddings (trifle and cheesecake) and white processed bread. However, we are told the quality of the food preparation depends on who is cooking it and a home made biscuit cake on the forth day of the inspection was delicious. Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People are at put at risk by the way the home manages health care support. EVIDENCE: People in the home looked clean and well dressed; some wore adornments such as jewellery and had their nails coloured. People have been assisted to buy new clothes in the last few months. We saw that care plans contain details of how the person prefers to receive their personal care. There is currently much concern about the care provided at Heatherside House. This concern resulted in a Safeguarding alert so the facts can be considered by health and social care professionals who have regular contact with the home, plus other agencies with involvement under the Safeguarding process. Although the concerns were specific, general feelings have been made very clear to the group. Comments include: • “Guidelines aren’t being followed”. • “I have chronic and enduring concerns about the home”. Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 19 • • “Despite much input at the home (from health care professionals) things haven’t changed”. “Repeated theme of having to explain something which should be a human right”. The provider and manager were aware of historic concerns about the home and on February 8th at a meeting with health care professionals the way forward was discussed. However, we are told the provider made no planned approach to health care improvement. We have seen evidence that a community nurse tried for six months to instigate a successful toileting routine to improve the dignity, comfort and wellbeing of one person, who is was known could achieve this. In that time the person’s care plan was not updated, staff did not complete monitoring forms adequately and progress was slower than expected. Where cleanliness was especially important to one person with continence problems there was no plan to support them with this, the lack of cleanliness causing them distress and indignity. Where a person needed a thickening agent to prevent them choking this was not always provided and on one occasion, whilst their care was being reviewed by a speech and language therapist, they choked. It was also found their hearing aid did not have a working battery in it. Where emergency medication was to be given in accordance with the plan of care it was not given when that emergency occurred. Despite this Miss Waters, the person responsible for the home on behalf of the organisation, wrote twice in recent diary entries: “Care and treatment is very good”. The registered manager Miss Gomm was proactive when new to the home in ensuring people had their care professionally reviewed. We saw that she has sought increased funding to improve the care for people. We looked at the way the home manages medicines. We found that the keys to the medicines cupboard were not stored securely, and were accessible to all people. This means there is a risk that medicines may not be available to people when they need them or that people may access medicines that are not theirs. We also found that for one medicine that the recorded stock levels was different to the actual stock held at the home. This may potentially pose a risk as the medicine may not be ordered as required so resulting in a shortage of medicine. We then found that for one person prescribed a medicine to be administered every 3 months that the home did not have complete records when the medicine had last been administered, and also had no records to indicate when the medicine was next due to be administered. Also this medicine did not appear on the person’s medication profile. This means that Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 20 the person is at risk of not having the medicine administered at the correct times. A serious concerns letter was sent following the inspection regarding the above three points which we asked for a response to by 20th June 2008. We also found that people were prescribed medicines to be administered “when required”. However when looking through the plans of care for these people we were not able to find any guidance to indicate how the decision to administer was to be made. Also the daily records made did not include information about why the medicine had been given. This means that people are at risk of not receiving consistent care or appropriate treatment. We also found that when medicines are prescribed to be administered with a variable dose, such as 1 or 2 tablets, that the dose actually administered is not recorded only an entry to indicate that some medicine has been administered. This means that it is not possible to feed back to the prescriber information about the response to treatment, as the dose given is not known. Many entries made on the Medication Administration Record charts were also seen to have been either written wholly by hand or else amended by hand. These entries were seen not to have been signed or dated. Whilst we were able to eventually find reference to the changes within the care plan documentation it involved going back many months in order to find confirmation of the changes. This may mean that people are not always protected by the systems in place for recording changes in medication at the home. We also found for one person that they had been prescribed a product to help thicken liquids to aid them swallowing. However when looking at the care plan for the person there was no information to indicate that this product was to be used. This means that they are at risk from not having liquids given to them in a form that they are able to manage. We also found for one person that they were prescribed a nutritional supplement. However there are no records made to indicate that they have ever been given this supplement. Also the person’s plan of care has no reference in it to their need to be given a nutritional supplement. This may leave the person vulnerable to weight loss and possible malnutrition. Another person living at the home was having their blood sugar monitored regularly. However there was no guidance within their plan of care to indicate the range of levels that were to be expected nor any indication of what levels would be considered to cause alarm or concern. This person is also having blood samples taking by the community nurse but again there is no record of the results contained within the plan of care. This may mean that the person does not receive appropriate care when required. Also when looking at the stock of medicines held at the home we found that several items were passed Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 21 the expiry date as specified by the manufacturer. This may mean that the products if used may not work in the way expected and may also mean that people are susceptible to an increased risk of infection. Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People isolated at Heatherside House may be at risk. EVIDENCE: Some people at Heatherside House regularly visit a day centre and so meet people outside the home. One said: “If I had a problem I could talk to my social worker”. It was also clear that people are happy and relaxed about visiting the manager and one, when asked if she’d made friends at the home, pointed indicating that the manager was her friend. Although we saw some interaction between people and staff it was minimal and the Expert by Experience said he saw none during his visit. This raises the question as to how comfortable people would be taking concerns to staff. However, one family representative spoke with praise about the service and friendliness. We looked at policies and procedures on complaints and safeguarding, abuse, aggression and bullying. Each was reviewed in 2008. The complaints policy had not been adapted to be ‘user friendly’ to people with limited or no literacy skills. Staff knew where the whistle blowing policy (which informs them what to do if they have concerns about people’s protection) was kept. We found it did not contain the contact details for the local authority safeguarding team or the Commission, which staff must be aware of so as to safeguard the vulnerable people at the home. Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 23 We have not received complaints about the home and the manager says no complaints have been received. The team leader of a day centre which people from Heatherside House attend said: “Sam Gomm is very approachable when there have been issues, which were responded to, and dealt with, and we have had good communication with them”. Staff received training in the safeguarding of vulnerable adults in autumn 2007 and three staff confirmed that it included ‘whistle blowing’. However, although the current safeguarding meetings have not been concluded we have identified (See Standards 6 and 19) that staff are being neglectful by not always following advice and instruction from health and social care professionals. This is contrary to people’s human rights and detrimental to their health and welfare. Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Parts of the home environment are worn, tired and in places unsafe. EVIDENCE: The manager showed us around the home and discussed the planned changes and how far the refurbishment had progressed. Currently some parts of the building are very worn with some very stained carpets held together by tape. Some woodwork is rotting. However, recently refurbished rooms are pleasant, clean, fresh, light, well furnished and have en suite facilities. The use of radiator covers prevent burns and first floor windows, which open to provide fresh air, are designed so as to prevent the possibility of falls from them. Doors can be locked if preferred offering the option of privacy. There are new bathroom facilities and en suites where rooms have been refurbished. Beds and bedding looked comfortable and people asked said they were. Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 25 The laundry contains commercial equipment necessary for the needs of the home. The room was fairly clean, but is very small and it is not possible to separate dirty from clean laundry easily which would reduce the possibility of cross contamination. We also found there was no hand washing soap or towels for staff use as there should be. The kitchen was clean and adequately equipped. We noticed a smell of urine in the communal areas and sometimes this was covered with an unpleasant ‘disinfectant’ smell. The expert by experience said this made the place feel very institutional and not welcoming or homely. The home benefits from large gardens, with lawn to the front and a vegetable plot to the rear. No person was seen using these areas during the four, sunny, days of visits. (See Section called Lifestyle). However, we saw people walking past piles of building materials and there was unsightly and potentially hazardous rubbish left in the area. Although the access road to the home is privately owned it has large pot holes, again a hazard, and some holes within the home grounds themselves. Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 & 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Many staff ‘go their own way’ leading to poor outcomes for people at the home. EVIDENCE: The job description for care assistant and key worker directs staff towards completing tasks rather than supporting people to reach their goals. This was discussed with the manager. There is a long established staff team at the home, who the Expert by Experience felt would not find change easy. Despite this six of the eighteen staff having achieved NVQ level 2 and three of the eighteen have achieved NVQ level 3 in care, which are qualifications relating to staff experience, skills and knowledge. It is then surprising that staff practice has been a major concern to health and social care professionals. Comments include: • “Staff don’t follow programmes or monitoring”. • “Half hearted fashion”. • “General sense of apathy”. Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 27 There were sixteen people resident throughout the inspection visits. The rota records that four care staff work through the day, sometimes three, and two at night. Two domestic staff, a driver and a gardener support them. The manager is mostly additional to those numbers. Whilst this may be sufficient to complete tasks (bathing, cooking etc) it is not sufficient to support people to achieve their goals, or work closely to help people make informed decisions about their lives, something much needed at the home. We also find that staff work twelve hour shifts in a home where some have “complex needs” and behaviour that is a challenge to people. There is a strong likelihood they will not be working to their best towards the end of that time, and when they have breaks the staff to service user ratio is further reduced. We looked at staff training, discussing this with staff and examining five files. The training includes first aid, food hygiene, safeguarding of vulnerable adults and handling medication. There was recent training in epilepsy but prior to this none since November 2002. This is greatly outside the Joint Epilepsy Council guidelines of update training every two years, and relevant to the current safeguarding alert which involves staff not giving emergency medication when that emergency occurred. However, during the inspection two staff, and two people who use the service, attended training in ways to improve communication for people; a very positive step for the home. Heatherside House provides for people with learning disability, behaviour that challenges, incontinence, autism and diabetes. There has been no training of staff in these subjects, and concerns raised do include the management of behaviour that challenges, continence and epilepsy. The manager says that where staff have asked for training it has been provided, but staff training needs should be identified by the manager and be part of a training plan. Staff records indicate that staff have received one appraisal a year and one supervision of their work. Whilst training is recorded there is no plan of training required and clearly staff have not been sufficiently supervised to ensure their work is of a safe and satisfactory standard. No new staff have been employed at Heatherside House since January 2007 and so there are no new recruitment records to test whether recruitment practice safeguards people in the home. However, the manager is continuing to advertise for additional staff. Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 28 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People at the home are at risk. EVIDENCE: The manager Sam Gomm has recently completed her Registered Manager’s Award, which is an indicator of her knowledge and competence. She is clearly trusted and liked by people who use the service and family of people at the home praised her. She has been proactive in ensuring people have their care reviewed and the person recently admitted to the home had a thorough assessment prior to admission and is thriving at the home. However, health and social care professionals have serious concerns about the care delivered at the home. Recent comments include: “Heatherside House is Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 29 extremely difficult to work with” and “There are chronic and enduring concerns about the home”. There was a meeting in February when those concerns were expressed to the provider and manager, but it is still reported that: “Despite much input (from professionals working with the home) nothing has changed”. A member of staff said about the management: “Staff need a bit of structure”. The manager says she feels very supported by the provider. We looked at how the provider monitors standards at the home. We found that the unannounced visits, required where the provider is an organisation, have not been monthly as they should and that the content of the report to the manager, so she can take steps as necessary towards improvement, is very minimal. This has not improved since the previous inspection. Although the provider visits the home regularly there seems to have been little or no effort to check the well being of people who use the service and deal with shortfalls in their care. By the same token the manager has not been properly supervising staff and dealing with those shortfalls, an example being a care plan six months out of date and the programme of care not followed. Measures have been taken to provide people/staff/others an opportunity to give their opinion about the home. These include surveys (followed by informal chats) regular staff meetings and each staff received a yearly appraisal of their work. There are many aspects of the home which have improved: new televisions, more outings and better community links, personalised rooms and each person having their own bank account. The manager says people also appear much happier and communication is improving. We saw some regularly updated instruction for staff, and policies and procedures have been reviewed. The manager keeps the Commission fully informed of events which affect the wellbeing of people who use the service, which protects them and is a requirement. We received the Annual Quality Assurance Assessment, which provides information about the home and the manager’s opinion of its strengths and weaknesses. It was honest and informative. We looked at Heath and Safety at the home. There were recently reviewed general risk assessments in place. However, individual risk assessments lacked depth and detail. Where the home had intended to reduce risk, this being a form to describe a person’s looks as they had previously left the home alone, the form was not filled in – of no use. There was rubbish in the garden, a pile of wood in the courtyard and a piece of wood on the corridor floor. All posed a hazard to health. The handling of medicines in the home was of particular concern and the provider’s response to the Serious Concern letter indicates they do not fully understand what is expected of them so as to make the situation safe. Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 30 Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 31 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 1 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 1 32 1 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 1 X X LIFESTYLES Standard No Score 11 1 12 1 13 1 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 1 X 2 2 2 2 X 1 X Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 32 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 YA1 Regulation 4 Requirement Timescale for action 01/08/08 2. YA6 15 3. YA19 12(1) 4. YA20 13(2) The Statement of Purpose must be up to date and contain all the information specified in the regulations. A copy of this document must be sent to the Commission. This document tells people about the service Heatherside House is to provide. Not met by due date of 1st September 2007. People must have a plan of how 30/09/08 the care they want and need is to be delivered. It must include how decisions are made and goals are to be achieved. It must be regularly reviewed, updated when things change and in sufficient detail to ensure care is consistent and in the person’s best interest. Advice and instruction from 31/07/08 health and social care professionals, and people’s plan of care, must be followed so they receive the necessary care and support they need. Arrangements must be made to 20/06/08 ensure that all medicines are stored safely and securely within the home. Serious concern DS0000069209.V366351.R01.S.doc Version 5.2 Heatherside House Page 33 letter sent. 5. YA20 13(2) Arrangements must be made to investigate the discrepancy regarding the audit of one medicine and arrangements made to prevent a recurrence happening. Serious concern letter sent. Arrangements must be made to record the administration of all medicines, and that arrangements are made to record when next administrations are due for those medicines prescribed to be administered monthly or three monthly. Serious concern letter sent. Arrangements must be made to ensue that when nutritional supplements are prescribed that the use of these is recorded and also that the plan of care reflects their use. Arrangements must be made to ensure that clear guidance and protocols are available to inform people how medicines prescribed to be administered “when required” are to used. Arrangements must be made to ensure that when medicines are prescribed with a variable dose that a record is made of the actual dose of medicine administered. This is to prevent the risk of over or under dosing occurring. People must not be put at risk of neglect by acts of omission in their care such as • none use of drink thickener to prevent choking • not promoting continence because not providing assistance with toileting • not following set protocol/procedure for DS0000069209.V366351.R01.S.doc 20/06/08 6. YA20 13(2) 20/06/08 7. YA20 13(20 01/09/08 8. YA20 13 (2) 01/09/08 9. YA20 13(2) 01/09/08 10. YA23 13(6) 31/07/08 Heatherside House Version 5.2 Page 34 emergency situation. 11. YA35 18(1) Staff must be trained and 31/01/09 competent in the conditions affecting people in their care. This includes learning difficulty, challenging behaviour, autism, continence and diabetes. This will ensure they have the skills and confidence to do their work properly. Each staff must have a training plan in place once their training needs are identified. The Registered Provider must 31/07/08 monitor standards at the home. To this end they must ensure monthly unannounced visits are made to report on the conduct of the home. Copies of these reports should be sent to the Commission. Not met by due date of 1st September 2007. The hazards connected with 31/08/08 building works must be assessed and remove or reduced to a safe level. 12. YA39 26 13. YA42 13 (4) 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. Refer to Standard YA11 YA16 YA33 Good Practice Recommendations People should have the opportunity for personal development and their plan of care should detail how this is to be achieved. Daily routines should promote independence and responsibility. Tasks should be done with people not for them, when ever possible. There should be sufficient staff to provide care and support in a manner that promotes independence and opportunity for people who use the service. Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Heatherside House DS0000069209.V366351.R01.S.doc Version 5.2 Page 36 - 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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