CARE HOMES FOR OLDER PEOPLE
Heatherside Scures Hill Nately cures Basingstoke RG27 9JR
Lead Inspector Annie Billings Unannounced 07.04.05 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Heatherside Version 1.10 Page 3 SERVICE INFORMATION
Name of service Heatherside Address Scures Hill, Nately Scures, Basingstoke RG279JR Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01256 762233 Pearl Care (Norwich) Ltd Miss Siobhan Mary Phillips CRH 34 Category(ies) of OP, 34 registration, with number of places Heatherside Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 9/9/2004 Brief Description of the Service: Heatherside provides care for up to thirty-four male and female service users over the age of 65 with associated needs of older people. The home is situated on the A30, in the small village of Nately Scures, about 5 miles from Basingstoke. The building is a large modernised Edwardian two-storey property, set in 2 acres of gardens. The gardens are extensive, well maintained and laid mainly to lawn and ample car parking is available at the front of the premises. Heatherside offers thirty-two single bedrooms, of which twenty-eight have an en-suite facility, and one double bedroom without en-suite. A passenger lift provides easy access to the first floor. The home’s communal space comprises of one quiet comfortable lounge, separate dining areas and a large conservatory lounge. Heatherside Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over seven hours as part of the normal regulation and inspection programme. A partial tour of the premises took place, and care records and staff files were inspected. The inspector also had the opportunity to observe lunch being served, and to observe an exercise class being undertaken by an occupational therapist. Fifteen service users, one relative and five members of staff were spoken to, in addition to the registered manager, who assisted with the inspection. What the service does well: What has improved since the last inspection?
The range of activities available to service users has been expanded by the employment of an activities organiser twice per week, in addition to an occupational therapist who visits the home on a further two days per week. Since the last inspection the kitchen and two bedrooms have been redecorated, with new flooring in one bathroom and re-carpeting of one bedroom. An additional washing machine has been added to the laundry, which has doubled the capacity. Heatherside Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Heatherside Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Heatherside Version 1.10 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 5, 6 The pre-admission assessments are not completed in sufficient detail, to ensure that all needs are identified. EVIDENCE: Pre-admission assessments are available on file. In discussion with some recently admitted service users, it was evident that not all needs had been assessed, particularly with regard to emotional, psychological and social needs. Generic risk assessments have been completed, but where a risk has been identified, individual risk assessments have not been undertaken to determine what action should be taken to minimise the risk. The manager has an awareness of the need to develop this area. Service users confirmed they or their relatives had the opportunity to visit the home prior to admission. The home does not offer an intermediate care service. Heatherside Version 1.10 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 10 Care plans do not address all assessed needs, and require clear guidance to staff to ensure that all needs are addressed. EVIDENCE: Care plans viewed did not support service user’s comments that the home meets their needs. Plans lack detail, and do not give staff clear guidance on how to meet the needs of residents. Health care needs are fully met, but this cannot be demonstrated from care plans, as they do not address all the assessed needs. One resident suffering with leg ulcers advised they were on 20 hours bed rest a day. No plan of care was detailed for leg ulcers or how their social or emotional needs should be met. Evidence was available to support prompt and efficient referral to the health care team, although details are not kept within the service user’s files. All service users spoken with confirmed they were treated with respect, and their privacy and dignity upheld. Observation of care practice within the home confirmed this. Heatherside Version 1.10 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15 Family contacts, social activities and meals are well managed, to reflect resident’s interests and preference. EVIDENCE: A variety of activities are advertised on the resident’s notice board. An activities organiser has been employed two days per week, in addition to an occupational therapist who visits the home two days per week. An exercise class, to encourage mobility, was observed to be well attended. One service user suggested they were interested in a stamp club, and would like the opportunity to go on more trips, and would be happy to discuss these issues at a group meeting. A suggestion was made to the manager to instigate regular residents meetings, to demonstrate consultation with service users. This is currently done on a one to one basis, but no records are available. Service users confirmed that visitors are welcomed at any time. Menus viewed offer service users a good variety and choice. The lunch observed being served was hot, attractively presented and according to comments received was excellent. One service user commented, “food is 1st class, with an excellent variety”. Residents are encouraged to the dining areas to socialise in very pleasant surroundings, but can take their meals in their room if they wish.
Heatherside Version 1.10 Page 11 Heatherside Version 1.10 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The home has a satisfactory complaints system, with some evidence that service user’s views will be listened to and acted upon. EVIDENCE: The complaints procedure is available to service users within the service user’s guide. Many of the service users spoken with were aware of the procedure and who to complain to, but were keen to advise they had nothing to complain about. One service user said their only complaint was they couldn’t have another weekly bath. This was discussed with the manager, who confirmed this would be rectified. Heatherside Version 1.10 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 23, 24, 26 Residents live in a homely, comfortable environment, which suits their needs, and a programme of repair, replacement and decoration is in place. EVIDENCE: A tour of communal areas and five bedrooms confirmed the home is kept clean and hygienic, and that decoration is ongoing. The kitchen and two bedrooms have been decorated since the last inspection. Doors and corridors are due for decoration in the next two months. The reception carpet is coming away at the join and is a potential risk to service users and staff tripping. Furniture is homely and comfortable, but several occasional tables are very worn and are in need of repair or replacement to create a more pleasing environment. Exterior window frame decoration is due for completion in the summer. Several minor maintenance issues were reported to the manager, for prompt action. Cleaning products found in the laundry room were immediately removed by the manager, who agreed to reinforce training in the Control of Substances Hazardous to Health. Heatherside Version 1.10 Page 14 Heatherside provides the majority of service user accommodation with en-suite facilities. A further four bathrooms are available to residents, three of which offer assisted bath facilities. A dedicated bath carer is employed each week day morning. All bedrooms viewed, apart from one vacant, had been personalised by the occupant. Many residents spoken with confirmed they are happy with their accommodation, and commented on its’ comfort. One service user chooses to share their family photographs with other residents by placing them throughout the communal areas, demonstrating their feeling of ownership of the home. The large grounds to the property are beautifully maintained, and offer additional seating areas to service users. Heatherside Version 1.10 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28,29, 30 The manager is supported by a fully vetted, and well-supervised staff team, who are well trained and competent to meet their responsibilities and the needs of service users. EVIDENCE: Three staff files indicate that all the appropriate checks are undertaken to ensure the protection of residents. As part of the home’s induction, staff are made aware of the policies and procedures in the home. Three staff interviewed confirmed they feel well supported by the manager, are regularly supervised and feel competent to meet the needs of service users. A training programme is in place, and training is regularly updated. Staff rotas and observation on the day confirm that staffing levels are adequate to meet the needs of residents. None of the staff members spoken with feel they are put under undue pressure, and residents confirm “there is always someone about”. Many service users commented on the cheerfulness of the staff. One described the staff team as supportive and responsive. From observation it is evident that staff have built good relationships with residents, which contributes to a real family atmosphere. Heatherside Version 1.10 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32 The home is well managed, and service users benefit from the open ethos and very much hands-on approach of the registered manager. EVIDENCE: The registered manager is currently undertaking NVQ4 in care and management, and is always open to suggestions to improve the home. Staff morale is high, and staff confirmed the manager is very supportive and approachable, and gives clear direction. From observation of interaction between staff, there was evidence of a good team spirit. Service user’s and relatives comments demonstrate a continued high level of satisfaction with the service. Heatherside Version 1.10 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 2 3 3 x 3 3 x 3 STAFFING Standard No Score 27 x 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 x x x x x x Heatherside Version 1.10 Page 18 No 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 3 Regulation 14[1]a Requirement The registered manager must ensure that new service users are fully assessed to ensure that their health, social and emotional needs can be met. Any risk identified must be fully assessed and action taken to minimise the risk. Service user plans must be in sufficient detail to give clear guidance to staff on the actions to be taken to meet their health and welfare needs. The reception carpet must be replaced. Until this can be organised the carpet join must be taped to minimise the risk of tripping. Timescale for action 30th June 2005 2. 7 15 31st July 2005 3. 19 23[2]b 7th April 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 14 Good Practice Recommendations A programme of formal residents meetings should be organised, to provide opportunities for consultation on how the home is run.
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