Inspection on 01/11/07 for Heatherwood

This inspection was carried out on 1st November 2007.

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

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

Other inspections for this house

Heatherwood 13/09/06

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 Heatherwood Heatherwood 33 Station Road Orpington Kent BR6 0RZ Lead Inspector Wendy Owen Unannounced Inspection 10:00 1 November 2007 st 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 DS0000067234.V343311.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. DS0000067234.V343311.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heatherwood Address Heatherwood 33 Station Road Orpington Kent BR6 0RZ 01689 813041 01689 822760 mandy.knighton1@virgin.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) Chislehurst Care Ltd Ms Sally Ann Perry Care Home 8 Category(ies) of Old age, not falling within any other category registration, with number (8) of places DS0000067234.V343311.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registration of Ms Sally Ann Perry as the manager at this home and Ashling Lodge, 20 Station Road, applies to Ms Sally Ann Perry only and is subject to ongoing assessment by the Commission through the statutory inspections of both homes. 13th September 2006 Date of last inspection Brief Description of the Service: Heatherwood has recently changed ownership to Chislehurst Care Ltd. It was first registered in April 1987 to provide care for eight older people. Heatherwood is an older style, three-storey house which has been converted to provide residential care. It is very conveniently situated for shops, transport and other local facilities very close to Orpington town centre. The home has a lounge, dining room, kitchen, bathroom/toilet and one double bedroom on the ground floor. On the first floor there is a second double bedroom and four single bedrooms. Bathroom facilities on this floor include a separate toilet with a rail surround and a wash hand basin next to a bathroom with a walk in bath and toilet facility. The administration office is located on the third floor with a flat occupying the remainder of the floor. To the rear of the property there is seating on a veranda overlooking an enclosed garden. The Manager of Heatherwood also manages another of the Provider’s homes, Ashling Lodge, located opposite. A Service Users Guide is available for all residents containing the information on what the home has to offer and a copy of the latest inspection report is available, on request, from the home. The fees range from £358-£551 per week. The charges for Local Authority clients are different to those for private. Personal expenditure such as toiletries, clothing, newspapers and private healthcare is not included in the fee. DS0000067234.V343311.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection included a visit to the service over one and a half days. During the visit I spoke to residents, relatives and staff, as well as touring the home and viewing of records. The inspection also included written feedback from residents and staff and viewing of the completed Annual Quality Assurance Assessment (AQAA) This report also details the findings relating to the random inspection carried out in February 2007. What the service does well: The pre-admission procedures ensure that people who are interested in using the service are provided with information on what the service has to offer to enable them to make a decision on whether they wish to live in the home. The manager also ensures that people are admitted to the home, only when they are able to meet their needs. Residents are well supported and looked after by staff who are caring and sensitive to individual needs. They have good information to ensure they are able to meet personal and health needs. Residents are able to voice any concerns or let staff know if they are not happy with any aspect of their care and are safe in the knowledge that the manager will listen to them and try and address their concerns. “ I can speak to any of the staff if I am not happy, but this never happens” This ensures that the quality of care is improved and that residents are kept safe. A variety of healthy meals are enjoyed by the residents, with refreshments provided throughout the day. “There’s always enough to eat” said a resident. Heatherwood offers people living there a homely, pleasant and comfortable environment to live in. The home is staffed adequately by staff who are, generally, competent and able, ensuring the needs of individuals are being met. The home is well managed by an experienced manager who generally ensures the health, safety and well-being of those people living there. DS0000067234.V343311.R01.S.doc Version 5.2 Page 6 Heatherwood is run in an open and inclusive way where individuals are able to be involved in how the care can be improved. What has improved since the last inspection? What they could do better: There are two repeated requirements from previous inspections. Whilst there is some evidence of progress in meeting, they still remain outstanding. The repeated requirements refer to the need to ensure all residents have details of the terms and conditions under which they live in the home and the need to ensure that there is a staff member trained in first aid on duty at all times to ensure the safety of those living there. This inspection has raised further requirements that the manager and Provider must meet. The Statement of Purpose must be reviewed to meet the regulations and ensure people who wish to use the service have full information available to them. Care plans were of a good standard but had some gaps in the identified areas of need that would benefit from being recorded to ensure they are not missed. All staff must have training in medication procedures and practices to ensure residents are kept safe, and where creams are prescribed, these must also be recorded on the medication records. The routines of the home need reviewing to ensure residents are provided with flexibility in stimulation and interaction. DS0000067234.V343311.R01.S.doc Version 5.2 Page 7 Staff would benefit from further training in the safeguarding of adults to ensure they have the information they need to ensure the safety of those they are caring for. Whilst the manager has improved the practices for storing of soiled items in the home these practices require continued improvements, including training of staff in common infectious diseases to further reduce the risks. There are areas of core training that require updating to ensure residents are in safe hands at all times. Recruitment procedures are sound but residents would be further protected by ensuring previous employment in care is verified before staff commence employment. Overall the health and safety of residents and staff is maintained through sound procedures. However, fire doors that are not currently fully closing must be checked and this safety issue addressed. 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. DS0000067234.V343311.R01.S.doc Version 5.2 Page 8 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 DS0000067234.V343311.R01.S.doc Version 5.2 Page 9 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): 1,2,34 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who are interested in using the service are provided with information on what the service has to offer and can be assured that the home will only admit people whose needs they are able to meet. EVIDENCE: The Service Users’ Guide and Statement of Purpose are being updated to ensure they meet with the Regulations and the current situation in the home. The “Guide” is now more reflective of the service offered and includes details about the terms and conditions. The “Guide” would also benefit from including the areas detailed in the standards as well as the Regulations. DS0000067234.V343311.R01.S.doc Version 5.2 Page 10 The Statement of Purpose is a generic information pack and therefore does not provide information specific to Heatherwood. This must be addressed to ensure it gives appropriate information to those interested in the service. (See requirement) The comment cards showed that not all people had received information on the home prior to admission. However, the manager has worked to ensure this shortfall is addressed and it is positive to note that the manager has taken on board the need to show where information has been provided to individuals prior to being admitted to the home and details of any visits prior to admission. This gives them the information they need (including copies of the terms and conditions template) to make a decision on whether the home is right for them. The random inspection that took place in February 2007 looked at the assessments and admissions procedures and these were found to be appropriate. Since that inspection there has been one new resident admitted. The file relating to this individual was viewed and was found, once again, to contain a Core Assessment completed by Social Services and an assessment undertaken on behalf of the home. The inspection that took place in February also viewed the provision of written information on the contract and terms and conditions of the service. Where the Local Authority Placement agreement was found to be in place there was no evidence of the terms and conditions between the Provider and the resident. The file of the most recently admitted resident showed there to be terms and conditions provided by the home. The Providers must also view the Regulations to ensure the information regarding fees is reflected in their terms and conditions. Of the seven residents who were assisted to complete the comment card five did not answer the question and two said yes. It is possible that residents are not aware of the contracts as their family member takes care of this aspect. (See requirement) DS0000067234.V343311.R01.S.doc Version 5.2 Page 11 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): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have good information on how they can best meet the needs of the people they are caring for. Medication practices ensure the health and well-being of residents. EVIDENCE: During the inspection visit in February I viewed the files relating to three individuals to determine the quality of documentation and whether staff had information on how they are to meet individuals’ identified needs. The home has changed to the “Standex” system and care plans were found to be much improved and generally, with a few gaps, contained information relating to the residents’ needs. DS0000067234.V343311.R01.S.doc Version 5.2 Page 12 Viewing of three individual files during this inspection also found the home continuing to improve in this area. The main issues are that staff appear to be “paying lip service” to the reviewing their needs each month and not updating the care plans where there are changes. In all cases staff wrote “no change” where there is clearly a change to their needs and the support required. The plans should be amended as and when changes occur. One resident had clearly deteriorated over the recent month and required more support with personal care and nutrition as well as ensuring the resident being prone to urinary tract infections. The second required information on the individual being constipated and suffering with depression. The reason for the prescribing of painkillers should also be documented. Risk assessments had been produced in respect of moving and handling, falls, nutrition and pressure care. There was some evidence of the home developing strategies and interventions to minimise the risks and where there were recommended to develop a separate care plan re pressure care risks this had been completed in respect of the one resident with a small sore. Once again there was evidence of the risks being reviewed and updated in some cases, although not in the case of the resident who has recently developed a small sore and where the risk assessment would be showing an increased risk due to a deterioration in their health. (See requirement) However, it is clear that the staff are aware of the changes in the individuals’ needs and appropriate action being taken. For example; the individual with a pressure sore has the District Nurse visiting to change dressings and monitor the sore and pressure-relieving equipment has been provided. Where the individual has lost weight this has been recorded and action taken by informing the GP and food supplements prescribed. Service user written feedback and discussions with residents during our meeting showed that staff do meet their needs. When asked: “Do you receive the care and support you need?” Six said “always” and one said “sometimes”. When asked “Are staff available when you need them?” Five aid always; one sometimes and one said usually. One resident said “ I am very happy here, there is noting they (staff) won’t do for you.” Healthcare records viewed during both inspections and were found to be of a good standard with clear evidence of where the home is requesting the support of the health professional, taking advice and ensuring they provide the DS0000067234.V343311.R01.S.doc Version 5.2 Page 13 required treatment. It is positive to note that the manager has taken this on board from the recommendation made at the last inspection “Do you receive the medical support you need?” It is clear that residents believe this to be the case. Residents are also weighed regularly with records maintained and as stated earlier, advice is sought. A relative spoken to also said they were happy with the care. Medication procedures were audited and found to be satisfactory. Prescribed medication now comes into the home in blister packs rather than nomad trays. There are pre-printed labels for each person with completed details, including allergies. Records were clear and completed with full details. Where there were hand-transcriptions these had been countersigned. Records of administration were also complete with non-administration documented with the reasons why. There was however, one gap in the recording. The manager must also ensure that where creams are prescribed and administered this is recorded. The inspector also recommends recording of medication that is carried over. There is a list of staff authorised to administer medication with their initials included. Some staff have received training through the distance learning “Safe handling of medication” course whilst for others have received in house training only. Staff would benefit from the more comprehensive course and there is a rolling programme for this at present. (See requirement) DS0000067234.V343311.R01.S.doc Version 5.2 Page 14 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): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents enjoy a varied and healthy choice of food. Routines are flexible with an improvement in activities on offer. Further improvement in this area would provide residents with a more varied and stimulating environment. EVIDENCE: Throughout the visit to the home routines were observed with staff assisting with personal care and the preparation and serving of meals. It is clear from the observations that residents as assisted to get up when they want within reason and that they can take their breakfast in their rooms either before getting ready or after. During the meeting residents told the inspector that they were able to get up and go to bed when they wish. DS0000067234.V343311.R01.S.doc Version 5.2 Page 15 Much of their day is spent in the main lounge reading, listening to music or watching TV. There is an activity schedule in place and for staff and residents and according to staff and residents this is an area that has been improved since the Providers have taken over. Residents also have the opportunity for visiting the home opposite to enjoy the entertainment on offer. On the second visit the hairdresser had arrived and residents were very keen to have their hair done. It is during the afternoons when “tasks” are completed that staff arrange activities such as bingo and quizzes or film afternoons. It is worth investigating how a change of these routines and completion of tasks could benefit the residents. (See requirement) It is clear that there are positive relationships between staff and residents and that they are treated with kindness and sensitivity. Much of the interaction is occurring during tasks and therefore limited. The written survey asked residents, Are there activities arranged by the home that you can take part in? Each one said yes. During the meeting the inspector asked residents how often they went out. The overall response was “not very often”. It is hoped that residents will benefit from the improvements being made to the back patio. Decking is being provided and the garden levelled for residents to gain access to areas they cannot at present. Residents are provided with their main meal at lunch-time which is taken in the dining room. This was observed to be a relaxed affair with a cold drink available during the meal and a hot drink in the lounge after the meal. One resident who has poor nutrition at present was offered supplements and encouraged to take food. Breakfast is taken in individuals’ rooms if they wish and throughout the day residents are offered refreshments of a hot drink and biscuit. When asked: Do you like the meals in the home? The seven who responded said yes. During meeting with six residents they all felt the meals were of a good standard-although there was confusion about whether they were given choices or not ( the menu does give choices). They were all satisfied with the quantity. DS0000067234.V343311.R01.S.doc Version 5.2 Page 16 DS0000067234.V343311.R01.S.doc Version 5.2 Page 17 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): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are free to raise issues or concerns in a safe environment where they can be assured they will be listened to and concerns addressed. EVIDENCE: A complaints procedure has been developed and is on display in the hallway. It provides appropriate information on how complaints or concerns can be raised and what action the manager or Provider will take. The document is in a fairly large print enabling people with vision impairment to read it. It can also be made available in other formats if required. The written feedback showed that residents knew what to do if they were not happy, who to complain to and who to contact. Complaints are recorded although no complaints or concerns have been received over the last year either through the home or external agencies. During the meeting with six residents I asked what they would do if they were unhappy. Some said they would speak to staff and others said to Sally, the DS0000067234.V343311.R01.S.doc Version 5.2 Page 18 manager. All felt they were kept safe and well and they had a good relationship with staff. Discussions with the manager also showed that she took on board any concerns, however minor they appear, and tried to resolve them without a fuss. The inspector viewed the safeguarding adults procedures and these were found to be comprehensive and covered the referral to the Protection of Vulnerable Adults register as well as guidance on abuse, types of abuse and how staff should manage any allegations made to them or instances where they have observed abuse. The procedures also detail how the manager and Provider are to manage allegations, including referral to the individual within social services and reporting to the Commission. Training records viewed detailed staff training in respect of adult protection over the last six months or so. Discussions with two staff showed them to have some knowledge of what constitutes abuse. Both knew they must refer concerns to the manager, although they had variable knowledge on, who apart from the manager, they would contact if they needed to. (See requirement) DS0000067234.V343311.R01.S.doc Version 5.2 Page 19 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): 19,20,21,22,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with a warm, homely and comfortable environment. Whilst overall the home maintains a good standard of cleanliness the practices for reducing infection require reviewing to ensure risks of infection and malodours are reduced. EVIDENCE: Heatherwood provides a homely, comfortable environment for people living there. DS0000067234.V343311.R01.S.doc Version 5.2 Page 20 Communal and private areas are pleasantly decorated with a good standard of furnishings with bedrooms personalised with personal possessions and mementoes. It is positive that residents are to benefit from new chairs that have been purchased specifically for the individual. Residents agree that it is kept clean and fresh. There is some work being completed in the back garden where decking is replacing the original patio area and the garden is being levelled to enable residents to gain open access. This is particularly important for those with mobility problems. The home has adequate bathrooms and WCs with one bathroom/WC located on the ground floor and a walk in both on the first floor. The inspector noted the clinical waste bag had been placed n the downstairs bath. This not only restricts its use (the bag was very heavy with used pads), it also had an offensive odour and is also poor practice regarding risk of infection. At previous inspections the Inspector required the practices for dealing with clinical waste to be improved. This has been commented on in the above paragraphs. (See requirement) The hot water is regulated by thermostats in each of the areas and water temperatures are checked before residents are assisted with bathing The random inspection in February found that a new stair lift has been fitted to enable the less mobile residents to access their rooms on the first floor. All areas, with the exception of the first floor bathroom have been fitted with an alarm call system. This is quite an antiquated system and the Providers have ordered a new system that is to be delivered and fitted in the near future. The first floor bathroom must also be included in this. The alarm was tested and found to be in working order and with staff quick to respond. The Environmental Health officer also visited recently to ensure they had addressed the requirements raised during their last visit. These issues had been addressed expect for the need to ensure the sealant around the kitchen sink area is replaced. DS0000067234.V343311.R01.S.doc Version 5.2 Page 21 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): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are provided with training and qualifications that enable them understand the care and support required by people in the home and to ensure they are kept safe. EVIDENCE: The staffing levels of two staff on duty during the day with the manager in support are adequate. The care staff also undertake domestic, laundry and cooking tasks. This does not appear to impact on the quality of care provided, although observations during the time spent in the home did not show the staff to spend much time in conversing or interacting with residents, as they were busy doing tasks. Feedback provided from residents was positive and all those spoken to during the meeting said that they had a good relationship with the staff, many of whom had been working there for a number of years. Staff were described as “kind” and “sensitive” with most agreeing that staff were aware of their individual needs and assisted them appropriately. DS0000067234.V343311.R01.S.doc Version 5.2 Page 22 At present there are three staff with NVQ 2, two staff completing the award NVQ levels and one member of staff who is a Registered Nurse. This is of a total number of eleven permanent and bank staff. They will therefore meet the requirement to have 50 of staff qualified to NVQ 2 or above when the two staff currently studying qualify with the award. The staff are trained in a number of areas including core raining such as moving and handling, first aid and food hygiene. First aid and moving and handling are out of date for some staff. Much training is provided through the DVD medium and previous discussions with the manager, Area Manager and Local Authority inspectors (who lead in these areas) have shown that this is not acceptable for moving and handling, first aid and food hygiene. The Area Manager assures the inspector that this training will be provided through a competent person, although updates could be provided through a DVD between training. (See requirement) Discussions with staff and viewing of the comment cards received from staff show that staff believe they are provided with adequate training to care for residents. New staff are also provided with induction to meet their needs through home induction and the TOPPS specific induction standards. The manager was advised of the need to implement the Common Induction standards for new staff. Recruitment procedures were audited by viewing of two staff personnel files. One file was that of a member of staff who works at another of the home and therefore all information referred to the main home. In the main the manager had obtained all the information and copies of checks with the exception of a copy of the Criminal Records Check. The second file viewed of a new member of staff showed, in the main, the checks and documentation required. There was proof of identity, Criminal Records Bureau check and two references. There is a need to ensure previous employment in care is verified as to the reasons why they left. (See requirement) Neither files viewed showed a copy of contracts but did show evidence of induction. DS0000067234.V343311.R01.S.doc Version 5.2 Page 23 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): 31,32,33,35,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using this service benefit from living in an environment that is well managed and organised and continuously looks at the quality of care provided to ensure it meets individuals’ needs. Residents’ health and safety is compromised at times because staff are not provided with core training that is regularly updated to ensure they are competent in these areas. EVIDENCE: DS0000067234.V343311.R01.S.doc Version 5.2 Page 24 Sally Perry is the Registered Manager of Heatherwood and the Ashling Lodge (a home owned by the same Providers and located opposite Heatherwood). She is experienced and qualified to manage the homes and ensures she keeps up to date with training. Her qualifications include the Registered Managers’ Award (RMA); D32/33 NVQ Assessors award and NVQ Level 2 in Care. Ms Perry is very much a “hands on” person and has very close contact with the residents enabling her to identify any change to individuals’ needs and working well with the GP surgery and other professionals. The inspection undertaken in February 2007 included viewing of a sample of health and safety service contracts and records. These were found to be satisfactory, although the fixed wiring examination was due in the next few months. This has now been completed and is satisfactory. A further sample were viewed during this inspection and included the stair-lift, gas, fire, Legionellas and Environmental Health Officer report. The Environmental Health report required a few improvements regarding the provision of foods. The Commission is aware that a recent inspection has confirmed the home has met the requirements with the exception of the need to replace the sealant around kitchen sink area. The home does not hold personal monies belonging to residents. The system currently used ensures that those responsible for monies are invoiced each month for any expenditure. Receipts are kept by the home and then sent to the Head Office for invoicing. A detailed invoice is them sent and relatives are able to view the receipts if they wish to audit the system. There is evidence of the servicing of the fire alarm system and equipment as well as the weekly checking of the fire alarm to ensure it is in good working order. However, a recent routine check in September 2007 found that two fire doors are not fully closing when the alarm is activated. This is potentially dangerous as the risk of smoke escaping during a fire is much higher when doors are not fully closing. The Provider has worked to address this and, in the one case, the doorguard needs replacing and has been ordered and, in the second case, more work is required to ensure it fully closes. The manager had been asked to confirm when this work has been completed and has confirmed, during the writing of this report, that the issue with one of the doors has been resolved. (See requirement) The February inspection noted that fire drill are taking place regularly and records are in place. It was recommended that the time of the fire drill be recorded. Action has not yet been taken. (See recommendation) There has been some concern regarding the Providers’ approach to the provision of some aspects of core training. For example the use of DVDs is seen as one of main ways of providing staff with training and guidance on First DS0000067234.V343311.R01.S.doc Version 5.2 Page 25 Aid, moving and handling, food hygiene and infection control. Discussions with the Environmental Health and Health and Safety Departments within Bromley Council have confirmed that this method is not acceptable, particularly in the provision of First Aid, food hygiene (for staff responsible for preparing and cooking foods) and for moving and handling. The Area Manager has assured the Commission, during the inspection visit, that this trained is to be provided by a competent external training provider. DVDs will be used as refreshers only or to provide staff with some guidance prior to the full training being provided. It was noted that a number of staff were in receipt of First Aid certificates that had expired and moving and handling training updates were due for a number of staff. This has not yet been addressed by the Providers which means that there is not always a member of staff on duty with a current First Aid certificate to ensure safe practice and that moving and handling practice may be unsafe. Where the manager believes the risks are minimal in respect of moving and handling of residents this must be detailed through a risk assessment that determines potential risks, the need for training and how often the training should be provided taking into account frailty of residents. Failure to take action may result in the Commission taking further enforcement action to ensure these requirements are met. (See requirement) Staff are also expected to prepare and cook meals and therefore must have the training appropriate to this role. It is clear form viewing of individual training records that not all staff, who are involved in this area, have benefited from training by an approved person. Staff spoken to also had a mixed knowledge of what to do in the event of an accident to a resident eg if a resident had fallen, one staff member said they would assist the person to sit up but did not say they would check them over or get someone else to do this. The other member of staff had a good knowledge and demonstrated good practice. The Commission rarely receives notifications of accidents or events occurring in the home. This is not due to the lack of awareness of reporting these events but because they rarely occur. (See requirement) Discussions with two staff showed a variable knowledge regarding infection control and two of the most common diseases that they may come across in the home ie MRSA and Clostridium Difficile. Whilst they had a limited knowledge of MRSA they were not aware of Clostridium Difficile. Staff were very aware of good hygiene precautions. (See recommendation) The Commission receives regular reports regarding the monthly Provider visits being undertaken. These do reflect the current situation in the home and requires action to be taken to comply. It is also positive that the person undertaking these visits does so during evenings and weekends as a way of monitoring the care during unsocial hours. DS0000067234.V343311.R01.S.doc Version 5.2 Page 26 The inspector also enquired as to what staff would do in an emergency. They said they would contact the manager. However, there should be a clear system whereby other people in the organisation are contacted with names and numbers on display for staff to access easily. (See recommendation) DS0000067234.V343311.R01.S.doc Version 5.2 Page 27 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 2 3 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 X 18 3 3 2 3 3 3 3 3 2 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 3 X 3 X X 2 DS0000067234.V343311.R01.S.doc Version 5.2 Page 28 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 OP2 Regulation 5 Requirement The Registered Person must ensure the home provides residents with the terms and conditions of residency and where funded by other agencies the placement agreement is also obtained and provided to the resident or their relative. This is a repeated requirement and whilst there has been improvement the requirement has not been fully implemented. The timescale has expired 1/12/06 & 01/04/07. The Statement of Purpose must be reviewed to cover the areas required by the regulations ensuring people have the full information. Care plans must reflect the individuals’ needs. These must be reviewed and where changes occur updated information provided to ensure people are receiving the support they require. All staff must be provided with DS0000067234.V343311.R01.S.doc Timescale for action 01/01/08 2 OP1 4 01/01/08 2 OP7 14 01/01/08 3 OP9 13 01/03/08 Page 29 Version 5.2 4 OP12 16 5 OP18 13 6 7. OP26 OP38 13 13 medication training and medication records must record administration of prescribed creams to ensure residents health needs are met. The manager must review the daily routines to ensure residents are provided with the opportunity for stimulation through various parts of the day. Adult protection training must be provided to staff that ensures staff are guided in what action to take where abuse has been alleged in order to protect vulnerable people. Infection control practices must be improved to ensure risk of infection is reduced. The Registered Person must ensure that there is one member of staff on duty at all times who is trained in First Aid to ensure appropriate action is taken and risks to residents minimised. This is a repeated requirement. Timescale of 01/04/07 has expired. Staff must be provided with updated training in core areas including food hygiene, infection control and moving and handling. When recruiting new staff the manager must ensure that any previous employment in care is verified as to the reasons for leaving ensuring vulnerable people are not placed at risk.. All fire doors must be fully closing to ensure residents are kept safe. 01/03/08 01/03/08 01/01/08 01/01/08 8 OP30 18 01/02/08 9 OP29 19 01/01/08 10 OP38 23 01/12/07 DS0000067234.V343311.R01.S.doc Version 5.2 Page 30 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 OP7 OP9 OP26 OP38 OP38 Good Practice Recommendations Residents’ needs should be reviewed with the residents and their family or representative at least six monthly. Where medication is carried over to the next cycle this should be recorded. Staff should be provided with guidance on MRSA and clostridium difficile. The time that fire drills are taking place should be recorded. There should be a clear system for contacting individuals in an emergency that is easily accessed by staff. DS0000067234.V343311.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup Kent 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. 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