Inspection on 10/05/06 for Heathfield

This inspection was carried out on 10th May 2006.

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

Heathfield 27/04/09

Heathfield 03/05/07

Heathfield 13/12/05

Heathfield 21/06/05

Heathfield 02/02/05

Heathfield 07/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Heathfield Cannell Green Norwich Norfolk NR3 1TT Lead Inspector Mr Pearson Clarke Unannounced Inspection 10th May 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Heathfield DS0000035281.V294855.R01.S.doc Version 5.1 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. Heathfield DS0000035281.V294855.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Heathfield Address Cannell Green Norwich Norfolk NR3 1TT 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) 01603 612768 01603 614765 Norfolk County Council Mrs Karen Sell Care Home 37 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (32) of places Heathfield DS0000035281.V294855.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. People who need wheelchairs to assist with their independent mobility can only be accommodated in the home in rooms 24, 36, 45 and 73 13th December 2005 Date of last inspection Brief Description of the Service: Heathfield is situated near to the centre of Norwich, in a quiet residential location close to Mousehold Heath. The service is operated by Norfolk County Council, providing residential accommodation for a maximum of 37 older people. Registration conditions stipulate that nursing care is not available and that of the 37 places, 5 may be offered to older persons suffering from dementia. Accommodation is on 2 floors in single rooms. The upper floor is served by a shaft lift and staircase. Service users have access to a pleasant, enclosed garden area.A day centre, providing specialist care for people suffering from dementia is attached to the care home. This centre has its own manager and staff, working there each week-day but the premises is overseen by the care homes manager. The Heathfield service users and staff can make use of the centres facilities when the day centre is not operational. Those service users with dementia who are resident at Heathfield have a daily place at the centre where they take part in recreational and therapeutic activities designed to meet their particular needs. Local bus services pass in the vicinity of Heathfield and the railway station lies within walking distance. Heathfield DS0000035281.V294855.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection of the service which took place over one and a half days. The inspector spent time with the management, inspected records, toured the building, spoke to staff, visitors and service users. In addition comment cards were received from thirteen service users and one relative. All of the above have helped the inspector form judgements about the service. What the service does well: What has improved since the last inspection? The homes management has worked hard to ensure that best practice is followed in the management of medicines, building on the improvements identified last time. The staff team have worked hard to find ways that the provision of activity and stimulation for service users can be improved. In line with this a reminiscence room has been created. The environment has been made safer for service users with dementia and a reduction in the numbers cared for has lessened the pressure on staff. Heathfield DS0000035281.V294855.R01.S.doc Version 5.1 Page 6 Care plans were well maintained with improved recording since the last inspection. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Heathfield DS0000035281.V294855.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Heathfield DS0000035281.V294855.R01.S.doc Version 5.1 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 the following standard(s): 1,2,3,4,5 The overall quality rating for these standards is good. The service provides appropriate information to help prospective residents choose their home. There is an assessment system which ensures that admissions are consistent with the care that can be offered. EVIDENCE: Although a significant number of the thirteen service user comment cards indicated that service users were unclear as to whether they had received a contract or written information at the time of admission, the inspector is satisfied that the home does ensure everyone receives this information. The manager confirmed that their own survey process had indicated a similar outcome and as such all service users had been reissued with a service user guide and this is also available in the reception area. For all admissions since that date a check list which includes the issuing of a service user guide and statement of terms and conditions has been used and this was seen when the inspector tracked the last admission to the service. Given that the last inspection identified concerns about the staffing levels, the service has reduced the number of people accommodated whilst reviewing Heathfield DS0000035281.V294855.R01.S.doc Version 5.1 Page 9 staffing levels. As a result there has only been one recent admission and this process was tracked by the inspector. Based on this and discussion with the service management the admission process is judged to be thorough with sound pre-admission assessment. Wherever possible prospective residents and their representatives visit the home and the dialogue with the service is based on ensuring that the home is suitable . Heathfield DS0000035281.V294855.R01.S.doc Version 5.1 Page 10 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 the following standard(s): 7,8,9,10 The service has an improving and effective care planning system, which helps ensure the meeting of service user needs and wishes. Health care needs are well met and the management of medication has significantly improved. Service users benefit from an approach to care which is mindful of the need to show respect and to protect privacy. EVIDENCE: Although the previous inspection of the service indicated a generally sound care planning system, recommendations relating to regular review of plans and further development of in relation to social care were made. During this inspection the inspector looked at a cross section of plans and found evidence that both of these recommendations had been met. The plans seen identified service users needs and wishes and showed evidence of their involvement. Risk assessments were in place and the plans were generally well maintained. The arrangements for the management of medication were also inspected as these had previously been found to be lacking and had been subject to requirements. As such the inspector looked at the arrangements for the Heathfield DS0000035281.V294855.R01.S.doc Version 5.1 Page 11 storage of medication , sampled medication administration records and checked for compliance with the requirements arising from the last report. Based on this the service is now operating a safer and more robust approach to this important area of service delivery. All medications were appropriately stored and record keeping has improved with no errors identified and action taken by the service to improve prescribing instructions. During his time in the home the inspector was able to speak to a visiting District Nurse, who commended the care that the home offers contrasting it positively with many other similar homes that she visits. As such the inspector was told that she finds the staff and management to be knowledgeable about those cared for and to communicate well with external health professionals. Care staff were praised for cooperating with treatment plans for service users with pressure sores and for being proactive in identifying potential skin break down and enlisting preventative help at an early stage. The service management confirmed that they generally had good working relationships with the many doctors and other health professionals dealt with and inspection of service user plans indicated that health care needs were being met. Discussion with service users confirmed that they felt that staff treated them with respect and were mindful of their privacy. This picture was supported by the inspectors observations and discussion with staff. Heathfield DS0000035281.V294855.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 12,13,14,15, The overall quality rating for these standards is adequate. Service users enjoy an appropriate approach to care which promotes their choice and control and seeks to provide the lifestyle that they wish to experience. Residents have a good diet with food served in pleasant surroundings. EVIDENCE: The views of six service users and two sets of visiting relatives helped inform judgements made in this area and the inspector also received thirteen service user comment cards and one relatives comment card. In almost all respects the views expressed were positive and in many cases extremely so. For instance the home was described as “ first class” and “ten out of ten “. One visitor to the home had recent experience of care elsewhere in the country and was keen to stress how good this service was in comparison. All of the service users spoken to felt that they lived in a good home and that they were treated with respect and their dignity and privacy was upheld. All of those spoken to were happy with the food served which includes choices at each meal. The inspector joined service users for lunch and found a tasty and well presented meal served in a pleasant dining area. The last inspection resulted in requirements relating to the provision of activity and the inspector was encouraged to see action taken in response to this. As such a structured programme has been developed and was about to be Heathfield DS0000035281.V294855.R01.S.doc Version 5.1 Page 13 introduced. This programme had arisen from consultation with the staff team and service users and the service has also created a reminiscence room which was viewed by the inspector. All of the above are encouraging developments , however the pressure placed on staff by current staffing levels makes it very difficult to give any meaningful one to one attention to service users. Heathfield DS0000035281.V294855.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 16,18 The overall quality rating for these standards is good. The service has an effective complaints process in which service users are assured that their complaints are taken seriously. There are systems in place to ensure service users are protected from abuse. EVIDENCE: The inspector looked at the services complaint record and found that since the last inspection one complaint has been received. Based on this record and discussion with the service manager the inspector is satisfied that the home takes complaints seriously and will act to investigate and make changes where necessary. Since the last inspection the management has complied with the requirements relating to an understanding of referral to the Protection Of Vulnerable Adults register. Staff at the home receive training in support of the services adult protection process and procedure. Service users talked to felt safe and well cared for. Heathfield DS0000035281.V294855.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 19,20,23,24,25,26 The overall quality rating for these standards is poor. Service users enjoy a generally comfortable and safe environment which is well maintained. However the current heating system does not allow individuals any control over the temperature in their room which detracts from their quality of life and causes considerable discomfort and a poor experience at times. EVIDENCE: Whilst Heathfield impressed the inspector as a generally pleasant and comfortable home, there remain some issues with the environment. The last inspection identified concerns that service users living in the homes small dementia unit were at risk because of their ability to freely access areas of the home outside of the designated unit. Requirements were made in respect of this and the provider has acted in response to those requirements. As such the numbers accommodated in the unit have been reduced , risk assessments have been carried out with control measures put in place and a folding door to prevent these service users from accessing the main stair case was being fitted at the time of the inspection. Whilst it is good to see this response it is Heathfield DS0000035281.V294855.R01.S.doc Version 5.1 Page 16 understood that future plans for the home are for it to become a dementia service and as such the environment as a whole will need to be assessed for its suitability. One significant area of concern is the homes heating system which does not allow individual service users any control over the level of heating in their own rooms. During the day the inspector talked to one service user who could only identify one concern with the service and that was that his room was unbearably hot. The day of inspection was hot, yet the management confirmed that the heating was on because some service users were still cold, however a result of this other service users found their rooms to be very uncomfortable. The fitting of thermostatic controlled radiator valves to individual radiators would allow for residents to exercise choice and control and a requirement to submit a timed plan for this is made. Unfortunately this task will be more difficult, as the wire radiator guards fitted to prevent scolding have been fitted over the radiator valves and as such the guards will need refitting to enable access. All areas of the home seen were clean and with the exception of the heating service users were positive about their environment. The service has an extremely attractive enclosed garden which is clearly much appreciated by those living at Heathfied. Although there is not a large lounge suitable for large group activities, each of the units has an attractive lounge dining room. The home is in reasonable decorative order although some areas would benefit from freshening up. The protection of service users safety is taken seriously with hazards identified and evidence of action taken to address problems. Heathfield DS0000035281.V294855.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The overall quality rating for these standards is poor. Service users benefit from committed, hard working and well trained staff, however there are still concerns about the overall level of adequacy of staffing in the home. EVIDENCE: Service users and visitors consulted by the inspector were extremely positive about the staff who were consistently described as caring, kind and very hard working. However staffing levels at the home have been the subject of previous requirements and whilst the provider has acted in response to the last inspection by reducing numbers and carrying out a review of dependency and staffing levels, the results of this review have yet to be translated into extra hours. As such although the reduction in numbers, including a reduction in the numbers in the dementia unit, has helped reduce staffing pressure there is still a need to establish a consistent staffing pattern which allows the needs and wishes of service users to be met in a reasonable manner and without placing an undue pressure on staff. The current rota allows for four care staff on duty on some occasions and yet on other days the same shift will be covered by three people and it was difficult for the inspector to understand why this discrepancy occurs It was the view of staff spoken to that when there are less than four people on a shift it is problematic to do the job and even with four people it is difficult for the inspector to see how service users could receive significant individual attention. Given the above a requirement is once again made in this respect. Heathfield DS0000035281.V294855.R01.S.doc Version 5.1 Page 18 During the inspection the inspector spoke to a number of care staff and was impressed with their commitment and motivation. Observations of them working with residents confirmed this impression. Discussion with management and examination of records showed an appropriate approach to staff training and whilst government NVQ targets have yet to be met the service is moving towards this goal. Suitably robust employment processes are in place. Heathfield DS0000035281.V294855.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,38 The overall quality rating for these standards is good. Service users benefit from a well managed home run in their best interests. Their financial interests are safeguarded and the general approach to health and safety is sound. EVIDENCE: The home is well managed with evidence of leadership. During the inspection the inspector talked to staff on duty all of whom felt that the current manager had improved the service and provided a clear sense of direction since assuming control. The service has a quality assurance system based on an annual survey of service users, relatives and staff. The results of the survey have been collated and a report produced which shows how comments made have influenced change. The service has structured resident meetings which are used to seek the views of service users through out the year and service users spoken to by the inspector believed the home to be well run and in their best interests. Heathfield DS0000035281.V294855.R01.S.doc Version 5.1 Page 20 The local authority has a robust system for ensuring that the financial affairs of service users are fully protected and whilst the inspector was in the home he witnessed an audit of records taking place. There is a generally satisfactory approach to health and safety maintained , supported by policies, procedures and training. The last inspection resulted in concerns about how well environmental risks were managed in relation to those service users with dementia. Whilst the provider has reacted in response to those concerns the inspector would urge continued vigilance in this respect and as indicated elsewhere in the report any plans to move the service as a whole to care of people with dementia will need to encompass a review of the whole environment. Heathfield DS0000035281.V294855.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 x x 3 3 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 x x 3 Heathfield DS0000035281.V294855.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP27 Regulation 18 Requirement The registered person must demonstrate to the Commission that staffing levels are adequate to safeguard the health and welfare of service users. Repeated requirement That the provider submit a timed programme for improvements to the service heating system, which allows for the individual control of temperature in service users rooms. Timescale for action 31/07/06 2. OP25 23(p) 30/09/06 Heathfield DS0000035281.V294855.R01.S.doc Version 5.1 Page 23 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 OP19 Good Practice Recommendations It is recommended that a programme of redecoration is planned and implemented. Heathfield DS0000035281.V294855.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 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 Heathfield DS0000035281.V294855.R01.S.doc Version 5.1 Page 25 - 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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