Inspection on 21/06/05 for Heathfield

This inspection was carried out on 21st June 2005.

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

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

Other inspections for this house

Heathfield 27/04/09

Heathfield 03/05/07

Heathfield 10/05/06

Heathfield 13/12/05

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 Kim Patience Unannounced 21 June 2005 9:30 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. HEATHFIELD I55 S35281 Heathfield V234486 210605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Heathfield Address Cannell Green, Norwich, Norfolk, NR3 1TT 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) 01603 612768 01603 614765 Norfolk County Council Mr Allan George Bennett Care Home 37 Category(ies) of DE(E) Dementia - over 65, OP Old age registration, with number of places HEATHFIELD I55 S35281 Heathfield V234486 210605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 To register for 37 Service Users who are Older People. 2 People who need wheelchairs to assist with their independent mobility can only be accommodated in the home in rooms 12, 19, 34 & 41 - addes in response to letter of 24.10.03. Date of last inspection 02 February 2005 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 home’s manager. The Heathfield service users and staff can make use of the centre’s 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 I55 S35281 Heathfield V234486 210605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took approximately 5 hours to complete. During the inspection, three residents were interviewed in their own rooms and three visiting friends/relatives were spoken to. In addition, several members of staff were spoken to and the acting manager was available for consultation at the start and finish of the inspection. A tour of the premises was carried out, the facilities were viewed and records relating to residents were inspected. Specialist pharmacist inspector Mark Andrews attended the inspection and simultaneously carried out an inspection of the homes medication policy and procedures. (See standard 9 for further details). What the service does well: What has improved since the last inspection? What they could do better: Improvements need to be made to the premises in order to protect people with dementia from unnecessary harm. Staffing levels should be reviewed and increased to ensure that the needs of all service users are adequately met. HEATHFIELD I55 S35281 Heathfield V234486 210605 Stage 4.doc Version 1.30 Page 6 A plan of staff supervision needs to be implemented so staff have the opportunity to meet with the manager on a one-to-one basis and have their work practice appraised. There are significant concerns in respect of the medication administration and record-keeping that need to be resolved within the specified timescales. The local authority needs to improve their response to requirements and recommendations made by the Commission and demonstrate a positive move to improving the service they provide to vulnerable people in need of care. 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 I55 S35281 Heathfield V234486 210605 Stage 4.doc Version 1.30 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 HEATHFIELD I55 S35281 Heathfield V234486 210605 Stage 4.doc Version 1.30 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 The home has a pre-admission procedure that ensures people’s needs are assessed and can be met before moving into the home. EVIDENCE: The file relating to a new resident admitted to the home eight weeks ago was inspected. In addition, the resident and his visiting partner were interviewed. The file contained a copy of a social work assessment and an admissions form. A pre-admission assessment had taken place and the resident was able to recall the manager from the home conducting a home visit to discuss his care needs. A record of the pre-admission assessment was seen on file and gave a brief overview of the residents needs. HEATHFIELD I55 S35281 Heathfield V234486 210605 Stage 4.doc Version 1.30 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) 7,8,9,10 The home is able to demonstrate that people’s health, personal and social care needs are assessed and appropriately documented. However, they cannot demonstrate that people’s needs are kept under review. Resident’s health care needs are fully met by appropriate and timely medical intervention. The health and welfare of service users cannot be reliably safeguarded by the home’s current medicine administration and record-keeping practice. Residents living in the home are treated with respect and have their rights upheld. EVIDENCE: Three residents files were inspected. New care plans have been recently introduced to the local authority homes and promote a person centred approach to care planning. The care plans included information such as, social history, personal needs and choices and personal routines. The home is in the process of phasing in the new documentation and therefore some files relating to residents who have lived at the home for sometime contain different information. In these cases, care plans were not always completed and reviews HEATHFIELD I55 S35281 Heathfield V234486 210605 Stage 4.doc Version 1.30 Page 10 have not taken place on a regular basis. In one file the last review was conducted June 2004 and in two other files, care plans had not been signed. A requirement is made in respect of the need to ensure that care plans are completed in full, reviewed on a monthly basis and signed by the resident to denote their involvement and agreement with what is written. See requirements and recommendations. Progress notes are kept and contained information relating to medical interventions. The new care plans contain records relating to medical care needs, medication requirements and a medical action review sheet, once phased in completely these documents will add clarity to how health needs are being met. The residents interviewed all confirmed that the staff respond appropriately to their health needs by calling the GP or district nurse where necessary and by ensuring that they receive any recommended treatment. One resident had identified a developing pressure sore area, the home responded swiftly by contacting the GP and by ensuring that equipment was introduced i.e. pressure relieving mattress and cushion for the chair. The inspection of Standard 9 was conducted simultaneously by specialist pharmacist inspector Mark Andrews. The inspector found widespread concerns in relation to medicine administration and record-keeping practice. He also found that the home does not adequately monitor the safety of service users self-administering medicines. Medicines requiring refrigeration were noted not to have been properly stored within the accepted temperature range. The inspector discussed the detailed findings of the inspection in full with Ms K Sell (acting manager) during a separately arranged visit on 22nd June 2005. A copy of the separate detailed Pharmacy Inspection Report has been sent to the registered provider and is available subject to request. Records relating to residents contained information about their preferences in respect of daily living and showed that issues around privacy, dignity and peoples rights were being considered. Residents interviewed spoke of staff being polite and considerate. They felt that staff were respectful of their privacy and never entered their room without knocking first. Members of staff spoken to clearly showed respect for the residents and held clear principles about peoples rights being promoted at all times. This subject is addressed during induction training and reinforced at team meetings. HEATHFIELD I55 S35281 Heathfield V234486 210605 Stage 4.doc Version 1.30 Page 11 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) ,13,14, People living at the home are able to maintain contact with relatives, friends and significant others as they wish without unreasonable restriction. People are actively encouraged to make their own choices and decisions about the way in which they lead their lives. EVIDENCE: During a tour of the home a number of visitors were seen and spoken to. Those visitors said that they were welcome in the home at any time and always found the staff to be friendly and helpful. One resident and his partner were interviewed, his partner stated that she visited on a regular basis and always felt welcome and on Sundays, she was able to stay for lunch. Records inspected also showed that people’s wishes in respect of social contacts were being recorded. It was evident when looking at residents plans that on admission to the home people were given the opportunity to state their preferences in all aspects of daily living and were encouraged to lead a self-determining lifestyle. One resident spoke of having the freedom to leave the home to visit her friends as she pleased. She also spoke of being able to make choices about her daily routines and how her week was structured to suit her. HEATHFIELD I55 S35281 Heathfield V234486 210605 Stage 4.doc Version 1.30 Page 12 Staff spoken to, talked of the residents right to choice, being of great importance and something that is actively promoted within the home. HEATHFIELD I55 S35281 Heathfield V234486 210605 Stage 4.doc Version 1.30 Page 13 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) 0 NA EVIDENCE: NA HEATHFIELD I55 S35281 Heathfield V234486 210605 Stage 4.doc Version 1.30 Page 14 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) 19,20,21,23,24,25,26 The home cannot fully demonstrate that they provide an environment that is safe and well-maintained for all residents accommodated. The home was not fully able to demonstrate the ability to maintain a clean, hygienic environment. EVIDENCE: A tour of the premises was undertaken. Generally, the home is well decorated and reasonably well maintained. However, some areas are in need of redecoration and repair such as, the lounge/bar room where the ceiling in one large area was peeling off and in the corridors, damage to the wall could be seen, possibly caused by wheelchair collision. See recommendation. One vacant room on the first floor was full of clutter made up of various items. At the time of the inspection, it was so full the door could not be closed and is considered a safety risk. See recommendations. HEATHFIELD I55 S35281 Heathfield V234486 210605 Stage 4.doc Version 1.30 Page 15 The home is divided into six wings each with single room accommodation, its own dining room/kitchenette and small lounge area. In addition, there is a communal lounge on the ground floor which includes a bar and shop. From this room there is easy access via a patio door to the outside, where a pleasant landscaped garden is situated. The garden contains adequate seating and tables. The residents rooms have a wash-hand basin and toilet/bathing facilities within close proximity. One resident expressed some concern about the bathroom she used being without adequate ventilation and found it almost unbearable to stay inside it for any length of time. The acting manager was made aware of this during the feedback at the end of the inspection. See requirements. A number of resident’s rooms were entered during the inspection and although small, were personalised. Evidence of people’s own personal belongings could be seen and those people interviewed were generally happy with their rooms. One recently accommodated resident would have liked his room to have been redecorated before he moved in as marks on the wall and holes from previous picture hanging could be seen. See recommendations. The main concern was for those residents accommodated with dementia care needs. This wing is not closed off to the rest of the home as it is felt that people should have the freedom to wander. However, this means that these people are possibly exposed to risk in other parts of the building. For instance, during the inspection one resident with dementia had opened the door leading out to the foyer and was exposed to the risk of being able to leave the building completely. A requirement is made in respect of ensuring that residents are safe. See requirements In addition, a requirement was made at the last inspection that the stairway opposite the dementia care unit is guarded to prevent people with dementia from wandering upstairs, thus being exposed to further risk of harm. It is disappointing that this requirement has not been met as the safety and welfare of residents should be of paramount importance. See requirements During the tour of the premises, it was noted that whilst most areas were clean and tidy, odours could be detected in parts of the home. The manager said that there had been some changes with domestic staff leaving and agency staff had been used to fill the gaps. She accepted that perhaps cleaning had not been as thorough as previous. See requirements. Residents interviewed were happy with the standard of cleanliness in their rooms and other parts of the home. HEATHFIELD I55 S35281 Heathfield V234486 210605 Stage 4.doc Version 1.30 Page 16 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 The home cannot demonstrate that staffing levels are adequate enough to meet peoples needs at all times of the day. EVIDENCE: A requirement was made at the last inspection that staffing levels must be reviewed and increased at night in order to meet the needs of vulnerable service users. This requirement has not been met and the concerns raised on the previous report remain. The following paragraphs were taken from the previous report and still provide an accurate assessment of this standard. Heathfield is registered to accommodate a maximum of 37 older persons, 5 who may also fall within the category of persons with dementia. It is however possible that, since their admission, additional service users, through progressively deteriorating mental health, have also slipped into this category. On week days a specialist day centre, attached to the care home, operates a service for persons with dementia and the recognised 5 service users with dementia resident at Heathfield are placed at this centre from around 9.15 am to 4 pm. HEATHFIELD I55 S35281 Heathfield V234486 210605 Stage 4.doc Version 1.30 Page 17 The care home’s registered manager was, at the time of this inspection, on long-term sick leave. The care home is being managed by a relief manager who works 9-5 on 4 week days and takes turns on the off duty on call rota. A support system is in place for all senior staff. In addition to the manager, a care co-ordinator is on duty from 7 am till 10 pm (this understands 2 shifts, one from 7 am – 2.30pm and one from 2 pm – 10pm. The care home operates with 4 members of the care team on shift each morning. There are 3 carers on shift in the afternoons and evening including one carer who is employed from 4 – 7 pm specifically to fetch service users with dementia from the day centre, supervise giving them their tea and remain with them till her shift ends at 7 pm. During the night-time there are 2 waking night staff of duty. Given the size of the care home, total number of service users in residence and the mental frailty of at least 5 and possibly more service users with dementia, the adequacy of there being only 3 carers on shift during parts of the evening and only 2 carers on duty during the night is questionable. It was the view of the inspector that even if there remain just 5 service users with dementia, 2 waking night staff is an insufficient number of carers to be able to fully meet the needs of 37 service users. The providers must ensure there is adequate coverage by staff at all times of the day and night and must review and increase staffing levels at night in conjunction with a recommended reassessment of the mental frailty of all existing service users. See requirements. HEATHFIELD I55 S35281 Heathfield V234486 210605 Stage 4.doc Version 1.30 Page 18 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) 31,36 This home cannot demonstrate that it is currently being managed by a person who is fit to do so. Staff are not being appropriately supervised. EVIDENCE: The registered manager is on long term sick leave and there is no indication that he will be returning to work at this stage. The home is currently being managed by an acting manager, who has recently submitted an application for registration with the Commission. A requirement was made at the last two inspections that staff must receive one-to-one supervision at least 6 times a year. This requirement has not been met and staff spoken to said they had not received supervision recently. However, they did feel well supported by the acting manager who is readily HEATHFIELD I55 S35281 Heathfield V234486 210605 Stage 4.doc Version 1.30 Page 19 available. The requirement is carried forward for the third time. See requirements. HEATHFIELD I55 S35281 Heathfield V234486 210605 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score N/A N/A 3 N/A N/A N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 N/A 13 3 14 3 15 N/A COMPLAINTS AND PROTECTION 2 3 2 N/A 2 3 2 2 STAFFING Standard No Score 27 2 28 N/A 29 N/A 30 N/A MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score N/A N/A N/A 2 N/A N/A N/A N/A 2 N/A N/A HEATHFIELD I55 S35281 Heathfield V234486 210605 Stage 4.doc Version 1.30 Page 21 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. 2. Standard 7 9 Regulation 15 13(2) Requirement The registered person must ensure that the service users plan is kept under review. The registered person must take steps to ensure arrangements are made for the recording, handling, safekeeping and safe administration of medicines received into the care home (see full Pharmacy Inspection Report for detailed statutory requirements). The registered person must ensure that all parts of the home are adequately ventilated. This refers to the bathroom. The registered person must ensure that unnecessary risks to the health, safety and welfare of service users are identified and eliminated. The registered person must ensure that the home is free from offensive odours. The registered person must ensure that staffing levels are reviewed and increased to ensure that the needs of all service users living in the home are adequately met.This is Timescale for action 31/07/05 Various see full pharmacy report. 3. 21 2(p) 31/07/05 4. 25 13(4) 31/07/05 5. 6. 26 27 16(2)(k) 18(1)(a) 31/07/05 31/07/05 HEATHFIELD I55 S35281 Heathfield V234486 210605 Stage 4.doc Version 1.30 Page 22 7. 36 18(2) carried forward for the second time. The registered person must ensure that all staff receive an appropriate level of supervision. 31/08/05 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. Refer to Standard 7 19 19 31 Good Practice Recommendations It is recommended that the service user is asked to sign their care plan to denote their involvement. It is recommended that a plan of maintenance and renewal is implemented to address the issues of redecoration and repair highlighted in the report. It is recommended that room 80 is cleared of rubbish and clutter to ensure that people are not exposed to unecessary risks It is recommended that the home continues to proceed with the registration of a new manager. HEATHFIELD I55 S35281 Heathfield V234486 210605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 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 I55 S35281 Heathfield V234486 210605 Stage 4.doc Version 1.30 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!