Inspection on 11/05/10 for Heathfield Care Home

This inspection was carried out on 11th May 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heathfield Care Home 20/10/09

Heathfield Care Home 16/11/08

Heathfield Care Home 26/07/06

Heathfield Care Home 08/12/05

Heathfield Care Home 27/06/05

Heathfield Care Home 02/11/04

Heathfield Care Home 22/05/04

Heathfield Care Home 10/10/02

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 17/07/2010.

Key inspection report Care homes for older people Name: Address: Heathfield Care Home Main Road West Wittering Nr Chichester West Sussex PO20 8QA     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Val Sevier     Date: 1 1 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Heathfield Care Home Main Road West Wittering Nr Chichester West Sussex PO20 8QA 01243511040 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): heathfield@tesco.net Intercare Orthopaedic Services Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 21 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Heathfield Care Home is a privately owned establishment registered with the Care Quality Commission to accommodate up to twenty one service users in the category of old age (OP). There is also a variation for one named person in the category of Physical Disablement (PD). The establishment is a detached property set in its own Care Homes for Older People Page 4 of 31 Over 65 21 0 2 0 1 0 2 0 0 9 Brief description of the care home attractive grounds. Situated six miles from Chichester and two miles from West Wittering village. The registered provider is Intercare Orthopaedic Services Ltd. There is a new manager in post. The responsible person on behalf of the company is Dr Mayank Gupta. Fees at the time of the inspection are £550.00 - £650.00 a week. A Statement of Purpose and Service Users Guide is available to reference. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service 0 star. This means the people that use this service experience poor quality outcomes. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The visit was carried out on the 11th May 2010 between the hours of 9:50 and 4:00pm. Prior to the visit to the home we reviewed, previous inspection reports and information received from the home, the home was last visited in October 2009 when several requirements for action were made. The Annual Quality Assurance Assessment (AQAA) was returned to the Commission by the due date before we visited the home. The AQAA is a document that we send to a service once a year, in it they are able to comment on improvements they have made, Care Homes for Older People Page 6 of 31 any barriers to improvement to meeting the standards and how they feel the service is meeting the needs of people who live at the home. We met with the manager, two staff, and there were four people who use the service involved in the inspection visit. Since our last visit there has been a change in the management of the home with a new manager and deputy now in post. There were 19 people living at the home on the day of our visit. We looked at three pre admission assessments, four care plans, medication records, staff files and training records and fire prevention testing and training records. Since the visit the manager has sent us information stating what action has been taken and what action is planned to meet the requirements made and to embed these changes into the service offered at Heathfield. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Whilst the home has improved in some areas and taken action to meet previous requirements the care plans still do not reflect all identified needs of individuals for example psychological well being. Care plans also need to instruct staff on their part on the care of wounds and pressure areas and when they need to request support. The home has decided they do want to be able to administer homely remedies therefore the previous requirement now needs to be met. There must be evidence that all recruitment checks for example references have been Care Homes for Older People Page 8 of 31 carried out before employment commences. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an understanding of individual needs using the assessment process, which involves other professionals or family as needed. The current assessment record would prove more beneficial to the assessment and care plan process for the individual if the information is used as a basis for the care plan to meet identified needs. Evidence: The AQAA for the home said:Assessments are carried out on all prospective service users prior to admission. Relatives are encouraged to be involved in the pre admission assessment process. We are able to assess in the persons home, in hospital or other care homes. The relatives are encouraged to view the home at any time and discuss the services that we provide. We advertise to the local community. The home also commented that: Documentation could be more robust. A requirement had been made previously regarding the statement of purpose and Care Homes for Older People Page 11 of 31 Evidence: service users guide. We looked at an example and saw that they had been altered and that the requirement was met. However the one we saw did not reflect that there had been a change in management of the home. A requirement was also made following the last visit regarding the assessment of people before moving to the home to ensure that the home could meet the individual needs. There have been several new admissions to the home since our last visit some have been temporary stays where people have come for respite, two individuals whose assessments we saw had decided to remain at Heathfield. One individual had come to the home as an emergency admission the manager told us that they had not been able to visit the person before this had happened and the information we could see had come from a telephone conversation with the family. We saw that there was information on individual needs based on their present and past medical history for example, history of falls. The assessment offered choices and space for individual issues. For example fell whilst walking pre hospital admission transfer with two. We saw risk assessments and other assessment tools such as nutritional screening these were completed after the person had moved to the home. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans give some information on basic care needs of the individual and support staff are to give. However they do not have information on specific individual needs and what support staff are to give. The medication records and administration within the home are generally carried out in a safe manner and protect the people who use the service. Staff working practice helped to ensure that the privacy and dignity of people who use the service is promoted. Evidence: The homes AQAA told us that:Individual comprehensive assessments are completed on admission, with the service user and or relative where appropriate. This assessment is used to provide a detailed care plan which is used to guide staff for their needs. Care plans are reviewed monthly or if changes occur, when necessary. Service users are encouraged to maintain their independence with their hygiene needs. Pressure areas are assessed and recorded in care plans. Equipment is accessed from local GP if not available in the home. We have a designated continence link person who updates information via meetings, and cascades this information down to Care Homes for Older People Page 13 of 31 Evidence: other staff via in house training. Continence aids and equipment are provided by the home. All service users have access to Health care Professionals covering this area. Medication is administered by a designated member of staff and policies are adhered to. Staff are expected to complete the Skills for Care Common Induction Standard which ensures that they are aware of the importance of Privacy and Dignity. The home also commented that:Homely remedies policy needs updating. Documentation could be more robust. Following the last visit to the home requirements were made regarding care plans which included health and psychological needs and medication. We saw that the requirements had been partially met and action is being considered outside of this report. We looked at three care plans in detail and two others for further information and saw plans to address individuals needs such as washing and dressing, bathing and mobility. We saw that information was available for staff on how they would support individuals with their needs, individual strengths and abilities and what staff needed to do to support them. For example supervision when mobilising and transferring, needs skin monitoring daily as at high risk of skin breakdown. What we could not see were plans of care to help staff support specific needs for example alterations in behaviour due to a physical illness, anxiety and panic attacks, what may trigger these and what staff should do to support the person. We saw from medication records that five people have been prescribed strong pain relief, for example one individual was to be given pain relief before medical dressings were changed and there were no plans of care for staff to follow. We discussed the care plans at the time with the manger and we gave examples of where we could see that individual needs were mentioned but had not been reflected in a care plan. We asked if there were any care plans where he thought specific needs may have been recorded. We looked another two individual files but there was no evidence. The manager said that discussion had taken place between himself and the directors of the care home about care planning and that this would take place again. We saw risk assessments had been put in place with information on how staff could lessen those risks for example manual handling and falls and nutritional assessments. We saw that these assessments and the care plans were reviewed regularly and as necessary. We saw that the district nursing team was supporting the home with care of continence and wound dressings for example. We saw that staff had completed a Waterlow assessment, a tool used to assess who may be at risk of pressure areas. Staff had coloured in areas on two care plans we saw. We showed this to the manager Care Homes for Older People Page 14 of 31 Evidence: who also could not see any information related to these shaded areas. We asked what staff were told about their role in monitoring pressure areas and or wounds such as leg ulcers, there was no evidence on the care plans we saw, or on the care plans of those who are receiving support from the district nursing team, about the roles and responsibilities of the staff at the home and what action they can or should take. We spoke with four individuals who use the service all are happy with the care and support they receive. The staff are kind and manage under the circumstances. Remarks are attended to. Good food nice staff. Requirements following the last inspection said guidelines must be obtained for when as required medication can be administered, service users GPs must give their consent before homely remedies are administered, medication administration records must be completed and signed for to indicate if prescribed medicines have been taken or applied, and risk assessments must be completed for service users who administer their own medication. We saw that the home had no homely remedies as following the last visit the home requested the GP to prescribe homely remedies for all individuals. However the manager explained that this was being changed again and that a list of homely remedies was with the GP for them to assess if any were contraindicated with individuals current prescribed medication. This had been requested in April 2010. There was information on medication that individuals had been prescribed to be used as needed, for example Glycerin Trinitrate spray, however there was no plan of care or information in the medication records of when this medication should be used. We looked at the medication storage and administration records. The medication trolley is attached to the wall by a chain in a downstairs office. The home currently has Zomorph, Zoplicone, Fentanyl and Buprenorphine patches stored as a controlled medication. We looked at the controlled drug register and compared this to the stock. We noted for one person there was a box of Zoplicone 7.5mg the controlled drug register listed the medication as Zoplicone 37.5mg; we could not see any medication for this amount. The manager said the medication had been changed by the GP and the individual was no longer having this medication. He undertook to have the unused medication returned to the pharmacy. We looked at medication administration records from the 3rd May 2010 to the day of our visit. With the exception of three gaps we saw that records had been kept of when medication had been offered to individuals, whether they had taken the medication or why it may not have been given. We saw that there are some individuals who have Care Homes for Older People Page 15 of 31 Evidence: requested to look after and administer their own medication and we saw that there was a risk assessment in place signed by the GP and the individual. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service participate in activities appropriate to their age, peer group and cultural beliefs as part of the local community. Dietary needs are well catered for with a balance and varied selection of food available that meets individual dietary requirements and choices. Evidence: The AQAA for the home said that:We provide activities to suit the different requirements of the service users. We take into account their personal capacity i.e., physical, mental, social etc. Visitors are encouraged to visit and join in any activities organised. There is no restriction on visiting. We enable the service users to maintain links with the local community. Service users can individualise their rooms within the homes policy on Health and Safety. Information is supplied to service users and relatives to outside agencies if they wish to access this. We offer a 4 week balanced nutritional menu with choices. Service users are encouraged to suggest meals that they would like to have included. Specific diets are catered for. Following our last visit a requirement was made regarding activities. We were told by the manager and people who live at the home that a new member of staff has started recently, an activities coordinator who is currently organising activities including Care Homes for Older People Page 17 of 31 Evidence: outings. They have also started producing a newsletter which gives information about upcoming events, has news about people who live and work at the home and people are asked to contribute. The activity person works ten hours per week; there is a weekly Monday to Friday programme of activities. We saw evidence of individual likes and dislikes regarding their activity and socialising. We saw that people have magazines of interest and newspapers delivered. There is cooking, board games, reminiscence, story reading and outings available. We saw on one care plan that someone does not like to socialise and we saw that they received one to one time. One individual who lives at the home used to be a fitness instructor and leads armchair exercises regularly for people who live at the home to participate in if they wish. We were told they were well attended. People we spoke with said they enjoyed the food, although sometime there is too much for them and they have to remind staff what they like and how much. One individual was seen to be enjoying a beer with their lunch. We also asked people about the changes in the garden with the new pond and raised flower and vegetable gardens. Those we spoke with did not express enthusiasm. Although some liked having the builders around as it gave them something to watch. The manager said one individual has taken to organising the greenhouse and likes being outside. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are protected through the open complaints process and staff knowledge and understanding of safeguarding and protection issues. Evidence: The AQAA for the home said:Heathfield has a clear complaints procedure which is included in the service users guide and Statement of Purpose. POVA training is given to all staff. CRB checks are sort prior to employment. Any abuse allegations or incidents are acted upon promptly. We encourage service users and their families to keep their own financial records. We do not keep any money or valuables for service users. The home has a complaints procedure, and people we spoke with said they knew how to complain and they said when they had they felt they had been listened to. We saw examples of where an individual had made complaints, the action the manager had taken and family input where necessary. The homes safe guarding adults policy was observed to have been regularly updated and included the West Sussex Multi Agency Adult Protection flow chart on how to report suspected abuse. We saw information relating to the Mental capacity Act and guidance on Deprivation of Liberty. We saw that staff receive training in safe guarding adults as part of their induction and that other staff receive annual updates. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have a pleasant and homely environment to live in which also has had adaptations to meet individual needs. Evidence: The AQAA for the home said:Heathfield is a cosy home and service users are encouraged to furnish their rooms to allow for individuality. Carpets and furnishings are maintained or replaced as necessary. Carpets in rooms and communal areas are cleaned professionally every 6 months or when necessary. Spring cleaning is performed on a rota system by the cleaner. There is a designated area for washing and drying of clothes with correctly installed washing machines and tumble dryers. There is a designated sluice area which has washing facilities for soiled articles. At certain areas around the home there are air fresheners which are changed monthly by the cleaner. Antiseptic hand gel is available for all to use around the home. We looked around some of the home and we were able to see communal areas such as the dining room, lounge, bedrooms and bathrooms. People who live at the home are encouraged to furnish their room with personal belongings such as furniture and pictures. The home has regular visits from a family of young ducks. The home was seen to be very clean throughout, with no malodour. When we walked about the home we saw that rooms are centrally heated, all radiators and pipe work are covered. Windows are fitted with restrictors where necessary and emergency lighting is Care Homes for Older People Page 20 of 31 Evidence: provided throughout the home.. Individuals commented to us that they were happy with their accommodation those that had them liked having en suite facilities. They described small pieces of furniture that they had been able to bring. They liked the lounges where they could sit with others and chat, watch television, read or listen to music or just be quiet. The laundry facilities have been moved, there are new machines and it is sited away from areas where food is prepared and stored. There is a new sluice area. The home is currently having work carried out with a new corridor being constructed between the main house and the villas. A conservatory is also being built giving more communal space and an optional place to sit. The garden area is being transformed enabling people to move around easier. There is a greenhouse which one resident is managing, there are raised gardens enabling a wheelchair to fit under so everyone can access them and plant vegetables and flowers if they wish. There is a new water feature with fish and people are able to sit round it. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current recruitment practices at the home generally protect the people who use the service. There is a plan to ensure staff receive all the mandatory training that is expected each year. Evidence: The AQAA for the home said:A 4 weekly rota is produced with the correct skill mix for the dependency of the service users. We also have dedicated domestic staff including 1 chef, 1 cook, 2 kitchen assistants and 1 cleaner. Staff are trained and encouraged to do NVQ. New staff receive an employees handbook, code of conduct and all other relevant paperwork. New staff receive skills for care training packs as part of their induction. Recording of staff supervision. Following our last visit a requirement was made regarding the checks to be carried out for the employment of staff. With the exception of the lack of one reference we saw that pre employment checks had been carried out. Since the visit the manager has contacted us to say that the reference was at the home. The staffing structure at the home consists of the directors, manager, care staff, kitchen staff, maintenance and housekeeping. Staff spoken with on the day of inspection indicated that they were aware of the needs of the people who live at the home. We looked at two staff files for people that have been employed since our last visit. Care Homes for Older People Page 22 of 31 Evidence: There was evidence that a CRB had been carried out and they were dated before the employee commenced work at the home. For one individual there was only one reference. The manager said the second had been received but he was unable to find it whilst we were there. All staff information is kept at the home in locked drawer in the managers office. One of the directors carries out most of the training and the manager said alternatives were in place should someone need training and the director was unavailable. The manager said that the director was trained to train others in areas such as moving and handling. The home uses an external trainer for fire safety. The home uses DVDs and questionnaires to assess knowledge and understanding. The new staff undertake induction training which includes an introduction to the home for example fire procedures. The individual works through a pack on areas such as the home, safeguarding and their own personal development. We saw that the individual meets with the manager as needed before being signed off as completing the induction. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems and procedures monitor and maintain the quality of the service provided and which, promote the safety and welfare of those living and working in the home. There is concern however that the care plans however do not support all individual needs. Evidence: The AQAA for the home said:The manager and assistant manager have the correct qualifications and experience to run Heathfield. Staff and service users attend meetings and fill out annual questionnaires. Service users are encouraged to feedback to management either at meetings or on a one to one. Policies and procedures are in place and are reviewed regularly and changed accordingly. Service users are encouraged to maintain their own control over their finances. The home does monthly accounts for service uses as we do not hold any money for individuals. Staff are trained in all mandatory training and are enrolled on any other relevant training courses. The health and safety of the service users and staff are promoted. Care Homes for Older People Page 24 of 31 Evidence: There has been a change in the management of the home since our last visit. The new manager had a three month handover with the outgoing manager who is also one of the directors for the home. A new deputy has been appointed. The manager has four years experience of working in care, he has obtained his registered managers award. He told us that he has begun the application process of being registered with the commission. We saw that the certificate related to the homes registration was displayed in the hallway and displays the details of the core registration for the home. The certificate relates to the previous commission and has the previous managers details on it. Following our last visit a requirement was made that the home should put in place a quality assurance system. We saw that the manager has undertaken staff and resident meetings. The residents commented on food, staff, activities and the homes environment. We saw that people who the service, visitors, relatives and staff had been asked to comment on the service provided at the home. Some comments included: I have been here only a few days and everyone without exception is welcoming, kind and very attentive which is a great help to me. In 99.9 of the time the home is alright but there are times when I am waiting longer. (Response in relation to question on call bell system). Mum is very happy here and particularly likes her room. The manager told us that the home does not manage or look after any personal money. One individual who looks after their own money often asks staff to get shopping for them The manager showed us that the amount taken is recorded on a sheet the individual keeps. It does not show however the amount spent and returned and only the staff member signs it. The manager said he would review this to ensure the individual is protected as far as possible. The manager informed the commission in the AQAA that the servicing of all utilities and equipment used in the home has taken place. We looked at the records for fire safety training and monitoring of equipment we saw records that indicated that fire safety equipment and emergency lighting has been tested regularly and staff have received regular fire safety training. Care Homes for Older People Page 25 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must ensure that a service users plan of care is generated from a comprehensive assessment as specified in schedule 3 and that this is drawn up with each service user and provides the basis for the care to be delivered. Each plan must be reviewed a minimum of monthly and as and when changes occur. To make sure that staff have the guidance they need to follow in order to ensure that support is provided safely and consistently. 31/12/2009 2 8 12 The registered person must 31/12/2009 as specified in Schedule 3 ensure that service users are assessed, by a person trained to do so, to identify those service users who are at risk of developing, pressure sores and appropriate intervention is recorded in the plan of care. To ensure the health safety and welfare of the service users in the home. 3 8 13 The registered person must ensure that service users psychological health is monitored regularly and 31/12/2009 Care Homes for Older People Page 26 of 31 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action appropriate restorative care provided. To ensure the health safety and welfare of the service users in the home. 4 9 13 The registered person must 31/12/2009 ensure that the homes policies and procedures for the handling and administering of medicines are followed at all times. In particular clear guidlines must be obtained for when PRN medication can be administered, service users GPs must give their consent before homely remedies are administered, medication administration records must be completed and signed for to indicate if prescribed medicines have been taken or applied, risk assessments must be completed for service users who administer their own medication. To ensure that people receive their medicines safely. 5 29 19 The registered person must 30/11/2009 ensure that recruitment practises are robust with all employment checks needed, to be in place before employment commences. To ensure that service users are supported and protected by the homes recruitment policy and practises. Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 15 (1) The registered person must ensure that there is a plan of care for all identified needs for each individual living at the home. For example when pain relief should be given. To ensure that all needs are met and staff are aware of what support they must give. 31/07/2010 2 8 15 15 (1) The registered person must ensure that where an individual needs support for any needs related to their mental well being there is a plan of care which states what staff at the home should do and who is supporting both the home and the individual. 31/07/2010 Care Homes for Older People Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that the needs and welfare of the individual are met in the best way for them. 3 8 12 12 31/07/2010 The registered person must ensure that where an individual receives care from health professionals a record is kept of the action staff at the home are to take and support they are to offer to compliment the support received from outside the home. To ensure that the individual living at the home received the care needed. 4 9 13 13 (2) The registered person must ensure that the homes policies and procedures for the handling and administering of medicines are followed at all times. In particular clear guidelines must be obtained for when the home can administer homely remedies. To ensure the safety and well being of individuals who live at the home. 31/07/2010 Care Homes for Older People Page 29 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 5 29 19 The registered person must ensure that all employment checks are in place before the employee starts work at the home. To protect the people who live at the home. 31/07/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 31 of 31 - 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. 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