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Inspection on 10/02/09 for Heathfield House

Also see our care home review for Heathfield House for more information

This inspection was carried out on 10th February 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There is a lovely calm and happy atmosphere at Heathfield House and this is what first struck us following our arrival. Staff and people living there clearly know each other well. We could tell this from the content of the good natured banter between both parties. Personal routines are flexible and people get up for the day over a long period of time according to their personal preference. People living at Heathfield House are able in many ways and are able to self care with prompts from staff. When people are poorly, medical advice is sought promptly. In between times they are supported to monitor their health by attending routine health appointments with the dentist and optician for example. People are provided with pleasant living accomodation and like the personal space available to them in their bedrooms. There is a high level of satisfaction about the service with maximum positive feedback provided to us from people living and working there, and to the service from relatives.

What has improved since the last inspection?

Care plans would benefit from further detail but since the last inspection they have been developed to provide improved guidance to staff about how to provide individual`s care. Activity levels have improved and the service is beginning to embrace the need to provide more individualised activities that accord with people`s individual interests. It is positive to see trips to the football and theatre being arranged for smaller groups and to see one person starting, with support to trace her family tree and another person attending regular manicures at a local salon. Things we identified for improvement in the environment have been addressed. There has been some redecoration and lighting has improved in a stair well which will reduce the risk of trips and falls. Additional staff have been appointed to release the manager to concentrate on managing the home.

What the care home could do better:

Pre admission documentation still needs to improve to ensure all parties are aware of their rights and responsibilities. Hazards are recognised but the level of risk these pose to individuals has not been sufficiently considered as assessments are in a standardised one size fits all format. Accidents however have been few and infrequent to date. Medication is being adequately managed on the whole but there is room for improvement to ensure there is sufficient guidance for staff in respect of the administration of as required medications. Also record keeping must improve toaccurately reflect the use of prescribed lotions and creams etc. Where there is doubt about prescribing directions these must be reviewed with the prescribing medic. The living environment is well maintained and comfortable but the worn and dated kitchen compares poorly with the rest of the home and needs replacing or refurbishing.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Heathfield House 318 Uttoxeter Road Blythe Bridge Stoke on Trent Staffordshire ST11 9LY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Deborah Sharman     Date: 1 0 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Heathfield House 318 Uttoxeter Road Blythe Bridge Stoke on Trent Staffordshire ST11 9LY 01782393909 01782393909 vpatrickjones@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Archangel Enterprises care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 6 Date of last inspection Brief description of the care home Heathfield House is a six bed roomed home registered for younger adults with a learning disability. The home is a converted detached house on the main road through Tean, Staffordshire. There is a forecourt area at the front of the house that has been laid to gravel to allow for cars to be parked, and there is a large and pleasant rear garden, with a patio area and a fishpond to the rear. The six bedrooms consist of two on the ground floor, and four upstairs. The ground floor rooms are not en-suite; although also on the ground floor is a bathroom with bath and a separate shower room, each of which is in close proximity to these two ground floor bedrooms. Although the bathrooms are small they are adequately fitted with appropriate grab rails, etc. Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home Also on the ground floor are two small lounges, one of which has patio doors that open on to the garden, and a separate dining room. There is a domestic style kitchen and a separate laundry room, and a further single toilet. Upstairs there are four en-suite bedrooms and a staff office. The bedrooms are spacious, with the en-suite areas varying in size and shape and fitted with a shower. The home is on a busy road through Tean, with easy access to local public transport routes. There are local shops available in close proximity and a pub that serves food is very close by. Weekly fees were not available to us. Information about fees should be sought directly from the manager or organisation. People living at Heathfield House pay for their own outside activities and holidays. Care Homes for Adults (18-65 years) 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: One Inspector carried out this unannounced key inspection between 9.30 a.m and 5.30p.m. As the inspection visit was unannounced this means that no one associated with the home received prior notification and were therefore unable to prepare. As it was a key inspection the plan was to assess all National Minimum Standards defined by us as key. These are the National Standards which significantly affect the experiences of care for people living at the home. Information about the performance of the home was sought and collated in a number of ways. Prior to inspection we were provided with written information and data about Care Homes for Adults (18-65 years) Page 6 of 31 the home in an annual return. We had sent surveys to people who live and work at Heathfield House and also to independent health professionals who have contact with the home. We received completed surveys back from all six people living at Heathfield House, six staff and one independent health professional. It is currently our policy not to send surveys to relatives in order to comply with data protection legislation and no visitors were available to talk to during the inspection. However satisfaction surveys had been carried out by the service after we last visited and relatives thoughts about the service were available to us in this format. During the course of the inspection we used a variety of methods to make a judgement about how people are cared for. When we arrived we found it was the managers day off. Staff contacted her and she came in at about lunchtime. Until then the deputy manager helped us. When the manager arrived later, she along with the deputy manager were available throughout the rest of the day to answer questions and support the inspection process. We also spoke to three people who live at Heathfield House and one additional person who works there. We assessed the care provided to two people using care documentation and we sampled a variety of other documentation related to the management of the care home such as training, recruitment, staff supervision, accidents and complaints. We toured the premises accompanied by a resident and three people showed us their bedrooms. All this information helped to determine a judgement about the quality of care the home provides. What the care home does well: What has improved since the last inspection? What they could do better: Pre admission documentation still needs to improve to ensure all parties are aware of their rights and responsibilities. Hazards are recognised but the level of risk these pose to individuals has not been sufficiently considered as assessments are in a standardised one size fits all format. Accidents however have been few and infrequent to date. Medication is being adequately managed on the whole but there is room for improvement to ensure there is sufficient guidance for staff in respect of the administration of as required medications. Also record keeping must improve to Care Homes for Adults (18-65 years) Page 8 of 31 accurately reflect the use of prescribed lotions and creams etc. Where there is doubt about prescribing directions these must be reviewed with the prescribing medic. The living environment is well maintained and comfortable but the worn and dated kitchen compares poorly with the rest of the home and needs replacing or refurbishing. 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 set out 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 Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. People are confident that the care home can support them. This is because there is an 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. Evidence: Since the last inspection, one person has moved in to Heathfield House. We could see that they visited the service regularly for two months before deciding to move in. We could see too that the service had sought information about the persons needs from a range of sources before deciding to offer the place. We feel that greater attention could be paid to exploring what the person hopes for and wants to achieve if they move in. Similarly, assessors should explore peoples cultural needs, traditions and norms as part of the pre admission process as currently, there is little evidence of this. We spoke to this person who said she had settled well and was happy. Brochures do not contain enough information to help people decide about moving in. We could see that a contract has been provided in an accessible format but it is not Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: clear that the person, who can read is aware of her rights and responsibilities as it has not been signed. The contract explains the rights and responsibilities of all parties but doesnt confirm the persons room number to protect them from having to move rooms. Also we would expect the homes brochures to provide a full range of information to enable people to understand more about the terms and conditions during the pre admission period, prior to the issue of contracts. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. Documentation could improve to better assure accountability for needs and risks, but shortfalls have not affected the quality of peoples lives and experiences. Evidence: A lot of work has gone into expanding the information available to staff in care plans, so they know how to provide peoples care. We advised the manager where further development is needed to better ensure that peoples abilities and specific needs are considered and documented. However this does not appear to be affecting peoples experience of the care provided. We talked to a staff member who could confidently describe peoples needs and preferences. We were also assured from looking at the minutes of residents and staff meetings that people living there are treated as individuals and that their wishes are sought and acted upon. For example, a request was made to visit a local farm and within two days this trip had taken place. In Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: surveys sent to us everyone told us that they can always make decisions about their lives. We advised the manager however, who agreed, that in future it would be better for independent advocates to support people to complete these questionnaires, rather than staff. Also, where they are able, people are being supported to manage their own money. Similarly, we identifed that systems in place to identify and control risks to people are not sufficiently developed. Risk assessments are standardised and do not consider levels of risk based upon individual peoples abilities and vulnerabilities. In one case, documented risk assessments were dated prior to the person moving in. This is not sufficiently accountable. However, we could see from records that accidents are infrequent and minor in nature. Everyone living at Heathfield House is mobile and able in many ways. Incident records show a known risk to some people is absconding when they would be at risk in the community if unsupervised. However, alot of positive work has gone into identifying what triggers these incidents. We talked to staff who were able to consistently describe what was required of them to minimise these risks. Managers reported this to have significantly reduced the number of occasions when someone has absconded. But when this situation has arisen, staff have responded promptly and appropriately. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 can take part in activities that are appropriate to their age and 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 and have healthy, wellpresented meals and snacks, at a time and place to suit them. Evidence: In their annual return to us, the manager told us that since the last inspection they have offered a wider range of activities with the individuals needs been taken into consideration. They said they are aware that they now need to provide life skills activities to promote peoples independence. Everyone living there, with the support of staff have told us they are happy that they can do what they want to during the day, evenings and at weekends. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: We could see that group activities continue but that more individualised activities are developing. There have been day trips to local places of interest and the sea side. We can see that there has been a trip to the pantomime and two people went to the theatre together. An additional staff member was booked on the rota to take people to a local football match and the resident whose care we looked at in detail, is clearly proud of her nails. She told us about and showed us photographs of herself attending a local nail salon to have her nails professionally manicured. Another person uses the local library computer facilities and is starting to research her family tree. We can see that people have regular contact with their families. We have advised the manager to ensure staff stop writing out with staff in activity records. This does not sufficiently show what the activity was or adequately demonstrate that this accorded with the wishes, choices and needs of the people who live there. People enjoy their meals and we could see that meal time is a pleasant and sociable occasion with the person who had chosen that nights meal describing it as her favourite. We saw everone else enjoying the meal which was plentiful, healthy and well presented. Nobody has any special dietary requirements or is particularly at risk at meal times but one resident continues to be supported to lose weight, had been to see a dietician the week before inspection and was pleased to be able to tell us he had lost further weight with the support of staff. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because medical advice is sought when peoples health changes and they have the opportunity for routine health screening. Some aspects of medication management could improve including ensuring that procedures are consistently in place for staff to follow. Evidence: When we arrived at 9.30 in the morning, to carry out the inspection, people were at different stages of readiness for the day. One person had been up for some hours as she prefers, another person came down at 10.30 for breakfast and said he had had a lovely shower. Most people are able to independently manage their personal care with different degrees of prompting from staff. We could see that changes in peoples health are responded to and medical advice is sought without delay. We could also see that the emotional health of one person whose care we looked at in detail had improved and had resulted in medication being decreased. We could see that people are also offered routine health screening such as Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: dental, optical and foot care. We received written feedback from one independent health professional who indicated maximum satisfaction and confidence in the service in all areas asked about. We looked at how medication is administered and identified some areas for improvement. Since the last inspection, there has been a medication error which had the potential for serious harm but fortunately did not result in injury. Medical advice was swiftly sought at the time and practice has changed to ensure the error doesnt happen again. We can see too that most staff have had medication training and there is now a system to check staff competence to administer medication from time to time. Three new staff are booked to attend medication training but in the meantime are administering medication to people. These people have been supported in house prior to taking responsibility for medication, but the manager accepted that a competence assessment for one new staff member remains outstanding and she agreed to give this her immediate attention. We found that not all prescribed medications and topical solutions are included in peoples plans of care meaning that clarity and guidance is not always available. Likewise, whilst oral medication is being signed for and being administered as prescribed, other none oral prescription treatments are not being signed for as administered. We can see that the treatment is being applied but documentation must reflect this. The manager also needs to review discontinued medications with the prescriber to ensure they are removed from medication records. We found fybogel prescribed to be taken twice daily but being given to someone as required, with none having been administered for the time period we sampled. Without evidence that the prescribing directions have changed, it seems this person has not been receiving his medication as the prescribing medic intended. Where medication is prescribed as required, we agreed with the manager that medically authorised written guidance for staff is always needed. We saw one positive example of this in place for a medication to manage agitation for one person, but in other cases, this was not available. Care Homes for Adults (18-65 years) Page 18 of 31 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. The care home safeguards people from risk of abuse, neglect and self harm. Evidence: Since the last inspection there have been no complaints, no allegations and no physical interventions or restraints. There have been a few accidents which have been minor in nature and few incidents. People are at risk from leaving the building unescorted and there have been a few incidents of this nature. However staff are aware of how to reduce these incidents and respond promptly in their event. Everyone has told us that they know how to complain and we could see pictorial information publicly available within the home to remind people how to complain should they need to. We are not aware of any concerns and staff we spoke to feel people living there are very safe. Staff have received safeguarding training mainly in 2008 since we last inspected. Three new staff are waiting for this training. We talked to a member of staff who had had this training and she demonstrated a very good understanding of what abuse is and her responsibility should she become aware of any concern. We looked at how peoples money is safeguarded. Financial records are robust and account for expenditure. Money is checked by two staff, twice per day. We advise that the use of PIN numbers by third parties is reviewed in consultation with the banks, Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: that financial records are double checked during regulation 26 visits by the provider and that systems to account for the safe key are tightened. Currently we are told the shift leader accepts responsibility for the key but as there is no senior system in place amongst care staff, the key can be interchangeable throughout the shift, with nothing in place to account for this. There are no known concerns about how peoples money has been managed but these additional measures if implemented, will provide extra safeguards. New staff are recruited properly to ensure vulnerable people are protected from people who may not be suitable to work with them. Care Homes for Adults (18-65 years) Page 20 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 stay in a safe and well maintained home that is homely, clean, comfortable, pleasant and hygienic. Evidence: We toured the environment and found it to be clean, tidy and homely with no evident hazards. The service works with occupational therapists to ensure the environment continues to meet peoples needs. We could see that there are systems in place to monitor the quality of the environment and that areas the service has identified for improvement have been met. For example, it was identified in December 2008 that one person needed new flooring and a chair and we can see that this was provided within the month. When we last visited, we expressed concern about the level of lighting in one ground floor stairwell. At this inspection we could see that steps have been taken to rectify this as the area has been repainted and strip lighting fitted at the bottom and top of the stairs. Bathrooms too have been repainted which has addressed feedback we gave at the last inspection. We are therefore satisfied that people living there will now benefit from the improved safety and decor. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: Three people showed us their bedrooms. Each person said they like their room, that they are warm and comfortable and that they have everything in them that they want. We could see that each room reflected the persons individual style and interests. The kitchen is clean and we could see that the fridge and oven are kept very clean. The kitchen however, is dated and worn and detracts from the positive impression created in all other parts of the home. The manager said that there is a plan to refurbish the kitchen this year and we would strongly recommend this. Care Homes for Adults (18-65 years) Page 22 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Peoples needs are met and they are supported because staff get the right supervision and support they need from their managers. The staff team are effective and do what is expected of them. Evidence: Prior to inspection we received six completed surveys from staff who all indicated maximum possible satisfaction in all areas of their job that we asked them about. They told us they are satisfied with the training and support they get to enable them to do their jobs and they are clearly proud of the quality of service they provide. None of them could think of anything that could improve with one staff member telling us, I feel the manager and staff team work to their full capacity in ensuring all needs are met. Common themes in their answers about what they do well are, meeting peoples individual needs, choice, privacy and dignity. One staff member told us, we care and look after our service users in all areas of our work. We excel with all health and care needs and activities. During the inspection we spoke to a different staff member who confirmed what we had been told in surveys. A staff member who said she loved her job, confidently demonstrated a good understanding of peoples individual needs. We experienced a lovely atmosphere in the home based on mutual respect and banter between staff and people living there. Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: New staff are recruited safely and are supported to settle in and understand their job role by undertaking inductions both in house and to national standards. We could see that most staff have received formal supervision to the required frequency and a rolling programme of training is in place. According to the matrix it has been 2 years since established staff have had fire safety training and this should be reviewed. However the manager was aware of gaps in the training programme and could tell us that training had been booked, especially for new staff. We looked at staffing levels. Additional staff have been recruited to enable the manager to have time to manage the home and agency staff are not used, ensuring continuity of care. Two care staff are on duty during most waking hours although we could see that additional staff were planned for occasional special occasions and to support one person to attend college weekly. The manager and staff feel they have adequate time to meet peoples needs and to provide activities. Subject to risk assessment, the manager could consider using existing staff resources more flexibly to achieve more individualised activity more frequently. Care Homes for Adults (18-65 years) Page 24 of 31 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 have confidence in the care home because it is run and managed appropriately on a day to day basis. The environment is safe for people and staff because health and safety practices are carried out. The manager has a good understanding of the strengths of the home and areas requiring development. Evidence: Staff have confidence in the newly registered manager who has recently returned from a period of maternity leave. They feel she is supportive, is making improvements and provides direction. Perusal of staff meeting minutes supports this. It is a legal requirement for services to provide us with their AQAA or annual return. We received Heathfield Houses annual return by the date we gave. It was brief in content but showed us that the service has a reasonably good understanding of its strengths and areas for development. We have identified additional areas for improvement at this inspection, but the manager responded to feedback positively. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: The manager feels supported on a day to day basis but is not receiving formal supervision as she should be. Having returned to work, she now needs to identify and agree a plan to meet her learning needs. Additional staff have been recruited to free the manager from providing hands on care for part of the week to enable her to have time to manage and develop the service. We had required the service to provide her with 18 hours off rota. The manager has 14 hours off rota each week and is satisfied that this is sufficient. She feels that this, combined with the times that she works as a carer is positively supporting her to effectively manage the home. This should be kept under review. We were told that regulation 26 visits by the provider have been hit and miss and when they have happened they havent been recorded. This does not provide evidence that quality is being checked and does not inform the home what they are doing well and need to improve. However, it seems these shortfalls have been identifed and the responsibility for these visits have been delegated with the first visit having taken place in January 2009. We were able to see a report of this visit. Other quality monitoring systems are in place however and audits of systems and the environment are carried out monthly by the manager. Surveys were sent out by the service to people living there and their relatives in October 2007. The results were very positive but it is time to repeat this exercise now to seek up to date feedback. Having said that, we have recently received positive feedback from all six residents with the help of staff but it is currently our policy not to survey relatives to comply with data protection laws. We looked at service and maintenance records to judge whether the home is being safely maintained. We were told that staff are taking the temperature of hot food before it is served to guard against giving people food borne illnesses. We have advised the service to record these temperatures to ensure better accountability and an audit in the event of illness. Procedures are not in place to check water systems for the risk of legionella but the manager said they would now act on this. We found hot water to be generated by a combination boiler which we were told discharges water at a set temperature to all outlets. Records show this temperature to be beyond the safe range although discussion showed staff to feel any risks from water temperature are minimal and effectively managed. Further advice about this should be sought. Otherwise documentation was available and up to date for most things that we asked for such as electrical safety, fire safety and hazardous chemicals. A first aid box is available and seven staff are first aid trained. Three new staff need to do this training. Staff have done fire training but this now needs to be updated. Policies and procedures have been reviewed in 2008 and the manager is undertaking this again currently. There are a wide range of risk assessments in place to limit environmental risks to Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: staff and people living on the premises and we can see that accidents and incidents are few and minor in nature. Therefore outcomes for people living at Heathfield House are good. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Adults (18-65 years) Page 28 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 9 13 Risk management strategies 31/03/2009 must be reviewed to ensure they consider, in partnership with all parties, risks and control measures for each individual This will ensure that variables affecting risk such as individuals abilities and needs are considered and agreed in the management of risk. This will avoid a one size fits all approach and will ensure that risk is accurately assessed and controlled for each person. 2 20 13 Medication systems must be reviewed to ensure all people receive their medication as prescribed and that records accurately reflect practice. This will protect peoples health and welfare by ensuring they always receive the medication as intended. 31/03/2009 Care Homes for Adults (18-65 years) Page 29 of 31 Improved records will evidence this. Improved guidance for staff will also support this improvement process and serve to minimise any risks arising from lack of clarity.. 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 1 1 The Statement of Purpose and Service User Guide should be reviewed to ensure they fully comply with regulation and national minimum standards. This will provide people with all information they need to know about the service available. Pre admission assessments should consider the full range of peoples diverse needs such as gender, sexuality, religion, traditions, cultural norms etc Peoples contracts should be reviewed to ensure they fully comply with the national minimum standards. This will promote their rights and help them to be more fully aware of their rights. The registered person should refurbish or replace the kitchen which is now dated and worn. The manager should receive regular recorded supervision to support her in the management of the care home. Steps should be taken to assess the level of risk from legionella. Water temperatures should be reviewed with someone competent to try to ensure they fall within the safe range. 2 2 3 5 4 5 6 7 24 37 42 42 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or 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. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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