Inspection on 14/09/07 for Heathfield House

This inspection was carried out on 14th September 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heathfield House 10/02/09

Heathfield House 17/08/06

Heathfield House 08/02/06

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Heathfield House 318 Uttoxeter Road Blythe Bridge Stoke on Trent Staffordshire ST11 9LY Lead Inspector Irene Wilkes Key Unannounced Inspection 14th September 2007 09:30 Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heathfield House Address 318 Uttoxeter Road Blythe Bridge Stoke on Trent Staffordshire ST11 9LY 01782 393909 F/P 01782 393909 vpatrickjones@yahoo.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Archangel Enterprises Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That service users with a mild to moderate learning disability are admitted to the home. Date of last inspection 17th August 2006 Brief Description of the Service: 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. 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, but again these are not of the ‘walk in’ type. 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. The costs of the service are negotiable dependent on the needs of the service users, and currently range from £630 to £990 per week. Residents pay for their own outside activities and holidays. Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection. This means that all of the national minimum standards that the commission for social care inspection consider most greatly affect the health, safety and welfare of the residents were looked at. The inspection took place over a seven-hour period. Some of the residents were at home at different times in the day and they were spoken to individually to gain their views about living at the home. 5 resident survey forms were returned, and also 1 survey form was received from a relative. A support worker and the manager were on duty throughout the day of the inspection and each contributed to the inspection process. The inspection included examining a sample of 3 residents’ files and a sample of health and safety documents. The arrangements for administering medication were looked at. The menu plan for the week was seen. The recruitment procedures were looked at as well as the training provided to the staff. This included inspection of 3 staff files. A tour of the home was undertaken. As required by law, the manager had returned an Annual Quality Assurance Assessment (AQAA) for the home. This was provided in a timely manner and contained satisfactory information about the home. Information from the AQAA has also been used as part of this inspection report. What the service does well: The residents all said that they like living at Heathfield House and that they like the staff. ‘They are the best’ was how 1 resident put it. A relative, whilst saying that she did not have any information about how to make a complaint stated ‘never needed to, don’t have any concerns about care.’ Staff had a good understanding of the needs of each person and at the inspection were heard talking to them in a friendly and respectful way. Residents are encouraged to take up college and other courses, with everyone attending an activity or course on at least 1 day per week. Some people are at courses at college for 3 days. Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 6 All of the residents have a Recreation Pass that allows reduced entrance fees to a range of leisure facilities run by the local authority, and each has a bus pass. Healthcare needs are well met. The home has ensured access to professional services for the residents that have not been considered previously. Anyone living at Heathfield House can be confident that they will be supported to gain any further health professional advice and treatment that they require. The manager also ensures that residents have access to an independent advocacy service to help support them in a range of decisions. Staff going to work at the home receive a good induction that gives them a good basic knowledge and understanding of the needs of people with a learning disability. They are then supported to obtain further National Vocational Qualifications and receive the mandatory training that they need to help them support the residents to remain safe. There is a new manager, who was the previous deputy. Residents and staff said that they liked her, with residents saying that she listens to them, and staff saying that she is approachable and ensures that they all work together in a positive way for the benefit of the residents. What has improved since the last inspection? What they could do better: There remain issues about the information given to residents in the Service User Guide and contract about what they can expect from the service. This information must be absolutely clear and the contract must not be changed without discussion with the residents. Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 7 Information needs to be provided in a more user-friendly way to help aid the understanding of each resident. At the moment only written information that in itself is not clear is provided. Residents, apart form attending individual college courses do not have much opportunity to enjoy personal interests and activities outside the home on a 1:1 basis. More planning around the goals and dreams of each person needs to take place, and then be followed up with support from staff to do this. Although there are enough staff on each shift to maintain people’s safety, the staffing levels do not allow for the 1:1 support highlighted above. The home has been required to review the staffing levels. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who may use the service and their representatives have information provided about the home. Written information would, however, benefit from being clearer and presented in a more user-friendly way. Contracts should not be changed without discussion. EVIDENCE: The residents had their own copy of the Service User Guide/residents contract. These need to be personalised to state what room each person has etc. An issue regarding the insurance of residents’ personal items that was found at a random inspection in December 2006 had been addressed. The contract/ Service User Guide should accurately reflect the terms and conditions of residency in the home and be clear as to what the individual fees cover, and what ‘extras’ residents will need to pay for themselves. Additional charges for ‘escort duties’ is unacceptable. The Guide at the last inspection stated that the home would pay for 1 activity per week for each resident but this has now been removed without discussion with residents. Any changes to what has been previously agreed in the contract must only be made with the agreement of the residents. Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 10 In addition, the Service User Guide should be revised to give the full information identified above, and a new copy provided to the residents. This would benefit from being in a more user-friendly style. Care records were seen for individuals who had moved into the home since the last key inspection. In each case the Social Services Department’s assessment and care plan were available, and the home had also undertaken their own initial assessment prior to them moving to the home. This consists of the manager doing an initial assessment with all professionals involved, the individual concerned, their carers and any family or independent advocate. Following this planned visits are put into place. These consist of short visits for lunch then overnight and weekend stays. The AQAA (Annual Quality Assurance Assessment) provided by the manager confirms this process. Both residents spoken with said that they were asked about what support they required before they moved in, and also that they had each made several visits to the home to confirm that it was somewhere that they could feel happy living. Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals have become more involved in decisions about their lives, but there is room for more active involvement by residents in the direction of their individual service. EVIDENCE: The care plans seen showed that they had been developed from the funding authority care plan and the home’s own assessment, and the plan covered the aspects of personal and social support that was required. The plans were regularly reviewed. The AQAA stated that the residents’ views were sought in the drawing up of the original care plan and that they each sat with staff and discussed their plan at each review. The residents confirmed this. They said that staff knew their preferred routines and supported them well. Staff spoken with had a good understanding of the needs of each individual. Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 12 The manager was in the process of restyling the format of the care plans and the draft seen was an improvement. The home should also consider presenting the plan in a more user friendly way that each resident can understand, and should consider the outcomes that are being sought for each individual, making the plan more person centred with the residents’ goals and aspirations at the heart of the development of the plan. There was information about an independent advocacy service displayed on the notice board. 1 resident has accessed the service in relation to a health issue. From this they were making an informed choice about having a complicated operation. There was some evidence of other lifestyle choices being made. One resident had expressed the desire to access community facilities alone and staff had discussed this with the person and provided advice and support to enable any risks to be minimised. There was evidence of residents making day to day choices within the home. There was a range of other individual risk assessments in place. Some were based on clear safety or health needs, such as escort in the community due to severe epilepsy or other health needs. The home is reminded, however, to always take the views of residents into account and to look at innovative ways of supporting them to take responsible risks, providing information and agreeing actions to minimise risks and hazards in their chosen activity where this is appropriate. The home has a clear policy in place regarding unexplained absences by residents. This was recently followed appropriately, with good outcomes. The staff team are reminded to use appropriate terminology regarding any records relating to residents. Terms such as ‘well behaved’ are not appropriate. Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14, 15, 16 and 17 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents are able to make choices about their daily lifestyle, and are supported to develop their life skills. They would benefit from a better focus on the provision of individual activities, based on each person’s interests. EVIDENCE: The majority of the residents are enrolled on college courses ranging from one day to three days a week. Some residents are also involved in garden projects with both arts and crafts and sports sessions intergrated into this. The residents who were at home all said that they enjoy the courses that they attend. These were individualised to meet each person’s needs and interests. However, the further development of person centred planning could identify further valued and fulfilling activities that residents may wish to become involved with, such as opportunities for volunteer/supported work placements. Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 14 During the inspection 2 residents went to the local library with a member of staff. All residents have a recreation key that entitles them to reduced rates for accessing recreational activities. They also all have a free bus pass; some are able to use public transport independently, others require some staff support. Some residents also attend the local church and stay after for drinks with other parishioners. Residents talked about going to the pub for drinks and meals, although it was noted that they did not go out much in the evenings. This was discussed with the manager who said that this was not always possible to arrange unless all residents wanted to go, because of ensuring sufficient staffing. The home is required to consider the needs of the residents and ensure more flexibility of staffing to enable individual choices. It was discussed with the manager that a resident had said that he wanted to go swimming. The resident needs male support in this activity but the service currently has only female staff. Residents would benefit form a mixed staff team. The small staff team and the inflexibility of the staffing rotas does not currently allow much 1:1 activity as is needed for true person centred care, although the manager said that steps are being taken to improve this, and that residents currently have at least one session per week each when they have 1:1 support in the community. This is addressed further under ‘staffing’ and ‘conduct and management of the home.’ Residents said that family and friends are made welcome in the home. A resident talked about his family coming to visit and about a planned visit to the family home. 1 relative returned a survey form to the commission and they were positive about the welcome afforded them by staff when they visit. Residents talked about making their own choices about getting up, going to bed and the general pattern of their day. On the morning of the visit 1 resident was still in bed, 2 had gone to college and 3 people were reading/ watching television in the lounge. All residents have a key to their bedroom and the front door. During the day residents made their own choices whether to sit in one of the 2 lounges or go outside in the enclosed garden. During the afternoon 1 chose to do some baking and 2 others did some gardening. Residents responsibility for housekeeping tasks was clearly recorded in their individual plan. There was a good rapport seen and heard throughout the day between individual residents and staff, with residents being the focus of all conversations. Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 15 Residents said that they choose their own meals. The manager explained that a weekly meeting is held and everyone chooses a main meal for the following week. Residents confirmed that they have an alternative if they do not like what is on offer. Individual breakfast and lunchtime meals are chosen, with the main meal being taken in the evening. At the inspection residents were heard choosing a variety of snacks at lunchtime which they each helped to prepare. They made hot drinks themselves throughout the day, and there was fresh fruit readily available. The inspector was told that a snack is offered at suppertime. The manager confirmed that the staff recognise individual choice but at the same time try to promote health eating. 1 resident had wanted to lose weight and is being successful in this, well supported by the staff team. The menu book was seen and the manager was asked to record the food provided each day in more detail, regarding vegetable choices and what residents have if they make an alternative choice to what is on offer for the main meal. This will better ensure and evidence that a range of varied vegetables/alternative meal choices is provided. Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of dignity, respect and privacy are put into practice. EVIDENCE: The AQAA states that residents need minimal support with personal hygeine but when support is required by staff they ensure that residents are treated with respect and dignity. 1 resident confirmed this saying that he attends to his own personal care needs but staff ‘remind me to shave and clean my teeth after breakfast’. He said ‘they are the best.’ Residents confirmed that they made their own choices about clothes and hair styles. There was evidence that an occupational therapist had given advice for the positioning of equipment in the en-suite shower for a resident. All service users are registered with a GP, dentist and have annual visits to chiropodists and opticians. There was information in individual files about the involvment of other healthcare professionals. Residents receive annual well women/well men health checks. There was good information to show that Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 17 where residents have individual healthcare needs requiring specialist health input they are well supported by staff to obtain this advice and/or treatment. The procedure for medication was discussed with the manager and records for the receipt, recording, storage, handling, administration and disposal of medication were seen. The service uses a monitored dosage system. All staff have received training in medication via a college course, and further training in the monitored dosage system, provided by the supplying pharmacy. The manager was confidnet that the training received by staff is appropriate to meet the level of support with medication required by the residents. None of the residents self medicate. Each had signed consent for support with medication. 1 resident has PRN (as and when) medication to help control epilepsy. There was an appropriate protocol in place, developd with the agreement of the specialist nurse. The manager undertakes monthly checks to monitor compliance with record keeping. All aspects of medication were satisfactory, although it would be good practice for an assessment to be carried out to ensure that each member of staff is competent to handle, record and administer medication properly. This should be undertaken for new staff and repeated at intervals for all staff. Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to express their concerns. They are protected from abuse. EVIDENCE: There is a complaints procedure in the Service User Guide that includes the timescales and stages of a complaint. An attempt at providing the complaints procedure in a user friendly style has been produced and displayed on the notice board but this does not provide sufficient information and is difficult to follow. The manager has since indicated that this has been addressed. Residents spoken with, however, said that staff talked to them in residents meetings about how they should complain if they were not happy with anything, and they would do their best to put it right. An individual resident spoken with said that he would feel comfortable in raising any issues and had faith in the staff that they would address his concerns. The home had not received any formal complaints. Day to day niggles between residents are dealt with as they arise. The home is recommended to record such incidents. The Commission has not received any complaints about the home. A relative said in a survey form that they did not know how to complain but stated ‘never needed to, don’t have any concerns about care.’ The manager was requested to provide all relatives with a copy of the complaints procedure. Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 19 A thank you letter from a relative was displayed on the notice board. The AQAA states that the home has dealt with two issues that have required POVA (Protection of Vulnerable Adults), now called safeguarding, investigations and these have been dealt with efficiently and sensitivly on both occassions, following correct procedure and offering emotional support to those involved. The commission is aware of these 2 investigations that related to disclosures made by residents about previous events unconnected with the home, and the managers statement can be confirmed. The proprietor and staff have also responded well to a recent issue at the home. The home has robust procedures in place for responding to suspicion or evidence of abuse or neglect that are well understood by staff. A staff member was questioned about her understanding about safeguarding adults by way of role play scenarios being set. She demonstrated an understanding of what constitutes abusive practice and her reporting responsibilities. However, she said that she had not received formal safeguarding training, which was borne out when training records were checked. Another member of staff had not received this training, although the AQAA stated that all staff had been given training. The manager is recommended to access an appropriate course for these staff. The home has appropriate policies and practices in place in relation to service user’s monies. Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Bedrooms and communal areas are pleasant and homely and the home is clean. Some repainting is needed. EVIDENCE: The home provides a homely environment for residents. There are 6 comfortable en suite bedrooms, 2 small lounges and a dining room, with 2 further bathrooms, communal kitchen and laundry. The furniture is domestic in style. The frontage of the home is open with space for 2 or 3 cars, whilst the rear garden is quite large but well enclosed and safe. The premises are generally pleasant, although it was observed that some of the paint had peeled off the walls in 1 of the bathrooms, and particularly the corners of walls were showing signs of wear and tear. The manager undertakes a monthly audit of the environment to identify any issues. This needs to be linked to a planned maintenance and renewal programme for the fabric and decoration of the premises, and records kept for an audit trail. Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 21 It has been raised at previous inspections that the lighting in the home could be improved. Some areas of the home remain quite dark. This is particularly so in the downstairs corridor, hall, upstairs landing and office. This is in part a design problem of the home. The provider has stated in previous responses that the home is ‘continually looking to improve lighting in an energy efficient manner’. Minimal change was noted at this inspection. The provider needs to ensure that there is adequate lighting in all parts of the home. The bedrooms of 2 residents were seen. Each said that they liked their room, that their bed was comfortable and that they had all that they needed. The residents had personalised their rooms and had brought in some of their own possessions. Bedroom doors were lockable and all residents had their own key. The bathroom/en-suites had grab rails/ equipment in place to meet the individual needs of those residents that required this. The home was clean and tidy. The manager talked through the procedures for the control of infection and confirmed in the AQAA that current good practice guidelines are followed. Protective clothing is available. There are appropriate floor finishes in laundry and bathroom areas, good positioning of the laundry, with a washer, drier and hand washing facilities. Communal bathroom and toilet areas had liquid soap and paper towel dispensers and sanitary and other bins. Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 33, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recruitment procedures are satisfactory and staff are appropriately trained. The inflexibility of staffing rotas does not well support the provision of person centred care. EVIDENCE: There is a small but committed staff team, comprising the manager (yet to be registered by the commission), a deputy and 5 support workers. The registered manager has left to lead a new service owned by the same proprietor. The new manager was the previous deputy, and the current deputy also previously worked at the home, so there is some continuity in management arrangements. The staffing rotas were discussed with the manager. Day staff work 12 hour shifts form 9am to 9pm, with 2 staff on duty every day. There is 1 waking night staff. Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 23 The service currently has 2 vacancies. There is active recruitment to 1 of these posts but there are no plans to recruit to the other post, the vacancy for which has occurred by the registered manager moving on. The problems of a small staff team with an inflexible rota were discussed with the manager. She said that all of the team support each other by covering additional hours for holidays/sickness. The issue about the lack of flexibility to effectively provide person centred care was also discussed. The manager said that recruitment to 1 vacancy would allow a third member of staff on shift on some occasions, allowing more individual activities for residents. With the appointment to the one vacancy this would allow her 12 hours off rota to address her managerial work and also allow 3 staff on duty on some days. The agreement reached with the proprietor previously was for a minimum of 18 hours for the manager to be off rota, to cover management duties. This must be maintained. There have also been discussions previously with the proprietor about staffing levels, when it was stressed that a minimum of 2 staff must be maintained on each shift to keep people safe. While this has been continued, this further reduction of a post does not allow the service to provide person centred care to meet the individual needs of the residents for social and recreational activities and community access. Group activities, whilst being occasionally enjoyed, are institutional. A requirement is made that the provider and manager review the staffing levels to ensure the service can provide person centred care/more flexible routines to meet the individual needs of residents, as highlighted above. It was evidenced that the home operates a thorough recruitment procedure to ensure the protection of residents. All files had evidence of POVA (Protection of Vulnerable Adults) First and CRB (Criminal Records Bureau) checks and 2 references, and there was an audit trail to show that all relevant information had been gained before the person started working at the home. All other aspects of appropriate recruitment were in place, such as staff being given copies of the codes of conduct and practice set by the General Social Care Council. It was discussed with the manager that residents could be more involved in the recruitment procedure. Currently prospective staff members are introduced to the residents and they are asked if they like them, but they play no further part in the process. It is recommended that some thought is given to this. The AQAA states that 95 of the staff team have or are working towards NVQ (National Vocational Qualification) level 2 or above. Staff receive appropriate induction and all staff have undertaken at least 2 units of LDAF (Learning Disability Award Framework). Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 24 The AQAA also stated that all staff have mandatory trainning that is updated when required. The training matrix confirmed this, apart from 2 staff that had not received safeguarding adults training, which is being addressed. The home has also addressed some specialist training needed to meet the individual needs of residents. Staff have received training about hearing loss and some training about epilepsy is booked. The manager has NVQ 3 and has nearly finished her Registered Manager Award, which she is to follow with NVQ4. The annual appraisal for staff is due this month. The manager said that she is to receive some support from the previous manager who still works for the company, to undertake these. Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The new manager of the service is coming to grips with her new role and is satisfactorily leading the service. EVIDENCE: The manager of the service was previously the deputy manager and she has worked at Heathfield House since it opened 2 years ago. She also has experience prior to this in working in a care setting. She is currently completing her Registered Managers Award, and will then move on to NVQ4. She is in the process of applying to the commission to become the registered manager for the home. Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 26 Residents and staff spoke highly of the manager. Staff said that she had an inclusive approach and an open management style. 1 resident said ‘she’s great. I like it when she’s on duty.’ The manager talked of how she was approaching her new role. She had good ideas about coaching the staff and developing a cohesive team. She talked of her plans for the development of the service. There were some discussion earlier in the year with the proprietor about the need to always provide a minimum of 2 staff during the day/evening for health and safety reasons. Although this has been maintained, the actual staffing hours have been cut by 1 post. A requirement is made for a review of the staffing structure to allow more person centred care. The restoration of the additional post will also help this. This would additionally demonstrate better value for money. The manager undertakes monthly monitoring of the service by way of quality assurance of all records and of the environment. Any deficiencies are discussed with staff at team meetings and how issues can be improved are addressed. There was an issue noted at the inspection regarding fire records and their monitoring, that is shown below. Any environmental improvements required are brought to the attention of the Operations Director. These audits have been considered and a development plan for the home, by way of a quality audit has been produced. The home is reminded that this must be a working tool and statements made about the development of the home need to be put into practice. Residents’ meetings are held monthly when their views about the operation of the home are sought. Individual care plans are regularly reviewed, when family representatives are invited where applicable. There has been no formal survey of residents, relatives or other professionals who are involved with the service to assess their satisfaction with the service. The manager has recognised this as a shortfall and plans to address this in the coming months. This is needed. The AQAA identified that policies and procedures are regularly reviewed. Residents were given every encouragement to talk to the inspector during the visit and to express their views. The environment appeared safe at this visit. Gas, electrical and central heating safety reports were up to date. COSHH (Control of Substances Hazardous to Health) products were stored correctly and data sheets for each product were stored with the product. PAT (Portable Appliance Testing) had been carried out. Protective clothing was provided. Accidents are appropriately recorded, and the storage of accident reports meets data protection requirements. Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 27 Whilst generally fire records were up to date, including individual fire risk assessments, a fire risk assessment for the environment and an emergency plan, there were some gaps in the weekly fire tests. The manager is reminded to be vigilant about this. These omissions were not recorded in the monthly audits. The audits need to accurately reflect the findings from any monitoring to have any effectiveness. Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 3 X Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 5 Requirement Provide residents with a service user guide/contract that accurately reflects the service that they have been promised and signed up to. The provider and manager must review the staffing levels to ensure the service can provide person centred care/more flexible routines to meet the individual needs of residents. Ensure that the staffing levels are sufficient to enable the manager to work for a minimum of 18 hours off rota to cover management duties, as previously agreed with the commission. Timescale for action 30/11/07 2. YA33 18(1)a 30/11/07 3. YA33 18(1)a 30/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 30 No. 1. 2. 3 Refer to Standard YA1 YA6 YA6 YA17 Good Practice Recommendations Provide information for residents in a more user friendly style, to meet each persons’ communication needs Consider presenting the care plans of residents in a more user friendly way that each resident can understand. Make the care plans more person centred with the residents’ goals and aspirations at the heart of the development of the plan. Provide more detail in the menu book about the content of each meal, such as what vegetables have been provided, and also the alternative choice offered. This will give a better audit trail for the home to ensure that each person is receiving a nutritious and varied diet. Periodically test the competency of staff in relation the administration of medication. Keep a ‘grumbles book’ to record any issues raised by residents and how they have been resolved. This will enable better monitoring of any patterns that may emerge. Ensure that the monthly audit of the environment is linked to a planned maintenance and renewal programme for the fabric and decoration of the premises, and keep records to show how improvements are addressed, including timescales. This will give an audit trail. Seek further ways of improving the lighting in the downstairs corridor and upstairs landing. Find ways of involving residents more fully in the recruitment and selection of staff for the home. Seek the views of residents, families and significant others involved with the service about the quality of the service being delivered, and consider these views towards the development of the service. 4 5 6 YA20 YA22 YA24 7 YA24 8 YA34 9 YA39 10 Heathfield House DS0000064907.V344641.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Local Office Commission for Social Care Inspection 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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