Inspection on 17/08/06 for Heathfield House

This inspection was carried out on 17th August 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 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 14/09/07

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 Stafford Staffordshire ST11 9LY Lead Inspector Irene Wilkes Key Unannounced Inspection 17 August 2006 09:30 Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 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.V291931.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V291931.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Heathfield House Address 318 Uttoxeter Road Blythe Bridge Stafford 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 Victoria Lynn Patrick-Jones Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 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 8th February 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. 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 £640 to £830 per week. Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection, was unannounced and was undertaken by 1 inspector. All of the core standards as required by a key inspection were looked at. In addition a small number of other standards were looked at where they related to requirements made at the last inspection. The home has been open for less than 12 months and this was the second inspection since it opened. The home is registered for 6 people with a mild to moderate learning disability. There are currently 5 people living in the home with 1 vacancy. At the inspection visit each of the 5 residents were spoken with about there life in the home. A Community Nurse who was visiting in a friendship rather than in her professional role spoke about the positive support that her friend was receiving from the home, and a relative spoke on the telephone about her satisfaction with the service. What the service does well: The residents and their families and/or friends are all satisfied with the service that they are receiving and talked about how the staff at the home are supporting them to become more independent. ‘They’ve talked to me and helped me to get more independent. I go out to the library and shops down the road on my own now, and I’m really pleased about that.’ A friend who was visiting spoke highly of the home and said ‘She is well supported here.’ Residents are encouraged to get involved in activities that they enjoy. Several have enrolled on various college courses for the start of the new academic year and one continues with work experience once a week at a gardening project. The staff are also supporting him in his attempts to find further gardening work. 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. Leisure activities meet individual needs and range from going to the snooker hall for 2 of the young men, to bingo, going to the gym, attendance at Red Cross meetings, to indoor hobbies such as knitting, cookery, pool and reading. There is also a computer available for those interested. Healthcare needs are well met. The home has ensured access to professional services for the residents that have not been considered previously. For Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 6 example one resident is to have a hearing aid and staff have received training in how to support her with this, two other people were referred to Speech Therapy services resulting in one of them receiving a portable computer aid on which she can spell out words as she has speech impairment. The same service user has received support to access a specialist who considers that an operation would be successful in stopping the regular seizures that she has, and she is being supported to think about having the operation with the support of an advocate who has been contacted on her behalf. All staff going to work in the home receive a good induction that gives them a good basic knowledge and understanding of the needs of people with a learning disability. The manager’s runs the home in a very open way, she is approachable and residents and staff said that she listened to them. This means that residents have felt able to raise concerns and know that they will be supported, and during a recent difficult period for the home the staff have been reassured that their views have been taken into account. What has improved since the last inspection? What they could do better: Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 7 Because of the good progress made by the home it was even more disappointing to find that a resident had been admitted to the home that they could not properly care for. The home has a condition of registration that says that they can only admit people with a mild to moderate learning disability, but it was found at the visit that someone who can become aggressive had been admitted. This is of concern because the building is too small to allow someone with these needs to be properly supported, and the staffing levels and staff training are not sufficient. This means that the health and safety of all the service users and the staff could be at risk. The home had already decided to ask the resident to leave and the Social Worker is looking at the best placement to meet her needs. Meanwhile the home has been required to provide sufficient staff to reduce the risk of any harm coming to all of the residents. The Commission takes very seriously any breaches in the conditions of registration and have told the owner and the manager that they must comply. The local authority pays high fees for the residents to live at the home. It was found that the individual residents’ contracts were asking for more money from the residents for staff support on some occasions. This is unacceptable and the home has been required to remove this condition from the contract. To balance this statement, the manager did say that no one has been charged additional amounts, but the contract must be altered to make absolutely certain that this does not happen. A discussion needs to take place with the residents about intimate personal relationships and the manager has been required to provide any relevant sex education as required in an appropriate way. Some of the other written information about living at the home, described in the standards as the Statement of Purpose and Service User Guide needs adding to. A fire risk assessment for each resident is needed to ensure that any risk to them should a fire break out, particularly at night, is understood and reduced as far as possible. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 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.V291931.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home must ensure that the needs of prospective residents can be met within the conditions of registration of the home and the number and skill mix of staff. Additionally residents and purchasers of the service need to have more transparent information about what is provided within the fee structure. EVIDENCE: At the last inspection, both the Statement of Purpose and Service User Guide required expansion. These documents were seen at this visit and were considerably improved. However, there were still elements of the required information missing, such as the key contract terms and clearer information about the cost of ‘extras.’ It is a requirement of this report that both documents are re-drafted to ensure that all of the required information is available. See requirements 1 and 2 at the end of the report. The care records of three residents were looked at in detail. In each case the Social Services Department’s assessment and care plan were available, and the home had also undertaken an initial assessment in every case via a visit to the service users in their previous placement or at home. The residents spoken with also confirmed that they were asked about what support they required Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 10 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. The home has a condition of registration that they can only accept people with a mild to moderate learning disability. For four of the people living at the home the examination of the care records and conversations with them demonstrated that the home was well able to meet their needs, and the manager and staff had made good progress in supporting them to become more independent and were meeting their health needs. This is discussed later in the report. However, on arrival at the inspection the Commission became aware that the home was having difficulty in meeting the needs of one resident who has challenging behaviour and who may self harm. Staff reported that they did not have the training or experience to meet this resident’s needs, and because of the behaviours that were occurring they were insufficiently staffed to support this person and also meet the needs of the other residents. Examination of the needs assessment information about the resident showed that their needs were known at the outset. These included verbal and physical aggression and self-harm. These needs were clearly beyond the registration of the home. This means that registration conditions have been breached, which is an offence. The manager had sought assistance from the relevant professionals, including a request for additional funding for extra staffing and some support in training for staff, but this had not been forthcoming and the home had made the decision that they could no longer support the resident, and were giving four weeks notice of termination of the contract with the resident from that day. The Commission views it as serious that the condition of registration has been breached, and an immediate requirement was made and a ‘serious concerns’ letter sent requiring confirmation from the provider that this breach would not occur again. The home is also required to provide sufficient staffing during the next four weeks to ensure the health, safety and welfare of all of the residents. This must be assessed following a risk assessment process that is regularly reviewed. See requirements 3 and 7 at the end of this report. At the last inspection the home did not provide an individual contract to each resident, and a requirement was made that this be addressed. At this visit there was a contract in place in each of the files seen. The Commission considers that there are elements in the contract about additional charges that are unacceptable, such as an additional hourly rate to be paid for staff support when accessing community activities, and for staff meals when eating out, although the manager assured the Commission that these charges are not enforced. Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 11 It was made a requirement that reference to additional charges for payment of staff costs must be removed. The Commission will discuss with the commissioners of the service for the individual residents their expectations about staff meals, etc. when supporting service users in the community, See requirement 4 at the end of this report. Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The involvement of the residents in the development of their care plans and in the opportunities for them to make decisions and choices has considerably improved since the last inspection. Further development of the plans in easier to understand formats would assist their involvement even further. EVIDENCE: The three care records that were examined in detail showed that there was an individual service plan for each resident that looked at all aspects of their life, with clear information about what support they required, the outcomes that were being worked towards for each individual, and their aspirations for the future. The plans were much improved since the last inspection. The residents said that the manager sat down with them every month to review their plan and to see if they were happy with how their lives were progressing. Further development of the plans in an easy to read format would assist the residents’ involvement even further, and the home is asked to be mindful of this when looking at the further development of the service. Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 13 The file for the resident who could become aggressive and self-harm was looked at. This showed that some consideration had been given to procedures for staff to respond to the behaviours, and the manager in staff supervision and team meetings also reinforced this information. An independent advocate had supported each resident in their move to the home, and each person still had the contact details of the advocate should they require support in the future. There was also an information leaflet on the notice board that gave details of the advocacy service. Discussions with the residents gave ample evidence that they are encouraged to be independent and to make decisions for themselves. One resident said: ‘They’ve talked to me and helped me to get more independent. I go out to the library and shops down the road on my own now, and I’m really pleased about that.’ The same resident and others also talked about making decisions about spending their money, about their lifestyle and registering for college courses. One resident manages her own finances completely. The other residents are supported with their finances and appropriate records were maintained of all ingoing and outgoing payments. Information about the choices made by residents was recorded in their individual plan. At the last inspection some improvement was required in the individual risk assessments for each resident. These have since been improved and there was a good range of risk assessments in place that the residents confirmed had been discussed with them. Each set of records where appropriate showed an individual risk assessment for when the resident went out alone, that had been well thought through. The residents confirmed that staff had discussed with them about their personal safety and what to do should they feel anxious when alone in the community. Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has worked hard to assist the residents to develop their skills, to identify their goals and to enjoy meaningful activities. EVIDENCE: The home has made good progress since the last inspection in supporting the residents to take part in activities that they are interested in. One resident said that he was continuing to attend his job once a week at the Apedale Project, where he undertakes gardening tasks. He is going to attend Stafford College in September, and he was pleased that some talks had been held with the Landau project about a gardening placement for further work experience. Other residents also said that they were looking forward to attending college in September. They were all doing different courses; for example cookery, and a full time ‘Next Steps’ course. Another resident had continued with the college courses that she was attending prior to moving to the home, and she was also a member of the Red Cross, that she continued to attend once a fortnight. Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 15 Residents have established themselves in the local community. According to their individual interests they attend the locals library, shops, bingo hall, snooker hall, cinema, pubs and leisure centres. They all have a recreation Pass that allows them reduced fees to a range of leisure facilities provided by the local authority, and they all make good use of these. They all have a free bus pass that the home has supported them to obtain. Within the home the residents choose their individual leisure pursuits. Two young men enjoy playing pool, one of the ladies enjoys knitting and other craftwork, another likes reading and another enjoys cooking with the support of staff. The residents also have access to a computer. The residents confirmed that their relatives visit and some go out with their relatives also. They are all involved in activities in the community, providing opportunities to meet other people, although none of the residents have developed any firm friendships with people from the wider community as yet. The manager confirmed that they would be encouraged to bring friends home as friendships developed. During the visit a Community Nurse visited one of the residents on a friendship basis rather than in her professional capacity. She said that from the start the home was interested to learn from her knowledge of the resident, she was always made welcome, and encouraged to see the resident in private. She considered that the resident had developed her independence in the 12 months since she had lived at the home, and she had been supported to gain confidence in her own capabilities. ‘She is well supported here.’ A relative also spoke on the telephone about her satisfaction with the service. A discussion was held with the manager regarding the need to provide education and support for service users regarding the development of intimate personal relationships. Such guidance has still not been provided for the residents although it was a requirement at the last inspection, and needs to be addressed, as required, to help them make important decisions about their lives. See requirement 5 at the end of this report. It was clear throughout the visit that the residents make their own choices regarding how they spend their day. One resident was still in bed at the start of the visit, one was in the shower, and the other three were ‘doing their own thing;’ watching television, reading, doing a jigsaw. Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 16 Throughout the day they were observed making their own choices about where to go and what to do in the home or outside. Two residents decided to bake a cake for afternoon tea (and it was delicious!) At the last inspection the residents did not have their own key to either their bedrooms or the front door. This has now been addressed. The home has made considerable improvements since the last inspection in addressing the lifestyle needs of the residents, with much more positive outcomes now being evidenced. The menu plans for the home were inspected and these showed that there was a three-week rolling programme for meal choices. The manager confirmed that this had been decided in discussion with the residents, and examination of the minutes of residents meetings confirmed that their satisfaction with the meal choices, or any changes that were required was regularly discussed. On the day of the inspection the residents had cheese on toast with fresh tomatoes for lunch. They had discussed the evening meal earlier in the day and decided to change from gammon that was planned, to beef burger, homemade chips and vegetables, with yoghurt for dessert. They also confirmed that they could have something different to what every one else was having whenever they chose. Throughout the day the residents were seen making or asking for a drink, as appropriate, and two residents baked the cake, supported by staff. One resident was observed assisting with cooking the evening meal, and another was seen setting the table in readiness. One resident discussed about her doctor suggesting that she stop eating dairy products due to a stomach problem, and she said that staff were helping her with this. She went shopping with the staff and had changed to Soya milk in drinks and when baking. Weight records for her were seen and she was very proud of the fact that in addition to helping her stomach problem she had also lost weight. It was clear that the home had worked hard to support the resident. Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The home has a good focus on meeting the healthcare needs of the residents and some successful outcomes have been achieved for individuals through the support provided to them by the home to access specialist services. EVIDENCE: The care records showed each person’s individual needs regarding personal care and how they wished to be supported. In the main the residents at Heathfield House are independent in personal care, with support required by way of prompts and guidance and support regarding personal hygiene. Residents confirmed that they rise and retire to suit themselves, and have a shower or bath when they choose. The bathrooms had grab rails fitted that had been discussed with an occupational therapist before fitting. There were appropriate risk assessments in place about the resident bathing or showering unaided. The service users are younger adults and at the visit each was dressed in their own style, with modern hairstyles of differing lengths that suited them. The residents are provided with support to access a range of health care specialists according to their needs. For example, one resident has been supported to attend a hearing clinic and it had been found that she requires a hearing aid that she is now awaiting. Staff are supporting her through this and Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 18 have also attended some training on hearing loss, how to manage a hearing aid, etc. to be better placed to support her. Two other residents have been supported to gain access to a speech therapist since going to live at the home. This has resulted in one of them being supplied with a computerised aid that allows her to spell out words when she cannot be understood due to difficulties with speech. All have access to Community Nurse specialists that have helped the home to develop individual strategies for supporting residents. Records showed good recording about the nutritional needs of one resident, there was good information for staff about epileptic seizures and how to support two residents through this, with good recording about events and how they presented and their length etc. to see if a pattern was emerging. For one resident it has been found that an operation can provide a cure for the seizures, and staff have contacted an advocate to support her in making a decision about the operation. A number of these investigations have been achieved by the home pursuing the appropriate professional services for the residents that have not been followed through previously. From discussion with the manager it was found that no one at the home is responsible for his or her own medication, although one resident collects his repeat prescription from the surgery and collects his medication from the chemist. The resident told the inspector that he preferred staff to keep it for him once back at the home. Procedures for the receipt, recording, storage, handling, administration and disposal of medicines were inspected and found appropriate. The home uses the ‘blister pack’ method for medication. A sample of MAR (Medication Administration Record) were looked at and compared to the medication still to be taken. They all tallied and there were no gaps on the MAR chart. There are no controlled drugs currently used in the home. Medication was safely stored in a locked cabinet attached to the wall in an under stairs cupboard, and the residents records had a photo of each person, that is good practice. A Homely Remedies policy was in place that had been developed with the input of the pharmacist. All staff have been trained to varying levels about medication and good practice in the administration of medication. The manager was provided with Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 19 the professional guidance issued by the Commission ‘Training care workers to safely administer medicines in care homes.’ It is recommended that the manager undertake an audit of the training provided via the home to staff to check its suitability in the light of this guidance. See recommendation 1 at the end of this report. Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The home has an open culture that enables residents to express their views and to feel comfortable in voicing issues of concern. The referral process for the involvement of other agencies in the area of protection is well understood. EVIDENCE: The home has a suitable Complaints procedure that has been developed in part picture format to aid better understanding by the residents. Two of them were asked if they knew about how to complain and they said that the staff had talked to them about the procedure and that they had a copy. The Commission has not received any complaints about the service. The home’s complaints log was looked at and 6 complaints had been recorded since the first inspection in February of this year. The complaints were about resident’s dissatisfaction with one another’s behaviours towards them at various times. There had been none about the running of the home since the last visit. The records showed good recording about each complaint. The complainant had been supported to make their complaint known by a staff member, the manager speaking separately to each party investigated the complaint, and then they were provided with both a verbal and written response to their complaint. Where it was upheld this had resulted in an apology from the other party, and in one instance by being recompensed for some wool that had been damaged. Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 21 The two residents that were asked confirmed that they had been satisfied with how their complaint had been handled. The home has a suitable policy and procedure document in place for responding to suspicion or evidence of abuse or neglect, including a Whistleblowing Policy. A copy of the local multi-disciplinary procedure to be followed and a copy of the Department of Health document entitled ‘No Secrets’ were also in place. The staff individual files and over-arching training file provided evidence that longer standing staff had attended a half-day foundation course on the Protection of Vulnerable Adults. The content of this course was discussed with a member of staff and whilst it was considered to be generally suitable, the home is recommended to consider providing further training to enhance staff knowledge about local procedures to follow, good practice relating to ‘No Secrets’ etc. Staff that have only recently been employed have not yet received any training. Reference to training requirements is made later in the report. Since the last visit the home has received an allegation of abuse from a resident about an incident at her previous placement. The home has dealt with this allegation appropriately, and investigations into the allegations are ongoing. The resident is being well supported through this process by staff at the home. Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. 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 very clean. However, some attention is needed to improve the lighting, particularly in the corridors. EVIDENCE: The home is in keeping with the local area and is indistinguishable as a care home. There is good access to local amenities and public transport. The furniture and fittings are comfortable and are domestic in character. The communal areas of the home are decorated in neutral colours and the overall impression is of a pleasant home. ‘Finishing touches’ such as lampshades, table lamps made as suggestions at the last visit have been provided. Heating and ventilation is suitable. While some improvement to the lighting was seen, some areas of the home remain dark. This is particularly so in the downstairs corridor, hall, upstairs landing and office. This is in part a design problem of the home, but it remains a requirement of this report that the lighting issues are addressed. Higher wattage bulbs, with the light on throughout the day, such as in the downstairs corridor, may suffice. See requirement 6 at the end of this report. Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 23 The manager stated that the home has introduced a format for the regular inspection of the home for maintenance purposes, with records kept, although this was not examined at this visit. Three residents were happy to show off their bedrooms and they said that they liked their room. It was evidence that requirements made at the last inspection for additional bedroom furniture to meet the standards had been provided. The rooms were well personalised. The premises were clean throughout, with appropriate floor finishes in laundry and bathroom areas, good positioning of the laundry, with a washer, drier and hand washing facilities and with satisfactory laundry procedures followed. There is no-one living in the home with any continence issues. Communal bathroom and toilet areas had liquid soap and paper towel dispensers and sanitary and other bins. It was also noted that toiletries belonging to individual service users had been removed. These are all improvements since the last inspection when requirements had been made. Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While recruitment procedures are appropriate the home needs to provide mandatory and specialist training for staff in a more timely way. Thought should be given to why there is some turnover of staff in a short period. EVIDENCE: The staff team were all in the home attending a staff meeting at the start of this visit, and so there was an opportunity to meet them following this. The staff were very concerned about not being able to meet the needs of the resident who was inappropriately placed, and the fact that her needs were taking up most of their time, to the detriment of the other residents’ support. The staff presented as a caring team who are motivated and committed. The one staff member that stayed on shift with the manager was observed in her approach throughout the day with the residents and they appeared very comfortable with her. The staff team overall do not have the skills to meet the needs of the individual resident discussed earlier in this report. As she will be leaving the home this issue is only temporary, but the affect on staff morale, apart from the effect on the individual whose placement has broken down should be given some thought by the manager. Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 25 The home provides sound induction for staff, with LDAF (Learning Disability Award Framework) units being followed by staff who are new to caring for people with learning disabilities, followed by Skills for Care induction training. There does, however, appear to be quite a high turnover of staff that the manager will need to consider if the home is to develop appropriately. The lack of training to meet the needs of the individual who is leaving may have been a cause of this. Staff training is discussed below. The files of two staff were looked at. In both cases there was a completed application form on file, evidence of POVA First and a CRB enhanced disclosure was available, and all of the other requirements of Schedule 2 ‘In formation and documents in respect of persons carrying on, managing or working at a care home’ were in place. Staff had been supplied with the General Social Care Council Code of Conduct leaflet, as is required. There were considerable improvements since the last inspection. There were some shortfalls in training at the last inspection and this remains a weaker area of the home. The manager has attended a Skills for Care Workshop where supporting materials to aid with identifying, recording and meeting training needs were provided. This information is yet to be used but should provide the basis from which the home can develop a training needs assessment for the staff team to inform future planning. The home provides appropriate induction training. This needs to be followed through with all of the mandatory training required. There were gaps in moving and handling training, first aid, food hygiene, abuse, fire safety, health and safety training and medication, although some of these gaps refer to staff that are still accessing induction training. The manager needs to be clear about which training is appropriately covered during induction and the areas that require additional follow up training. The manager advised that she is awaiting information on the training courses to be provided through the Staffordshire Social Care Working Partnership to access these courses. She has also sent for the college price lists for the forthcoming academic year. The home is required to enrol all of the relevant staff on the mandatory training courses that they require, and to provide the Commission with the dates of these courses. See requirement 7 at the end of this report. Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 26 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager has an open management style that residents and staff appreciate. The home has improved considerably since the last inspection under her leadership but the issue of the breach of the registration condition is of concern. Higher management need to become more aware of the national minimum standards and regulations and how residents’ needs should be met. EVIDENCE: There is an experienced manager in post who is undertaking the Registered Managers Award, which she plans to complete by the end of the year. At the last inspection there were a considerable number of requirements that the manager has worked hard to address. The requirements have been considerably reduced at this inspection and the Commission notes this. The increase in the ‘off rota’ hours that the manager has been allowed will have also helped towards these improvements. Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 27 The atmosphere in the home is very friendly and generally relaxed. Staff and residents seemed comfortable in talking to the manager, and all said that she listened to them about their concerns. The Commission was disappointed to find that the condition of registration referred to earlier in the report had been breached. Whilst the manager indicated her reasons for considering initially that the home would be able to meet the residents’ needs, it was discussed that she must be much more vigilant when assessing the needs of any prospective residents to gain a thorough insight into their holistic needs and what will be required of the home. This is the second placement to have broken down in 12 months, and this indicates a weakness in the assessment process. See requirement 8 at the end of this report The home undertakes an individual review with each resident on a monthly basis to discuss how the home is meeting his or her needs. Monthly residents meetings are held and the outcomes recorded so that any improvements considered needed by the residents can be put into action. The home has not yet been open for 12 months and service user surveys have not yet been introduced. The manager recognises that this is an area that will need to be addressed in the coming months. Areas relating to the home environment and the health, safety and welfare of service users were sampled as follows: Appropriate testing of the fire alarm and fire safety equipment is carried out. Sufficient fire drills are completed, but staff require fire safety training. (Addressed under staff training). The need for individual risk assessments relating to fire was discussed, but it was also noted that the Fire System is modern and an appliance such as a vibrating pillow can easily be installed for one resident. A Fire Risk assessment for each resident must be undertaken. This is a requirement of this report. See requirement 9 at the end of this report. The manager is reminded to undertake a fire risk assessment for the whole building if this has not been completed. (This was not discussed at the visit). An emergency plan is also required which details a nominated place (s) of safety should the home experience a fire or any other untoward incident that would mean that residents had to be moved. Gas, electrical and central heating safety reports were up to date. Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 28 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. A sample of risk assessments were seen related to safe working practices and these were appropriate. Accidents are appropriately recorded, and the storage of accident reports meets data protection requirements. The requirement for staffing levels to be maintained relating to the risk presenting in meeting the needs of the resident with challenging behaviours has been identified earlier in the report. The need for mandatory training to be provided for staff is addressed earlier in the report. Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 29 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 1 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 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 2 X Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 30 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4 and Schedule 1 Requirement Expand the Statement of purpose to ensure that it includes all of the provisions highlighted under Standard 1, Schedule 1 and regulation 4 of the national minimum standards. (This has been partly addressed) Expand the Service User Guide to ensure that it contains all of the information as outlined in Standard 1, and compliance with regulation 5 of the national minimum standards. (This has been partly addressed) Ensure that there are suitably qualified, competent, experienced and sufficient staff at all times to maintain the health and welfare of residents. (This was an immediate requirement) Remove reference in the individual contract or statement of terms and conditions between the home and the resident to additional charges for staff time and ensure that such charges are not made from the date of DS0000064907.V291931.R01.S.doc Timescale for action 17/10/06 2. YA1 5 17/10/06 3 YA3 18 (1)a 17/08/06 4. YA5 5 (c ) 17/09/06 Heathfield House Version 5.1 Page 31 the inspection. (Date shown is for the date by when the written contracts are amended) 5. YA15 12 (1-4) Provide information, support and guidance for service users regarding intimate personal relationships (This was a previous requirement) Improve the lighting of the home (This was a previous requirement and has been partly met in some areas) Provide all of the mandatory training required by staff and confirm to the Commission the dates by when courses are booked. (Date shown is for when courses must be booked by, not necessarily for when the course must be available – dependent on the availability of the course places) The registered manager must ensure that on every occasion the home meets the condition of registration that it can only accept residents with a mild to moderate learning disability. (This was an immediate requirement) Undertake an individual fire risk assessment for every resident, to include the night time period 17/10/06 6. YA24 23(2)p 17/10/06 7 YA35 18(1)c 30/09/06 8. YA37 Care Standards Act 2000, Part 2, (24) 17/08/06 9. YA42 13(4) and 23(4) 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 32 1. YA20 Undertake an audit of the staff training in medication against the professional advice about medication training of care workers as provided by the Commission Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 33 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Heathfield House DS0000064907.V291931.R01.S.doc Version 5.1 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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