Inspection on 08/02/06 for Heathfield House

This inspection was carried out on 8th February 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 no outstanding requirements from the previous inspection report, but made 30 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 17/08/06

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 Announced Inspection 8th February 2006 09:30 Heathfield House DS0000064907.V277362.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.V277362.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.V277362.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 01889 883003 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.V277362.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 Brief Description of the Service: Heathfield House is a six bedroomed 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 fish pond 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. Heathfield House DS0000064907.V277362.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over a whole day in February 2006 and was conducted by two inspectors. This was the first inspection of the home since it was registered with the Commission in September 2005. Because of this the majority of the national minimum standards were inspected. The report has identified a considerable number of requirements, but it is considered that this number will reduce as the home becomes established and more aware of its responsibilities. At the visit, all of the six service users were spoken to, as were the staff who were on duty, to varying degrees. A relative visited the home and was also able to make her views about the service known. What the service does well: Everyone who lives at Heathfield House said that they were very happy in the home and that staff had helped them to settle in well. ‘The staff are all nice, I like everybody.’ ‘I like it here. I like the food, and we have what we want’. A relative of a service user visited and she said that she was very happy with the care that was being provided. ‘They are a good team of staff. What I like about everybody is that they listen to me and respect that I have a good knowledge of the needs of X.’ All of the people living at the home had visited before they decided to move in, and those already living there had been asked if they were happy to share their house with the new people. This is good because it is important that everyone gets along really well. The manager had been to visit people and talked to them and their relatives or carers to find out what sort of help that they required, what they enjoyed doing, and what they wanted from their life. This helped everyone to know that the home could look after them and help them to do the things that they wanted for themselves. Heathfield House DS0000064907.V277362.R01.S.doc Version 5.1 Page 6 It takes a lot of hard work when a new home is being opened, and even though the manager and staff have still got quite a few things to do they are working hard to try to get everything right. What has improved since the last inspection? What they could do better: 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.V277362.R01.S.doc Version 5.1 Page 7 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.V277362.R01.S.doc Version 5.1 Page 8 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, 4 and 5 While introductory visits to the home are offered to prospective service users, other information that should be available to them via the Statement of Purpose, Service User Guide and contract information was not as comprehensive as is required. This means that they may not be aware about how the home deals with important issues that may affect their day-to-day life, and this must be addressed. EVIDENCE: Both a Statement of Purpose and Service User Guide were available in the home. However, whilst some of the required information was available such as the number of people the home caters for, links with the community and staff training, this was not to the level required, and other important information, such as the Complaints Procedure, review of the service user plan etc. was not included at all. The home is required to expand on and improve both the Statement of Purpose and Service User Guide to include all of the relevant information as contained in Standard 1, Schedule 1 and regulations 4 and 5 of the care home regulations, so that prospective service users have the information they need to make an informed choice. Current service users must all be provided with a copy of the guide. The documents must be dated and reviewed on at least an Heathfield House DS0000064907.V277362.R01.S.doc Version 5.1 Page 9 annual basis or when any aspect of the service changes, and the revised copy provided to the service users. It would be good practice to develop the Service User Guide further to a format that is suitable to the needs of the service users, e.g. pictures, audio, etc. as required, once an initial written copy has been developed. In each file seen there was a copy of the multi disciplinary Community Care Assessment that provided the home with the initial information necessary for them to begin an assessment as to whether the home could meet each person’s individual needs. Following this the manager had held further discussion with the service user and their carer, where appropriate, to develop this information further, so as to form the basis of the individual care plan. There was evidence that an independent advocate had been involved in some instances. Discussion with the service users and a member of staff evidenced that each service user had visited the home on at least one, or in some instances, several occasions, including overnight, to determine whether the home could meet their needs, and if they felt that they would be happy living there. These visits had included meeting other service users and seeing or staying in the bedroom that they would be allocated. The home advised that they would not take an emergency admission, and is reminded that this must be included in the Statement of Purpose/Service User Guide. Each of the service users living at Heathfield House were being sponsored in their placement by the local authority as well as them paying an element of their own fees from their own state benefit entitlements. In these instances the contract is drawn up by the local authority and is signed by all parties to the contract, to include the service user or their representative. The above contract was not available on the service user’s file. In addition the service user should have a copy of an individual contract with the home stating all of the areas identified under Standard 5 that are not available via the local authority standard contract, including clear guidelines as to the expectation of funding for holidays, activities, outings, etc. to be paid for personally. This is a requirement of this report. Heathfield House DS0000064907.V277362.R01.S.doc Version 5.1 Page 10 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, 8 and 9 The home has basic information and procedures in place to meet in part the appropriate outcomes for each service user in relation to these standards. However, all of the actions taken by the home and the record keeping in place need to be improved in each of the areas to demonstrate fully that each individual is supported to make decisions and choices, and is involved in all aspects of life in the home. EVIDENCE: Each service user had an individual plan in place that covered areas such as health care, finance, religion and cultural needs, etc. However, there was no evidence that the service users had been involved in the development of their plans, and they also required further development to include information on activities, goals and aspirations etc. The plans were clearly reviewed on a monthly basis, which was good practice, but again there was no evidence to show that the service users were involved in the review, or to identify what progress was being made towards the required outcomes identified for each person. Heathfield House DS0000064907.V277362.R01.S.doc Version 5.1 Page 11 The home is required to develop the plans further in line with Standard 6 of the national minimum standards. Discussion with the manager, staff and some service users showed that staff respect the service users’ rights to make decisions. There was evidence that service users have access to an independent advocate. Individual service user files showed that some of them were supported to manage their own finances, and the home is reminded to maintain clear documentation about the manner of support and that this is regularly reviewed. Following questioning of the financial arrangements for service user monies the manager identified that one service user has not yet been able to open his own bank account, and his personal finances are currently being managed via the provider. Whilst some documentation is in place to support this, more robust information is required to provide an appropriate audit trail of the individual’s finances, and what money is required to pay towards the home’s fees, what is personal finance etc. The current situation must be remedied as soon as possible. This in no way implies that the resident is not receiving their entitlement, rather that current arrangements are not in line with the standards, and better record keeping as stated above is required following this visit. There was some evidence to show that the service users are involved in aspects of running the home. Discussion with them identified that those already living at the home have been able to influence the selection of other service users, which is important regarding compatibility, and there had been some involvement in the appointment of staff. Service users had assisted in the weekly shop with staff on occasions. As the service at Heathfield House is relatively new, this is an ideal time for the service users to have their say in all aspects of Standard 8, including further involvement in the selection of staff, joining staff meetings, discussion on policies and procedures, day to day running of the home etc. This is a requirement of this report. There was information found in each service user file examined that the home have considered some of the risks presenting to each person in the development of an independent lifestyle, such as going to the local shops unescorted, other visits out in the community, and health and safety risks around cooking, self medication etc. However, there was no documentation to show that the service users had been involved in the formulation of the risk assessment and risk management strategy, but rather that they had just been presented to the service users and developed from the information that was held about them. Additionally, there were areas of risk that had not been considered on an individual basis, such as the risk presenting from unguarded Heathfield House DS0000064907.V277362.R01.S.doc Version 5.1 Page 12 radiators, and an unfenced garden pond. Any risk assessments that were in place had not been dated and signed by the service user. The home is required to involve each service user in the consideration of any risks and their management, including the maintenance of personal safety. The home is also reminded to use appropriate language in the development of documentation, i.e. ‘may leave without permission’ conveys the wrong message about the rights of all service users in the home. Heathfield House DS0000064907.V277362.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 and 17 While there is some good practice in evidence in terms of developing a fulfilling lifestyle for each service user, this needs to be expanded upon to provide a greater range of activities and recognition of the rights of all of the service users to make choices and develop their independence. A number of requirements have been made to ensure that the home’s practice is improved in these areas. EVIDENCE: The service users had developed a range of activities relating to their individual needs and interests prior to moving into the home, and these have continued being facilitated by the home since they moved in. These include attendance variously at Stafford and Burton colleges and the Hamilton Centre. One service user has continued undertaking voluntary work at a gardening project. The manager advised that she had negotiated wit the local further education college at Stafford to visit the home and provide a course to further develop the service users’ skills in literacy and numeracy. This had been discussed with Heathfield House DS0000064907.V277362.R01.S.doc Version 5.1 Page 14 each of them on an individual basis and was something that they were keen to be involved with. There was evidence available to show that the service users are being supported to be a part of the community to some extent. Service users spoke of visiting the local shops and being members of the local library. Two of the service users made a visit to the library on the morning of the inspection. There were records to show that two of the male service users visited the nearby town of Longton to play pool, and it was also documented that a couple of service users chose to go to church, and the nearby pub had been visited occasionally. Within the home, the service users chose to play pool (one of the service users has a pool table), play football in the garden, to read, to knit and watch television or listen to music. However, further discussion with both staff and service users showed that for some service users they were inactive for large parts of the day. One service user told the inspectors that she was bored, and staff agreed that they did not always have sufficient staff on duty to undertake outside activities particularly, and there were certainly very limited opportunities to do anything with the service users that was unplanned and spontaneous. Staffing issues are addressed further at Standard 33. The home is required to improve the social inclusion and range of leisure activities provided for the service users linked to their individual needs and choices. The home is recommended to provide a notice board in the home and to furnish this with information about local amenities, events and the like, and to display the Complaints Procedure and the inspection report. Each care plan see showed that the home supports the service users to maintain family links and friendships. It was seen from the care plan that at least 1 of the service users goes home at weekends, and others have family to visit. A relative visited on the day of the inspection to take her nephew out to do some shopping and to get some lunch, which she said was a regular occurrence. The relative said that she was more than happy with the home, and she was always made very welcome by the staff and that they had listened to her in the early stages of the placement about the needs of the resident, which she had found encouraging. 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 not as yet been provided for the service users and needs to be addressed, as required, to help them make important decisions about their lives. Heathfield House DS0000064907.V277362.R01.S.doc Version 5.1 Page 15 Service users confirmed that they chose their own routines for rising and retiring, linked to whatever plans they had for the following day, although there was some evidence in an incident file that there was a set time for service users to go to bed linked to the night staffing arrangements. The home is reminded that it should be service user’s choice as to what time they retire, rather than routines based on the convenience for staff. Staff were seen to knock on service user’s bedroom door before entering, and it was clear from observation that each service user chose where to spend their time both inside and outside of the home and rear garden. There was clearly a good rapport between all of the service users and the staff. On discussion with the manager it became clear that the service users do not have their own key to either their bedroom or the front door of the home. The standards clearly show that these must be provided, unless the service user on an individual basis chooses not to exercise this right, which must be clearly stated in the care plan. It was discussed that service users undertake their own laundry and assist in some cleaning tasks. These responsibilities and their extent must be clearly shown in the Service user Guide and in each individual plan. Meals at the home are served in the separate dining room. The manager confirmed that there was no-one living at the home for whom a special diet was required, and she and the service users confirmed that there was an alternative choice available should anyone not want what was available on the menu for that day. The manager stated that there was a four week rolling menu and a sample week’s menu was seen. This appeared appropriate in terms of variety, nutritional content etc. The service users spoken with confirmed that they were happy with the choice of food available. Heathfield House DS0000064907.V277362.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 21 The home appropriately addresses the physical and emotional health needs of each service user and medication procedures are sound, although improvement in medication storage is a requirement of this report. Once this is addressed, and consideration given to the ageing, illness and death of a service user, the home will be better placed in ensuring the health, safety and welfare of service users is comprehensively met. EVIDENCE: The service users at Heathfield House are independent in personal care. There was good evidence found in the individual plans that the home pays full attention to the health needs of each individual. There was clear recording of all appointments relating to both physical and mental health for each person, and documentation showing that any actions required for follow up had been acted upon. Information provided by the home showed that when moving in the service users had been promptly registered with a local GP. Each file had a ‘consent to medical treatment form’ in place that was signed by the service user. Heathfield House DS0000064907.V277362.R01.S.doc Version 5.1 Page 17 Medication procedures were discussed with the manager and a senior care worker. It was found that no-one in the home currently self medicates. Medication is stored via ‘blister pack’ that is provided by the pharmacy on a monthly basis; there are no controlled drugs used in the home at the present time. Further discussion evidenced good practice in the receipt, recording, handling, administration and disposal of medication, but the cupboard being used to store medication was unsuitable and did not comply with current regulations and guidance issued by the Royal Pharmaceutical Society of Great Britain. A requirement was made for the home to place an order for a medication cupboard/trolley that is compliant within seven working days from the date of the inspection. The staff who administer medication have received appropriate training in the safe handling of medicines. The manager reported that they had a good working relationship with the local pharmacist who was available for advice and liaised well with the home. Further discussion highlighted that the home does not at present have any ‘homely remedies’ medicines in the home, although these would be useful for minor headaches etc. They were recommended to develop a homely remedies policy for such ‘over the counter’ medication and to agree this with the GP of each service user. Examination of the individual plans, and discussion with the manager and a senior care worker highlighted that the home does not as yet have a policy relating to ageing, illness and death of a service user, and that these issues have not been discussed with the service users and their relatives, where appropriate. It was discussed that service user’s wishes concerning terminal care and death, and their views regarding religious and cultural customs are important areas to consider in the on-going holistic care of each person. The home is required to develop a policy relating to dying and death to include all of the elements as documented at Standard 21. Heathfield House DS0000064907.V277362.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The home has sound policies and procedures in place for dealing with complaints and responding to any abusive practice. Service users and their families can feel confident that those living at Heathfield House will be listened to and protected from harm. EVIDENCE: The Complaints Procedure was looked at and it was considered appropriate. It included the stages and timescales for the process, and information for the service users to understand whom they could complain to. However, a copy of the complaints procedure had not been provided to each service user on an individual basis, and this is required. A complaints log was in place and this showed that one complaint had been received from a service user and that this had been taken seriously and responded to promptly and appropriately. The home is reminded that the Service User Guide, a copy of which is to be provided to all service users, must contain full information about the Complaints Procedure. Discussion with two of the service users found that they were aware of their right to complain and how they could go about this. The service users also have access to advocacy services should they so wish. A relative spoken with was clear about her right to complain and who to complain to. It is considered good practice, however, that there is a copy of Heathfield House DS0000064907.V277362.R01.S.doc Version 5.1 Page 19 the Complaints Procedure on display in the home so that service users and visitors have ready access to this procedure, and this is recommended. The home had 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’ was also in place. The staff individual files and over-arching training file provided evidence that 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. A service user raised an issue relating to a past experience with a member of staff during the visit. It was pleasing to hear that the staff member had responded appropriately and in line with good practice. Heathfield House DS0000064907.V277362.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 and 30 Heathfield House provides a pleasant home for the service users, but some attention is needed to aspects of the environment, such as improved lighting, the provision of further items of bedroom furniture, and an increased emphasis on infection control. Attention to these areas will further promote the comfort and safety of all those living at the home. EVIDENCE: The home has only been open for approximately six months, and was developed in line with the national minimum standards. Conditions of registration, such as the need for a ramp to be fitted to the patio doors leading out of one sitting room, and for the front garden area to be made safe within three months of registration have been addressed. 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, although some areas would benefit from ‘finishing touches’ such as lamp shades, table lamps to give a more homely feel. Heathfield House DS0000064907.V277362.R01.S.doc Version 5.1 Page 21 A Fire Officer visited the home before it opened and was considered compliant with their requirements. It was found at the visit, however, that while the heating and ventilation was suitable, areas of the home would benefit from increased lighting. This was particularly so in the front lounge, downstairs corridor, bathrooms, hall, upstairs landing and office. It has been made a requirement of this report that these lighting issues are addressed. The home is reminded that a planned maintenance and renewal programme for the fabric and decoration of the premises, with records kept, will be required for future inspections. The manager stated that each service user had been involved in helping to choose the decoration for their room and some had brought elements of their own furniture with them. Two service users confirmed this to be the case. Two service users were also happy to show off their bedrooms and they said that they liked their room. During these bedroom visits it became apparent that the rooms had not been fitted out to the level as required by the standards, e.g. lacking in chairs, a table, lockable storage space, lack of keys provided to bedroom doors. The manager is required to discuss the content of Standard 26 with each service user on an individual basis to see if they require any additional furniture to meet the requirements as set out. If any service user chooses not to have any element of furniture as listed, this should be documented in their individual plan and signed by the service user. 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. An issue raised, however, was that whilst there was liquid soap available in the communal bathroom and toilet areas, there were no paper towel and towel dispensers fitted, and an absence of sanitary and other bins. It was also noted that toiletries belonging to individual service users were in the bathroom. It is a requirement of this report, to prevent the spread of infection, that paper towel dispensers are fitted and paper towels are supplied, that appropriate bins are put in place and that individual toiletries are stored in each person’s bedroom and carried to the bathroom. These are requirements of this report. Heathfield House DS0000064907.V277362.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34, 35 and 36 Staff receive adequate supervision but the home needs to improve in all other areas to ensure that service users are adequately supported and protected by robust recruitment procedures and an effective, well trained staff team. EVIDENCE: The home had supplied copies of the staff rota as requested, prior to the visit, and staffing was further discussed with the manager at the visit. These evidenced that the home is staffed by four Support Workers and a Team Leader with an additional vacant post, which staff are covering between them by undertaking additional hours. The manager also undertakes 28 hours on the rota at present (with nine managerial hours), as this is the only way to ensure that there are two staff on duty on each shift, with one waking night staff. It was discussed with the manager and the Team Leader that the level of activities for the service users falls short of what has been identified in their individual plan, and that this may be related to the number of staff available. The staff agreed that it was sometimes difficult to undertake activities with the number of people at home and health etc. appointments to be met. It was further discussed with the manager that the 28 hours that is spent covering the rotas is more than likely the reason why a high number of requirements Heathfield House DS0000064907.V277362.R01.S.doc Version 5.1 Page 23 have been made throughout this report. The issue of managerial hours is addressed more fully under Standards 37 and 38. The home is required to look again at the needs of each service user and undertake a review of the staffing hours available linked to these needs, and to provide a copy of the review and the outcome to the Commission. It is suggested that consideration be given to the recruitment of part time workers, to allow more flexibility to cover rotas, but the Commission emphasises that this is a suggestion only, and that such decisions are for the home to make. Two staff files were chosen on a random basis to be inspected and whilst an application form, evidence of POVA First and a CRB enhanced disclosure was available in each case, there were elements of required information that was missing, such as a declaration regarding the individual’s physical and mental health. The manager is required to ensure that all elements of Schedule 2 of the national minimum standards are in place prior to the commencement of any employee. Additionally, there were no clear dates available for when each member of staff commenced employment at the home, and therefore it was difficult to evidence an audit trail to establish if correct procedures had been followed for the obtaining of a POVA First clearance prior to the staff member commencing work. The manager is required to ensure that appropriate records are kept to ensure an audit trail. Staff had not been supplied with the general Social Care Council Code of Conduct leaflet, as is required. This must be addressed. It was disappointing to find that in spite of reassurances made by the Operational Director, he had still not taken the necessary steps to ensure that he had undergone an enhanced (CRB) criminal records bureau check in spit of the home having been open for six months, and the director visiting the home on a regular basis. It has been made a requirement of this report that the director applies for the appropriate check within seven working days of this visit. The Commission will monitor this closely. Staff training was discussed with the manager and the record of training for the Team Leader was inspected. This showed evidence of induction training to the level recommended by the Skills for Care organisation, provision of medication and abuse training, possession of NVQ 2 and enrolment on an NVQ 3 course. The manager confirmed that she was in the process of registering staff with a local college for food hygiene and health and safety training. Moving and handling training was not in evidence and the manager acknowledged that this had not yet been addressed. Moving and handling training must be provided to all staff and be updated on an annual basis. This is a requirement of this report. Heathfield House DS0000064907.V277362.R01.S.doc Version 5.1 Page 24 Through discussion with staff it was identified that they feel well supported by the manager and that sound briefing arrangements are in place for the passing on of necessary information from shift to shift, and from and to the manager. It was also confirmed that staff receive regular supervision on a 1:1 basis with the manager and that these meetings are recorded. The manager acknowledged that an annual appraisal would be undertaken for all staff at the relevant time, to review performance against the job description and to agree career development plans. Heathfield House DS0000064907.V277362.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41 and 42 In the time that she has available the manager has worked hard towards producing and maintaining the required paperwork needed in the home, and it is considered that people are safe. However, far greater managerial hours are needed to ensure that the home is meeting its requirements for record keeping, and in further developing the service for the residents. A review of managerial hours is required with some urgency. EVIDENCE: There is an experienced manager in post who confirmed that she was undertaking the Registered Managers Award. Discussion with the manager at her interview with the Commission for registration as a ‘fit person’ and subsequently at the inspection demonstrated that she has the knowledge and skills to satisfactorily manage the home. Standards 37 and 38 set out in detail the overall responsibility of the registered manager. This report shows the good progress that the manager Heathfield House DS0000064907.V277362.R01.S.doc Version 5.1 Page 26 has made in significant areas to meet the requirements of the minimum standards, but the number of requirements that have been made also shows a considerable number of areas still to be addressed. While some of these relate to the financing of the home, others require time and management input to be developed. The expectation placed on the manager to work on the duty rota for 28 hours per week, with only nine hours dedicated to managerial tasks is insufficient, particularly as in addition some of these nine hours will require work on supervision of staff etc, leaving scant time available for the development of care plans, revision and development of further policies and procedures, development of quality assurance and quality monitoring systems to name but a few. It is considered by the Commission that unless the management hours are increased the home will continue to fall short of the requirements in a number of key areas. It is strongly recommended that the management hours are increased to full time on a temporary basis whilst all of the requirements of this report are implemented, and then gradually reduced on a more permanent basis once the home is established, although it is envisaged that it would be impossible to reduce to the current level and for the home to be managed successfully even at that stage. The provider is required to undertake a review of the management hours with the involvement of the manager. A copy of the review must be provided to the Commission, with a clear identification of the management hours proposed. The Commission will then consider these proposals. The registered manager has demonstrated her commitment to involving service users and their relatives in the provision of the service by holding regular reviews, monthly service user meetings, and ensuring that service users and their relatives were made aware of the planned inspection by the Commission and ensuring that all had every opportunity to meet with the inspectors in private to share their views of the home. The Commission considers that the right approach is in place on which to build. The home is reminded that future inspections will consider this standard in its entirety, and work will be required by the manager to develop a quality assurance and quality monitoring system that meets the requirements. The pre inspection questionnaire completed and supplied by the manager identified that the majority of the policies and procedures that are required and are relevant to the home, as set out in Appendix 2 of the standards, are in place. A sample of these procedures were looked at during the inspection, and it was noted that some of them were ‘over-arching’ procedures that had not been modified to accurately reflect the procedures that are followed in the home on a day to day basis. Heathfield House DS0000064907.V277362.R01.S.doc Version 5.1 Page 27 The manager is required to work through the policy and procedure documents and to ensure that they reflect the position in the home. There were a number of policies that were missing that must be produced. These included emergencies and crises, death and dying, moving and handling and nutrition. This list may not be exhaustive. The manager is required to undertake an audit of the documents in place to ensure that the full list, as relevant to the home, is available. Other than those areas identified elsewhere in this report, the records required by the home were generally in place, up to date and accurate. The manager needs to work with the service users on an individual basis to provide opportunities to help maintain their personal records. It was noted that the office on the first floor is permanently open and the security of some of the records, in line with the Data Protection Act 1998 was compromised. In addition, the Accident Book held in the home, whilst it being compliant with the above act was not being used correctly, so that the records on each accident were open for other people to see. It is a requirement of this report that individual records and the home records are maintained and used in accordance with the Data Protection Act 1998. A number of certificates in relation to the safety of the building had been seen at registration. A limited number of areas only were examined at this visit. These included: A fire procedure was in place; Fire fighting equipment was regularly checked; Fire alarm and six monthly lighting checks had been undertaken; There were some gaps in the weekly fire tests; Two staff had not been present at either fire drill that had been carried out. The home is required to undertake all fire checks to the required timetable, and to ensure that all staff take part in a fire drill at satisfactory intervals. During a tour of the home the COSHH (Control of Substances Hazardous to Health) cupboard was found open. All COSHH substances must be securely stored at all times. Discussion evidenced that the COSHH date sheets are stored in the office away from the products themselves. It is recommended that the sheets be kept close to the site of the substances for timely reference. Heathfield House DS0000064907.V277362.R01.S.doc Version 5.1 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 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 X 33 2 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 3 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 2 2 3 3 2 2 2 X Heathfield House DS0000064907.V277362.R01.S.doc Version 5.1 Page 29 Are there any outstanding requirements from the last inspection? N/A 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. 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 Provide each service user with an individual contract or statement of terms and conditions between the home and the service user, containing all of the elements listed within this standard Further develop the service user plan for each individual with their involvement, and ensure that the review of each plan documents the progress of each individual towards the desired outcomes. Make alternative financial arrangements for one service user, and maintain more robust records until the current DS0000064907.V277362.R01.S.doc Timescale for action 07/04/06 2 YA1 5 07/04/06 3 YA5 5 (c ) 28/02/06 4 YA6 15 07/04/06 5 YA7 20 07/04/06 Heathfield House Version 5.1 Page 30 situation is remedied. 6 YA8 YA9 7 24(3) 13(4) Provide greater opportunities for service users to be involved in the running of the home Provide greater attention to individual risk assessments and risk management strategies, to include risk from unguarded radiators, garden pond (This list is not exhaustive) and involve the service users in their development. Ensure that each risk assessment is signed and dated. Provide better access to a range of leisure and social activities, following consultation with the service users. Provide information, support and guidance for service users regarding intimate personal relationships Provide each service user with a key to their own bedroom and to the front door of the home, subject to individual assessment, or document in their individual plan if the service user does not require this. Place an order for a suitable medication trolley/cabinet for the home for the safe keeping of all medication. Address the issues of ageing and dying with each service user, including the development of policy. Record the wishes of each service user in their care plan Provide a copy of the Complaints Procedure to each service user and their significant others Improve the lighting of the home 08/05/06 30/04/06 YA13 8 YA15 9 YA16 10 16.2 (m) (n) 12 (1-4) 08/05/06 08/05/06 12 (4)a 08/04/06 11 YA20 13(2) 20/02/06 12 YA21 12(4)a & 15 08/05/06 YA22 13 YA24 14 15 16 YA26 YA26 22(5) 23(2)p 16(2)c 16(2)c 08/03/06 08/04/06 Provide lockable storage space 08/04/06 for each service user Provide each service user (unless 08/04/06 agreed otherwise and recorded DS0000064907.V277362.R01.S.doc Version 5.1 Page 31 Heathfield House YA30 17 18 YA30 13(3) 13(3) 19 YA33 18(1)a 20 YA34 19 YA34 21 19 YA34 22 YA34 23 YA35 24 19 19 18(1)c YA37 25 18(1)a YA40 26 Heathfield House Appendix 2 in their individual plan) all of the furniture and fittings as identified at standard 26 Communal areas must be provided with suitable equipment to minimise the risk of the spread of infection Provide alternative storage for service users so that individual toiletry items are not stored in communal areas Undertake a review of the staffing hours linked to a review of the individual needs of the service users, and provide a copy of the review and the outcome to the Commission Ensure that all elements of Schedule 2 ‘Information and documents in respect of persons carrying on, managing or working at a care home’ must be in place before any new employee commences employment Ensure that all records are dated and signed to maintain an audit trail, particularly in this instance re the commencement date of each employee. Provide each employee with a copy of the General Social care Council Code of Conduct Ensure that the Operational director undertakes a CRB check Ensure that staff are booked onto a course for moving and handling training within the timescale shown (it is recognised that the training will not be delivered within this timeframe) Undertake a review of the time allocation of the manager re management hours and care hours, and provide a copy of the review to the Commission Undertake an audit of the home’s policies and procedures DS0000064907.V277362.R01.S.doc 08/03/06 08/04/06 03/03/06 20/02/06 20/02/06 08/03/06 20/02/06 20/02/06 03/03/06 08/05/06 Page 32 Version 5.1 YA40 27 YA41 28 Appendix 2 17 YA42 29 YA42 30 13(4)a 23(4)e in line with Appendix 2 and provide the missing policies Ensure that all policies and procedures used in the home appropriately address the procedure that is followed Ensure that all the statutory records maintained in the home are stored to meet the requirements of the data Protection Act Ensure that all COSHH substances are suitably and safely stored Fire drill training is required for all staff 08/05/06 08/03/06 20/02/06 20/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 YA23 4 YA13 5 Refer to Standard YA20 YA22 YA23 Good Practice Recommendations Consider producing a Homely Remedies Policy Consider displaying the Complaints procedure in an accessible place within the home Consider providing more advance training for staff regarding the protection of vulnerable adults Consider providing each member of staff with a copy of the ‘No Secrets’ Policy Consider providing a notice board within the home to advertise local events, advocacy services, complaints procedure etc. Heathfield House DS0000064907.V277362.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. 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