Inspection on 16/08/06 for Heathfield House Nursing Home

This inspection was carried out on 16th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Heathfield House Nursing Home 03/01/07

Heathfield House Nursing Home 08/11/05

Heathfield House Nursing Home 26/04/05

Heathfield House Nursing Home 07/01/05

Heathfield House Nursing Home 01/09/04

Heathfield House Nursing Home 10/02/04

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Heathfield House Nursing Home Bicester Road Bletchingdon Oxfordshire OX5 3DX Lead Inspector Annette Miller Unannounced Inspection 16th August 2006 9.45 X10015.doc Version 1.40 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 Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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 Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heathfield House Nursing Home Address Bicester Road Bletchingdon Oxfordshire OX5 3DX 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) 01869 350940 01869 350251 info@heathfield-house.co.uk Heathfield House Nursing Homes Limited vacant Care Home 40 Category(ies) of Dementia (20), Old age, not falling within any registration, with number other category (40) of places Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. On admission persons should be aged 60 years and over. The total number of persons that may be accommodated at any one time must not exceed 40. 8th November 2005 Date of last inspection Brief Description of the Service: Heathfield House is a privately owned care home for older people registered with the Commission for Social Care Inspection to provide nursing care for up to 40 people, including up to 20 with dementia. The home has been established since 1986 and is situated north east of Oxford City, surrounded by open countryside. Accommodation is provided in a mixture of single and double rooms over two floors. There is a sitting room, dining room and conservatory, with a patio area and grounds with seating and a walkway. There are two communal bathrooms and the majority of rooms have en-suite facilities, although some are not in use. An extension providing twelve single bedrooms is nearing completion. Nurses and care assistants provide care. There is a housekeeping and kitchen team. The proprietor works as the administrator in the home. Fees range from £650.00 - £800.00 per week. Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the 1st April 2006 the Commission for Social Care Inspection has developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. The inspection took fifteen and a half hours over two days and was a thorough look at how well the service is doing. It took into account detailed information provided by the manager and any information the commission has received about the home since the last inspection. The inspector asked the views of the people who use the service and other people seen during the inspection or who responded to questionnaires the commission had sent out. Eighteen relatives and two GPs provided comments directly to the commission and the majority were extremely positive. The inspector looked at how well the home was meeting the national minimum standards set by the government and has in this report made judgements about the standard of the service. During the inspection a number of potentially serious issues regarding health and safety were identified which resulted in the inspector contacting the Health and Safety Executive (HSE). The inspector carried out a joint visit with the HSE on 22nd August 2006 lasting two and a half hours. The HSE officer made eleven requirements to be met by 14th December 2006. Whilst the Commission and HSE have identified a number of issues that need resolving, these relate mainly to environment and maintenance matters. The inspector received many good comments from relatives about the standard of care and the kindness of staff and it is important that this positive feedback is taken into account when reading the report. The home has a new manager who has submitted his application to the commission to become the registered manager. The inspector hopes that this report will assist the manager in identifying what needs to be done to be able to move the home forward so that it meets standards and fulfils its potential. What the service does well: Comment cards from relatives contained many good comments about the standard of care provided, such as: “My mother has been a resident at Heathfield House Nursing Home for the last 4 years. They are all very caring and look after mum with lots of love. She is always clean and tidy whatever time I go and visit”. Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 6 “I find the staff very friendly and helpful. My husband is settling in very well. I am happy I have found a good nursing home for him”. During the inspection relatives told the inspector they thought the home was very friendly and homely, and that staff tried very hard to make life pleasant for the residents. A resident said staff are ‘lovely people’. The full-time activity organiser aims to provide a range of interesting activities, as well as organising musical events involving musicians who visit the home regularly. A relative said the entertainment, particularly the musical events, was extremely good. Staff said they found the new manager approachable and liked the fact that he worked as part of the team to provide care to residents whenever he could. A relative spoke positively of her dealings with the manager and was pleased he had resolved a problem to her satisfaction. What has improved since the last inspection? What they could do better: The information given to prospective residents about the home needs to be reviewed, updated, inaccuracies corrected and more information included. This is to ensure people have the information they need to make an informed decision about admission to the home. The two pre-admission assessments examined did not include all the information required and residents cannot, therefore, be assured their needs will be met. A range of training has already occurred in 2006 and this is good, but there are gaps in some important areas, such as adult protection, where training is needed and must be arranged. Regular training is important to ensure that all staff are competent to carry out their work. The hot water system to some parts of the home does not provide water that is hot enough to wash in and in one bedroom there was no hot or cold running water to the washbasin. A staff hand basin in a sluice room also had no running hot water. The registered person is required to inform the Commission that this matter has been resolved. Staffing levels vary and whilst staffing is usually slightly above the minimum number required during the morning period, this is not always the situation later in the day. Also, the skill mix of staff (the mix of nurses and carers) is not always as required by the home’s staffing notice. Staff reported they were very busy during the inspection and the inspector observed this to be the situation. Staffing levels must be reviewed regarding Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 7 skill mix and the number of staff on duty to ensure staffing is adequate throughout the day and night. Three recruitment files were looked at and none contained all the information and checks required. This potentially places residents at risk. Maintenance checks are poorly completed, and in some case are not carried out at all. The home does not employ maintenance staff, using instead outside contractors to deal with specific repairs when needed, and this means that the routine day-to-day monitoring and checks are not done regularly, placing residents and visitors at risk. The standard of care planning varied and whilst there were some very good examples of care planning, there were also some shortfalls that could mean some residents do not receive the care they need. The management of medication needs to be improved in a number of areas to ensure it is administered safely. Redecoration and refurbishment of the dining room is considered by the inspector to be a priority. 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 Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The home’s Statement of Purpose is unsatisfactory as it does not have all the information that is needed and some of the information provided is incorrect. A copy of the Service User Guide was not available. Therefore, prospective residents cannot be confident they have the information they need to make an informed decision about moving into the home. Pre-admission assessments do not cover all areas of potential care needs, which mean prospective residents cannot be sure their needs will be met. Intermediate care is not provided. EVIDENCE: The home’s Statement of Purpose is included in the welcome pack given to all prospective residents. A relative confirmed her mother had received this before being admitted. There is no reference to a Service User Guide in the letter attached to the welcome pack and a copy has not been submitted to the Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 10 commission. The registered person must produce this document and provide a copy to every prospective resident, and the Commission. The Statement of Purpose does not include the business address of the registered person or her qualifications and these must be added. This information will also be needed for the manager when his application to become the home’s registered manager is approved by the commission. Information must be included in the Statement of Purpose about those aspects of the environment that do not meet the government’s national minimum standards. This relates to bedroom sizes, number of bathing facilities and the amount of communal space for residents. There is no requirement for the home to increase what was in place on the 1st April 2002 when the standards came into force, as it was an existing care home, but must explain in the Statement of Purpose where shortfalls exist. This information also needs to be summarised in the Service User Guide. The Statement of Purpose makes reference to the ‘majority of bedrooms having en-suite facilities’. The en-suite facilities provided in most rooms consist of a toilet and shower in a cabinet unit within the room. At the inspection staff said that only one of these units was in use and that the others were locked because the toilets blocked easily and overflowed. This situation needs to be identified in the home’s Statement of Purpose. Staff also told the inspector there were three bedrooms with separate en-suite facilities (as opposed to the en-suite cabinets in most rooms), but these have domestic baths that most residents cannot use because they cannot get in and out on their own. Following the site visit the registered person has written to the commission stating the home has three bedrooms with ‘spacious showers, basins and toilets with full disability facilities’. Also, that the en-suite cabinets units are locked in some rooms to ‘prevent the service users in those rooms from harming themselves’. There is reference in the Statement of Purpose to bedrooms exceeding the current regulations regarding bedroom size. This is incorrect as a number of bedrooms are below 10 sq metres. There is also reference to a ‘doctors’ room’ but doctors do not use it and its purpose needs to be clarified, as this could lead prospective residents to believe that the home has special doctors’ facilities, which is not the situation. Following the site visit the registered person has written to the commission stating the ‘doctors’ room’ will be renamed. The Statement of Purpose refers to the provision of hairdressing twice a week, whereas it is only available once a week. Also, there is reference to relatives’ support meetings, but these are not currently taking place. It is the registered Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 11 person’s responsibility to make sure the information provided is accurate and current and that the document is kept under review. It is recommended that all pages are numbered with review dates shown. Following the site visit the registered person has written to explain the reason why hairdressing is currently only once a week and hopes to be able to increase this service to two sessions a week in the near future. Following the site visit the registered person has written to the commission stating the home’s Statement of Purpose and Service Users’ Guide have been amended. NHS registered nurses assess residents admitted to the home to establish the level of care that is needed. Information about this is clearly set out in the home’s contract. The pre-admission assessments of two recently admitted residents were looked at and whereas one contained a reasonable amount of information, there was scant information in the other assessment. These assessments are important because the information obtained determines whether or not the home can meet prospective residents needs. Following the site visit the registered person has written to the commission stating a new pre-admission form has been produced. There was evidence that registered nurses attend training courses to ensure they are competent in particular areas of work. Records showed that a nurse had attended training in wound management, infectious diseases and infection control during 2005. Information provided by the manager showed that further relevant training had occurred in 2006, although records of this training were not examined. There are, however, some shortfalls that need to be addressed to ensure staff individually and collectively have the skills and experience to deliver the services and care that the home offers to provide. There was no evidence of staff attending dementia training, which is needed as the home is registered to provide care for up to 20 residents with dementia. The new manager has extensive experience in the field of mental health and this experience will be a valuable resource to staff. Following the site visit the registered person has written to the commission stating that dementia training is being arranged. The manager must ensure registered nurses are trained to administer and monitor analgesia given by a syringe driver. The situation found at inspection was that a GP had set up a syringe driver the previous day because none of the nurses on duty was trained to do this. The inspector was told that the GP Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 12 did not intend the syringe driver to last for longer than 24 hours and it was discontinued during the inspection as planned. However, the nurses had not had training in monitoring this equipment and had not kept records showing the syringe driver had been checked to ensure the medication was being administered at the correct rate. This should have been done. The nurse in charge should have discussed with the GP an alternative means of providing pain relief until nurses were proficient in this area of care. Training is arranged for September 2006 and it will need to be regularly updated. From the evidence seen and comments received, the inspector considers that this home would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The standard of care planning is varied and whilst some care plans were completed extremely well, others had significant shortfalls that could result in residents not receiving the care they need. A number of issues were identified regarding the management of medication that had the potential to place residents at risk. EVIDENCE: A number of care plans were looked at with two being examined in detail. Most care plans contained clear information about residents’ actual care needs, but some lacked sufficient detail to inform staff about the action that was needed to ensure care was appropriate. One care plan said: “Apply suitable dressings to promote healing”, but this could lead to a variety of dressings being used depending on the preference of each nurse. Wound care dressings need to be specified to ensure a consistent approach is followed. Every resident has a folder in which their care plans are kept, together with daily progress notes, medical reports, risk assessments etc. The amount of Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 14 information held in some folders made it difficult to locate specific information easily. Information that is no longer needed should be removed and archived in a timely way. There was some evidence to show involvement of residents, or their representatives, in drawing up care plans but this was not consistently found, which was also the situation regarding care plan reviews. Also, nurses are not routinely signing and dating their records and they need to do this (reference: Nursing and Midwifery Council Guidelines for Records and Record Keeping 2005). Following the site visit the registered person has written to the commission stating the care planning system has been reviewed and changes made. Doctors from two GP surgeries regularly visit residents and are very willing to give telephone advice to nurses when needed. GPs see residents in their bedrooms, which is good practice because privacy can be assured. The inspector was told that occasionally residents are seen in the manager’s office and this should be discouraged, as it is a very busy office and privacy cannot be guaranteed. There is a room on the first floor used for storing items such as wound dressings and also the medication fridge. It is called a doctors’ room, but the reason for this is unclear because doctors never use it. Medicines are stored in a cupboard and mobile trolley in the dining room, which are locked when not in use. The inspector observed many residents to be in the room throughout the inspection and some were seen wandering around, occasionally becoming noisy and agitated. This could distract a nurse when dealing with medication and it is strongly recommended that medication is moved to a designated medication storage area away from residents. This has been raised in previous inspection reports dating back to 2003 and the manager had said that alternative space would be found, but this has not happened. Every resident has a medicine administration record chart (MAR chart), which is the working document signed by a nurse administering medication. A nurse handwrites a new MAR chart when the old one is completed, but a doctor is not always available to sign the chart before it needs to be used. In this situation it is strongly recommended that a second nurse checks what is written, as there is potential for error when charts are regularly rewritten by hand. Handwritten charts written by nurses should always be referenced back to the original prescription, rather than copying from the old chart, and should be signed and dated by two nurses. Controlled drugs were checked against the controlled drug register and the number in stock matched the number recorded in the controlled drug book. However, whilst undertaking this check it was noted that on one occasion a resident was given a controlled drug from another resident’s supply. Medication is the property of the resident to whom it is prescribed and must not be ‘borrowed’ for other residents. A controlled drug for a resident who Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 15 died in the home in April 2006 had not been returned and the manager must ensure these medicines are returned promptly to the home’s licensed waste disposal company. It was found that controlled drugs are not regularly checked against the controlled drug register. The manager should implement these checks as this ensures any irregularity is quickly identified. A number of residents are prescribed a liquid medicine in bottles named for each individual. It was found that nurses administer this medication to all residents who are prescribed it from one bottle, as there is not enough space in the medicine trolley to carry more than one bottle. The manager should discuss with GPs whether a bulk prescription can be supplied for medication frequently prescribed, to limit the number of containers supplied. The alternative is to administer the medicine from each person’s own supply. Medicine pots are kept on a table in the dining room near to the medicine trolley and should be stored in a cupboard, or other appropriate place, when not in use to keep them clean. The drug keys were on a key ring with other keys and the inspector was informed they were occasionally given to carers when stock was needed from store cupboards. Key security is integral to medicine security and access should be restricted to authorised members of staff only. The inspector was informed during the inspection that the drug keys had been separated and had been put on a separate key ring to be held by a member of the nursing staff. It was noted that a bottle of insulin with an expiry date of six-weeks had not been dated when opened. Medicines with a short expiry life should be dated at the time of opening so that they are not used beyond the expiry date. The manager must ensure that registered nurses are aware of their responsibility regarding this. Following the site visit the registered person has written to the commission confirming the recommendations made regarding medication have been implemented. The staff have a good understanding about how to treat residents with dignity. A visitor said her relative appreciated being asked by the manager if she would like a female carer to assist her to the toilet. Staff demonstrated good practice by knocking on bedroom doors and waiting before entering. Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Social activities are provided and are generally well managed. Further consideration should be given to developing the activities for residents with mental health needs. Lunch, although busy, was well managed by attentive staff. EVIDENCE: The inspector spoke individually to four relatives and they all praised the home for its friendliness and homeliness. They said they were made to feel welcome and could visit whenever they wished. The home operates open visiting between the hours of 9 am and 9 pm. Refreshments are routinely offered and one relative said: ‘It’s really nice to have a cup of tea with my husband when I visit’. A resident said the staff are ‘lovely people’. Most residents were unable to comment on the care they received. There is a range of recreational and social activities listed each month on the activity programme, which is displayed on the home’s notice board. A relative said the entertainment, particularly the musical events, was extremely good. Musical entertainment was provided on both days of the inspection. Trips are Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 17 occasionally organised, such as to local garden centres and to places where afternoon tea is served. The hairdresser visits weekly and during the inspection had 12 appointments. The activities organiser provides beauty care to coincide with hairdressing and had three appointments. It is good that individual attention is given to residents, but this means that other residents are not involved with activities unless the care team assists, and this was not seen to happen. The inspector observed residents in the main communal area becoming restless, wandering around, shouting and on occasions showing some aggression. The manager should review the deployment of staff and ensure that nurses and carers help with recreational activities to assist the activities organiser when she is involved individually with residents. The hairdresser had a very busy morning and had not finished the hair of two women before lunch was ready to be served. Staff collected these residents and took them to the conservatory with curlers still in their hair, although neither woman was able to say whether she minded. The manager should explore the possibility of providing extra hairdressing, or staff should consider arranging for meals to be kept hot until hairdressing is finished. Staff respect residents choices and try hard to ensure they spend their time as they wish. Most of the bedrooms seen during the inspection contained many items of personal possessions, helping rooms to look homely. Residents have access to their care records, which was confirmed by a relative. Many of the residents need help to eat and although the lunch period was very busy, staff gave individual help appropriately and in an unhurried way. The activity organiser also assisted, as well as two visitors who arrived to help their own relative. A choice of main course is provided and the cook said there were always alternatives if residents did not like the choices provided. Printed menus are not provided, instead the day’s menu is written on a board by the kitchen. Pureed meals could be improved by liquidising food portions separately to provide different colours on the plate to make meals more visually appealing and also to retain different food tastes. The manager sent out food questionnaires in July 2006 to obtain feedback about the standard of food and was awaiting responses. Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The home’s complaints procedure needs to be made clearer so that anyone wishing to make a complaint knows who to complain to and where to send their complaint. The policy needs to show that formal complaints are dealt with at the home. This is not clear at present. Arrangements for protecting residents are unsatisfactory placing them at possible risk of harm or abuse. EVIDENCE: The registered person must ensure there is a simple, clear and accessible complaints procedure. At present the policy states that the home ‘welcomes comments and suggestions from service users’, but that any formal complaints will be referred to an ‘appropriate body’. The policy must make clear the responsibility of the registered provider to investigate any formal complaint received. The registered person should ensure that formal documents are printed on the company’s headed notepaper and that documents are dated when written and include review dates as they occur. A welcome pack had a complaints policy that was on plain A4 paper with no reference to the home, or to any named person within the company. Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 19 The comment cards returned by relatives showed six people had raised concerns. The manager said he had dealt with one concern since coming into post, but had not kept a record of it, and was unaware of any other concerns. He must ensure that a log is kept of all complaints/concerns and that this is available for inspection at any time. The commission has received no information about any complaint since the last inspection in November 2005. Following the site visit the registered person has written to the commission stating that a log of any concerns or complaints received will be kept. The manager was not aware of the guidance issued by Oxfordshire County Council for the protection of vulnerable adults from abuse. This needs to be obtained so that he knows how concerns or allegations about possible abuse are investigated in Oxfordshire. There was no evidence that staff had received training on protecting vulnerable adults from abuse and this must be arranged. The manager confirmed that none had been arranged this year, and no evidence of any previous training could be found. Following the site visit the registered person has written to the commission stating that the manager now has a copy of the guidance and that this has been shared with staff. Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 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, 21, 23, 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. There are a number of areas within the home that are poorly maintained with no robust procedures in place to regularly check the fabric of the building, or fixtures and fittings. This situation has placed residents and visitors at risk. There is a real need within this home for improvements to be made to provide residents with assurance that their health, safety and welfare will be effectively managed. EVIDENCE: There is an ongoing redecoration and refurbishment schedule, and at the time of inspection the lounge was being redecorated. The manager told the inspector the home does not have permanent maintenance staff, using instead contractors to carry out specific work. Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 21 Following the site visit the registered person has written to the commission to say the home employs a full-time maintenance person who was on annual leave. The inspector considers the dining room should be treated as a priority for redecoration and refurbishment. It was observed that paintwork was badly knocked and scratched and the décor was bland. The conservatory is a pleasant room but its position has affected the amount of natural light into the dining room, making it seem dark, although there are small windows that allow some natural light into the room. A relative commented that the home’s décor was not the ‘best she had seen’, but she liked the home because it was friendly and homely. Following the site visit the registered person has written to the commission stating that it is the company’s intention to redecorate and refurbish the dining room in the near future. The inspector was concerned that a resident on the first floor had no running water to his washbasin from either the hot or cold tap. It was later established that the water supply to the room had been disconnected because the resident blocked the plughole causing water to overflow into his room. The resident said he fetched water from a nearby room, which the inspector found was a sluice room used by staff to empty and clean bedpans in the machine provided. There was a small washbasin for staff to wash their hands, but there was no running water from the hot tap. This situation indicates the serious lack of understanding of staff concerning the rights and needs of residents. Not only does it raise concerns about how the resident was able to manage his personal hygiene without access to water, but also raises concerns about increased risk to the personal safety of residents entering areas where they are unable to comprehend that risk exists. Following the site visit the registered person has written to the commission to say the hot water has been restored. The home has sash windows and these have not been maintained satisfactorily, resulting in the lower windows not staying open on their own and during the site visit trapping a person’s hand. Staff told the inspector this had happened on a previous occasion. The health and safety officer required the registered person to repair the windows by the 14th December 2006 so that they stay open. The temperature of the hot water to the assisted bath on the first floor was tepid on three occasions when the inspector checked to see if the water coming out of the tap exceeded the safe temperature limit of 43ºC. Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 22 During the health and safety officer’s visit he found that the circulating water temperature was low and this was possibly the reason why hot water to the first floor bath was not hot enough. Circulating water temperature needs to be at a specific temperature to limit the growth of legionella bacteria in water systems and the health and safety officer made a requirement that the registered person must arrange for this to be assessed by 14th December 2006. An environmental health inspection was carried out on 25th August 2006 when a number of issues relating to food safety were identified as unsatisfactory. The environmental health officer is due to return on 6th October 2006 to carry out a further check. An inspection by Oxfordshire Fire Service is planned. There are two communal bathrooms (one assisted bath and one shower) and three bedrooms have an en-suite room, each with a toilet and domestic type of bath, although the baths are not used because they do not have bath hoists. The majority of other bedrooms have en-suite cabinets in the room, but only one is used. The others are locked to stop residents using them because the toilets block easily and overflow, and the space for showering is limited. Staff said they had not been used for some time. This means that the present bathing facilities are extremely low for up to 40 residents. The requirement for homes registered from 1st April 2002 is one assisted bath or shower for up to eight residents, as well as en-suite facilities (minimum toilet and washbasin) in every bedroom. Following the site visit the registered person has written to the commission to say there are three bedrooms with ‘spacious showers, basins and toilets with full disability facilities. Storage space for equipment such as wheelchairs, spare mattresses etc., is very limited and the inspector observed these items to be stored in one of the three larger en-suite rooms, which is unacceptable. The owner had stated that more storage space would be provided during the course of the building work, but this has not happened. Following the site visit the registered person has written to the commission to say there is a spacious storage room located centrally within the home but that this is not always used to its full potential’. The registered person made the point that equipment that is almost continuously in use is not normally put away. Hoists were given as an example. A number of the bedrooms have beds that fold against the wall to provide extra living space during the day. A resident said he had difficulty pulling his bed down because he had arthritis in his hands. As most residents do not spend much time in their room during the day, consideration should be given to keeping beds down if this is the wish of individual residents. This would mean that it was easier for them to rest during the day, as they would not Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 23 have to find a member of staff to pull their bed down. Fixed-height beds are gradually being replaced with variable height beds, as this type of bed is more appropriate for residents with nursing needs and for staff. The size of some bedrooms makes it difficult to provide suitable seating for visitors. The inspector observed one relative sitting on a commode chair, which was the only seat in the room. The resident, who was in bed, and her relative agreed to speak to the inspector and the inspector fetched a chair from the dining room, although space was limited with two visitors in the room. Seating in bedrooms should be reviewed, as it is undignified for people to have to sit on commode chairs whilst visiting. Following the site visit the registered person has written to the commission agreeing that commodes should not be used to seat visitors and that a review is taking place of seating provided in bedrooms. Staff said the laundry facilities were generally good, although one of the two washing machines was out of action at the time of the inspection, which had been the situation for several weeks. Owing to the large volume of laundry dealt with each day, this had caused problems. The manager explained the machine was fairly new, although was out of guarantee, and the owner was discussing repairs with the manufacturer. Following the site visit the registered person has written to the commission stating that the washing machine has been repaired. Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. It is not clear that sufficient nurses and carers are available at all times to meet residents’ needs. The number of NVQ trained staff is inadequate and residents cannot therefore be assured that all staff are competent and qualified to provide their care. The home does not have robust recruitment procedures and this has the potential to place residents at risk. EVIDENCE: There were 37 residents in the home at the time of inspection and most had medium to high levels of dependency. A significant number had dementia. The number of staff on duty on the morning of the 16th August consisted of the manager, who is a registered nurse, and 7 carers. There should have been a second nurse on duty, although the total number of staff on duty exceeded minimum staffing levels by one carer. Support staff consisted of a laundry assistant, administrator, activities organiser, 2 domestics and 2 kitchen staff. During the inspection staff reported they were very busy and the inspector observed this to be the situation. Several residents wandered around the home shouting, banging on furniture and occasionally becoming aggressive, suggesting they needed more one-to-one attention than was available. Many of the present residents need help to eat making mealtimes particularly busy, although staff seemed to be coping well with this during lunch on the 16th Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 25 August. The activity organiser helped and two visitors also arrived to assist their own relative. The duty rotas for the period 7th – 20th August showed there were normally two nurses on duty during the mornings, but only one during the evenings and at weekends. The home’s staffing notice states there must be two nurses on duty from 7 am to 10 pm seven days a week. The staffing notice states there must be a minimum of 5 carers on duty from 5 – 10 pm and the rotas showed this was the usual situation. However, as there is only one registered nurse from late afternoon through to 10 pm, instead of two, this means that the total number of staff on duty is one below the minimum number required. The registered person must inform the Commission in writing why the skill mix and number of staff on duty does not always meet the requirements of the staffing notice, and how this situation is being managed. The manager completes the duty rota and then submits it to the registered person, who makes changes as needed. This information is then written in a diary but the information about who had actually worked was not always clear. It is required that the home has a duty rota of persons working at the care home that shows whether or not the rota is actually worked. The arrangements for obtaining residents’ medications should be reviewed as this involves a member of staff driving to the doctors’ surgery in Bicester to collect the following week’s supply of medicines. The manager reported that depending on the traffic this could be time consuming. Consideration should be given to changing the pharmacy supplier to ensure valuable staff time is spent in the home. Following the site visit the registered person has written to the commission stating it is unusual for a member of staff to be taken off the floor to collect the drugs, as the registered person usually does this. Thirteen relatives responding to the Commission’s survey considered staffing levels were sufficient. Five relatives thought staffing levels were not sufficient, two made the following comments: “I believe that staff numbers are lower than they ought to be. There have been occasions when I have felt that residents may have been vulnerable due to lack of staff.” “I am often at the home when staff go for meal breaks – they all go at the same time and no one is left to supervise residents. Staff should take staggered meal breaks and someone should be left to supervise residents at all times.” Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 26 Whilst it is important to take account of all comments received, the inspector wishes to acknowledge that the majority of relatives who returned comment cards to the commission did not raise any concerns about staffing levels. Only two out of 25 carers working at the home have a national vocational qualification, one at level 2 and one at level 3. This is extremely low, considering the timescale for achieving 50 of care staff with at least a level 2 NVQ was December 2005. The registered person must write to the inspector providing information about the arrangements in place for staff to undertake this training and what support is available. Following the site visit the registered person has written to the commission stating the company is now making it a condition of employment for new staff to complete NVQ level 2. The registered person deals with all aspects of recruitment and it was found that staff personnel files containing highly confidential information were stored in an unlocked cabinet in a wooden hut in the grounds of the home. At the time of the inspection building workers had congregated around the open office door and some were in the office. The inspector and the manager identified a lockable cabinet in the registered person’s office within the home and staff files were moved there during the inspection. Three recruitment files were looked at and none contained all the information and checks that are legally required. The registered person is required to inform the Commission in writing that the necessary information and checks have been obtained. The inspector was informed that new members of staff undergo a two-week induction programme. A copy of the induction programme was seen, which is in the form of a checklist. It is recommended that an appropriate induction programme, which meets the Skills for Care standard, be made available and is completed within the first six weeks of employment. Following the site visit the registered person has written to the commission stating that an appropriate induction programme has now been instigated. Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The lines of accountability between the registered person and the manager are unclear and this is adversely affecting the overall management of the home. The standard of maintenance checks and recording is particularly poor and this has the potential to place residents at risk. EVIDENCE: The manager was appointed in February 2006 and has applied to the Commission to become the home’s registered manager. This application is currently being processed. He is a registered nurse and has worked extensively in the field of mental health. Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 28 The registered person is a director of the company and works in the home from Monday to Friday dealing with administration and general management duties. It is the view of some staff of different grades that the role of the registered person and the manager overlap, and there is some confusion as to each person’s responsibilities, which needs to be resolved. Members of staff told the inspector they found the new manager approachable and liked the fact that he was prepared to work as a member of the staff team whenever he could. Relatives also spoke positively about him and one commented he had dealt with an issue in a constructive and timely way. Questionnaires were sent to relatives in February 2006 to obtain feedback about the services provided. The manager said the findings had not been collated and this should be done to assist in the future development of the quality of the service for residents. The inspector checked whether small amounts of pocket money were held for residents’ daily incidental expenses. The manager said he had checked this with the registered person when he took up his post and was told that money was not held on behalf of residents. The inspector was told that the company pays for incidental expenses as they occur with monthly invoices sent to residents, or representatives. Fire training consists of staff watching a video and completing a questionnaire. The training records of four members of staff were randomly selected to see when fire training was last undertaken and two had watched the video and completed the questionnaire in July 2006. According to the training records one had not had training since July 2003, although this member of staff later confirmed he had attended training in July 2006 but his questionnaire could not be found. There was no evidence of the fourth person attending fire training. The inspector queried whether the content of the present fire training was adequate and has made a requirement that the registered person checks this with the Oxfordshire Fire Service and informs the inspector in writing of the advice given. The home does not have any qualified fire marshals at the present time. This qualification is recommended to ensure there are members of staff knowledgeable about fire training. At present registered nurses provide this training to new workers, but the inspector was uncertain of their level of knowledge. The registered person must review this and provide extra training if needed. The registered person was previously a fire marshal but her training had lapsed as she last attended this training in 2001. Therefore, documents showing her to be a fire marshal must be amended. Hot water temperature checks have not been done since 2005 and this means that residents cannot be assured that the hot water is maintained at a safe level to minimise the risk of scalds. Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 29 The last fire test was on 16.6.06 and consisted of a fire panel test without sounding the audible alarm. The registered person must consult with the Fire Officer to establish if the extent of present testing is sufficient. The fire alarm should be tested weekly. There were no records of emergency light tests being done. The registered person must ensure that maintenance checks are carried out as required to ensure the safety of residents and visitors. Ten staff attended health and safety training provided by an external trainer on 26th July 2006. Eighteen staff attended moving and handing training on 4th August 2006. Two first aid training sessions are planned for September 2006. This level of training is good, indicating the registered manager’s commitment to this particular area of training. However, carers involved in preparing and serving meals have not had basic food hygiene training and this must be discussed with the environmental health officer. Following the site visit the registered person has written to the commission stating that action is being taken in relation to the health and safety issues identified in the report. Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 1 X 2 X 2 2 1 2 STAFFING Standard No Score 27 1 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score N/A X 3 X 3 X X 1 Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO 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 OP1 Regulation 4 and Schedule 1 Requirement The registered person must ensure the home’s Statement of Purpose contains all the information that is required by this regulation, and that the information given is current and accurate. A copy of the document must be submitted to the Commission. The registered person must compile a Service User Guide that contains the information required by this regulation. A copy of the document must be submitted to the Commission. The registered person must make arrangements by training staff or by other measures to prevent service users being harmed or suffering abuse or being placed at risk of harm of abuse. Timescale for action 31/12/06 2 OP1 5 31/12/06 3 OP18 13(6) 06/10/06 4 OP21 23(2)(j) The registered person must write 06/10/06 to the inspector confirming there is hot and cold running water to all washbasins used by residents. Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 32 5 OP21 23(2)(j) The registered person must 06/10/06 ensure that the home’s hot water system is sufficient to heat water to a suitable temperature for washing and bathing. The registered person must write to the inspector confirming this. The registered person must write 06/10/06 to the inspector confirming that there is hot water to the staff hand basin in the first floor sluice room. The registered person must inform the inspector in writing why the agreed staffing notice is not being met and should, if necessary, propose an amended staffing statement for discussion with the Commission. 06/10/06 6 OP26 13(3) 7 OP27 18(1)(a) 8 OP27 17(2) Schedule 4 The registered person must 06/10/06 ensure there is a copy of the duty roster of persons working at the care home and a record of whether the roster was actually worked, and be available for inspection at all times. The registered person must inform the inspector in writing how a minimum ratio of 50 trained members of care staff (NVQ level 2 or equivalent) will be achieved, and the timescale for doing so. 06/10/06 9 OP28 18(1)(a) 10 OP29 19(4) and Schedule 2 11 OP30 18(1)(a) The registered person must write 06/10/06 to the inspector confirming that the information and checks that were missing from the three staff files seen during the inspection have been obtained. The registered person must 06/10/06 ensure that the home’s programme of induction meets the Skills for Care requirements. DS0000027155.V306561.R02.S.doc Version 5.2 Page 33 Heathfield House Nursing Home 12 OP38 12(1)(a) The registered person must write 31/12/06 to the inspector confirming the work required by the Health and Safety Executive has been satisfactorily completed. The registered person must find 06/10/06 out from Oxfordshire Fire Service whether the home’s present fire training programme is adequate. The registered person must write to inform the inspector of the outcome of this. The registered person must ensure that maintenance records are kept of health and safety, checks and that these are available for inspection at any time. The registered person must find out from the environmental health officer what food hygiene training is needed for staff who periodically work in the kitchen preparing and serving food. The registered person must inform the inspector in writing of the outcome of this. 06/10/06 13 OP38 23(4)(d) 14 OP38 12(1)(a) 15 OP38 13(3) 06/10/06 Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 34 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 Refer to Standard OP3 Good Practice Recommendations Arrangements should be made to review the preadmission assessments of self-funding residents to ensure assessments cover all the aspects of care listed by Standard 3.1. Dementia care training should be provided for all staff by a trained dementia care trainer. ●A training update should be provided for registered nurses regarding assessment, planning and evaluating care. ●The care plan folders should be reorganised and old information archived. ●Nurses should ensure their records are signed and dated. Medication ●Ensure that medication keys are kept separate from other keys and held only by authorised staff. ●The registered person should consider relocating medication out of the dining room to a locked designated place. ●Medicine pots should be stored in a cupboard, or other appropriate place, when not in use. ●A second nurse should check handwritten medication record charts when they are not checked by a GP. ●Controlled drugs should be checked against the controlled drug register at regular intervals. ●Medication that is no longer needed should be returned promptly via the home’s licensed waste disposal company. ●Discuss with GPs if they will supply bulk prescriptions for medication frequently prescribed to limit the number of containers held in stock. ●Medication with a short expiry life should be dated when opened to ensure medication is not used beyond the expiry date. ●Review the collection of weekly medication from the dispensing GP so that staff time is not taken up with this activity. Give consideration to providing hairdressing more frequently than weekly. 2 3 OP4 OP7 4 OP9 5 OP12 Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 35 6 7 8 OP15 OP16 OP18 Improve pureed meals by liquidising food portions separately to retain different food tastes. The company’s formal documents should be produced on the company’s headed paper. Obtain the local guidance issued by Oxfordshire Adult Protection Committee on the protection of vulnerable adults from abuse and ensure all staff are aware of its contents. The redecoration and refurbishment of the dining room should be treated as a priority. There should be adequate storage facilities so that equipment and other items are not stored in areas used by residents. There should be sufficient armchairs in bedrooms for residents and visitors to use, without the need to use commode chairs. Ensure that beds that fold to the wall are left down during the day if this is the resident’s preference. The broken washing machine should be repaired at the earliest opportunity to ensure laundry and clothing is laundered promptly. Consideration should be given to sending some staff on fire marshal training so that the home has appropriately trained staff to monitor fire safety within the home. 9 10 OP19 OP24 11 OP24 12 13 OP24 OP26 14 OP38 Heathfield House Nursing Home DS0000027155.V306561.R02.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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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