Inspection on 04/05/06 for Heathfield Lodge

This inspection was carried out on 4th May 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Heathfield Lodge 04/05/07

Heathfield Lodge 08/12/05

Heathfield Lodge 05/07/05

Heathfield Lodge 22/02/05

Heathfield Lodge 21/09/04

Similar services:

Thornton Lodge

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

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

CARE HOMES FOR OLDER PEOPLE Heathfield Lodge 22/24 Melling Lane Maghull Liverpool Merseyside L31 3DG Lead Inspector Mrs Janet Marshall Unannounced Inspection 09:00 3 & 4th May 2006 rd 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 Lodge DS0000005374.V290756.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 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 Lodge DS0000005374.V290756.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Heathfield Lodge Address 22/24 Melling Lane Maghull Liverpool Merseyside L31 3DG 0151 526 9463 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) Mrs Doris J Gidman Mr A J Gidman Mrs Doris J Gidman Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Heathfield Lodge DS0000005374.V290756.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 26 OP. Date of last inspection 8th December 2005 Brief Description of the Service: Heathfield Lodge is a care home registered to provide personal residential care for a maximum of 26 older people. The home is privately owned by Mr and Mrs Gidman. Mrs Gidman has been the registered manager since it opened in 1988. Heathfield Lodge consists of two large semi-detached Victorian houses that have been amalgamated into one building. It is situated in the well established area of Maghull, and is close to all local amenities and transport links. A large enclosed garden and patio area at the back provides an attractive space that is well used by residents when weather permits. The space at the front of the home is mainly shrubs and car parking space. The home has a large lower ground floor that contains the kitchen, laundry and storage areas, a ground floor on which residents accommodation and the communal spaces are found, and a first and second floor that contain rooms and bathrooms and toilets. Twenty rooms are single; three are registered as double but each of these currently has one resident living in them. The communal space comprises a sitting room and large dining room that is divided into two smaller areas. The home has a lift to all floors. The current scale of charges for the home is £254.00 up to £375.00 per week. Heathfield Lodge DS0000005374.V290756.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first of two inspection visits (site visits) that are required at the home this inspection year. The inspection was unannounced and took place over two days for a total of 12 hours. The Commission considers 22 standards for Care Homes for Older People as Key Standards, which have to be inspected at least once in a 12-month period. All Key standards, which are identified within the main body of the report, were inspected during this inspection. On the first day of the inspection the requirements and recommendations from the last inspection report were discussed and checked with the management team. A number of them have been fully met so improving standards in the home. Those that have not been met have been raised again as part of this report in addition to a number of other statutory requirements and good practice recommendations identified during this inspection visit. A partial tour of the home was conducted. Care records and other required records were inspected. Records that were examined included a selection of residents care plans, daily diaries, medical notes, medication and records, staff rotas and certificates of health and safety checks. A number of residents were “case tracked”. Case tracking means that the Inspector concentrates on the care given and experiences of one or more residents to get an idea of what is like to live at the home and how that person’s needs are being met. A pre - inspection questionnaire, which was sent out to the home was completed by the manager and returned prior to the inspection. The manager, deputy manager, 6 staff, a visiting GP and a district nurse were interviewed. 15 residents and 4 relatives were also spoken with. Surveys from the Commission for Social Care and Inspection titled ‘Have your say about…’ were given out to eight residents and returned completed. Details given in the pre - inspection questionnaire, comments made during interviews, observation and the results of the Commission for Social Care and Inspection surveys and questionnaires produced by the home have been used towards measuring standards for the purpose of this report. What the service does well: There was a warm and friendly atmosphere at the home. Staff were observed providing assistance to residents in a sensitive and polite manner. With the assistance needed residents were encouraged to make their own decisions and choices in all aspects of their lives so maintaining a level of independence. People who visit the home are welcomed and treated with respect. Heathfield Lodge DS0000005374.V290756.R01.S.doc Version 5.1 Page 6 Staff were seen interacting well with residents and they showed a good level of knowledge and understanding of their needs. Comments about the home made by residents, relatives and visiting healthcare professionals included: “I receive a good level of care and suppor”t. The care and support is very good”. “My sister always looks clean”. “The healthcare support seems to be very good, my aunt has her own GP who will visit the home when she needs him to”. “The staff are very nice”. “They always knock before coming into my room”. “Staff are respectful”. “They talk to me when they are helping me”. “The staff always help you, they are very good”. “The staff are very nice, yes they always knock before coming into my room”. “The staff are all very nice and helpful”. “The staff are always polite and respectful”. “The staff are all very good they seem to look after my aunt very well”. “The staff seem to be caring”. “Staff are always polite and welcoming”. “Staff always treat residents well”. “The staff are polite and caring”. What has improved since the last inspection? Care plans include more details about the type of care and support needed by residents enabling staff to be sure of meeting each persons needs. Residents are protected by a safer system for administering medication, which has been introduced to the home since the last inspection. Staff have been provided with training in the use of the new system. Assessments carried out by the home for prospective residents are more detailed ensuring that needs can be fully met. The home has developed questionnaires for residents, relatives and visiting healthcare professionals and service providers as part of their quality assurance and quality monitoring processes. Protection of Vulnerable Adults training has been arranged for some staff to raise their awareness about the protection of residents. The home now has access to a training agency, which can offer mandatory and specialist training to all staff. Residents contracts have been developed and now include most of the required information, all newly admitted residents receive a new contract on admission, they are gradually being distributed to all other residents. Parts of the environment have been improved enhancing the comfort and dignity of the residents. Heathfield Lodge DS0000005374.V290756.R01.S.doc Version 5.1 Page 7 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 Lodge DS0000005374.V290756.R01.S.doc Version 5.1 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 Lodge DS0000005374.V290756.R01.S.doc Version 5.1 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): 3&5 The quality in this outcome area is adequate. The judgement has been made using available evidence including a site visit. Resident’s contracts include more information about the terms and conditions of occupancy but have not been completed in full. Assessments carried out by the home are more detailed so that the home can be sure of meeting prospective residents needs. EVIDENCE: The manager confirmed that new contracts for residents outlining the terms and conditions of the home have been developed. A copy of the new contract was examined. It included most of the information required for this standard. The manager said that newly admitted residents receive a copy of the new contract on admission to the home and that the contracts are gradually being distributed to other residents. A list of resident that have been given an up to date contract was seen. Six out of eight residents who completed surveys from the Commission for Social Care and Inspection said they had received a contract. Two residents Heathfield Lodge DS0000005374.V290756.R01.S.doc Version 5.1 Page 10 who said they had not were unable to remember. Copies of contracts were viewed in their care files. Contracts for two newly admitted residents were seen. The documents showed that the section for recording the homes charges to residents was incomplete as was the last section, which requires the residents/representatives signature and date to show that they agree with the terms and conditions of the home. This was discussed with the manager who said that she would ensure that all information included in resident’s contracts is completed in full. A total of six residents care files were case tracked. They all included copies of assessments carried out by the home and the Care Management Team (Social Workers). Assessments carried out by the home for two newly admitted residents were examined. Both assessments provided a good amount of detail to showing that the home was suitable for meeting the person’s needs. Heathfield Lodge DS0000005374.V290756.R01.S.doc Version 5.1 Page 11 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 & 10 The quality in this outcome area is adequate. The judgement has been made using available evidence including a site visit. Care plans were more detailed but did not show the involvement of residents and/or their representatives therefore there is a risk that needs are not being fully met. Residents were protected by the procedures for administration of medication. EVIDENCE: A requirement was raised as part of the last inspection report for care plans to be developed to include more detailed information about the personal and healthcare needs of residents. A total of six residents care files were examined. Each care file included the following documents for each resident: a recent photograph, personal information i.e. date of birth date of admission into the home, details of next of kin, a care plan, records of health and personal care, moving and handling risk assessments, daily records and agreements by residents/representatives regarding the holding open of bedroom doors and keys to bedrooms. Care plans have been developed since the last inspection. The care plans contained more details about the type of support and care that residents need. Heathfield Lodge DS0000005374.V290756.R01.S.doc Version 5.1 Page 12 Case tracking showed that care plans were consistent with the initial assessments carried out by the home and the care management teams. A number of care plans did not provide evidence that the resident and/or their representative was involved in developing the document and subsequent reviews. During interview a resident’s relative said that they were not aware of a care plan for their relative and had not been consulted about one. A care plan was available for the resident. This was discussed with the manager. All residents care files were locked away securely in the home. The manager confirmed that residents are able to access their own information on request. Records in a number of care files have not been updated at regular intervals. For example a resident had recently received hand and nail care which was not recorded in the appropriate section of her care plan. Moving and handling risk assessments were available in care files, however there were no risk assessments for the daily tasks or activities that residents are involved in that pose a risk to them. These risk assessments must be carried out detailing appropriate action that needs to be taken so that residents can maintain a safe level of independence. This was discussed with the manager. Examination of daily records showed that the documents are not being completed on a regular basis. Daily notes for one resident had not been completed since December 2005. The manager was advised that daily records need to be kept so that residents care can be appropriately monitored and assessed. A requirement was raised as part of the last inspection report for the home to introduce a safer system for storing and administering medication. Since the last inspection a monitored dosage blister pack system has been introduced to the home. A random selection of medication and Medication Administration Record sheets were examined, they were in good order. All medication and records were locked away safely. Discussion with the manager and staff and examination of records showed that training around the use of the new system was undertaken by staff who are involved in the administration of medication. The training was delivered by a pharmacist advisor to the home who issued a certificate confirming that the training took place and the names of the staff who attended, this was seen during the inspection. Comments made during the inspection by residents, relatives and visiting health care professionals included: “I receive a good level of care and support”. “The care and support is very good”. “My sister always looks clean”. “The healthcare support seems to be very good, my aunt has her own doctor who will visit the home when she needs him to”. Heathfield Lodge DS0000005374.V290756.R01.S.doc Version 5.1 Page 13 “There have been improvements in the home recently i.e. how medication is managed and ordered”. “Equipment and dressings are always available and stored appropriately”. Residents spoken with and completed surveys confirmed that staff treat residents with respect and provide them with personal care in a sensitive and flexible way. Comments made by residents included: “The staff are very nice”. “They always knock before coming into my room”. “Staff are respectful”. “They talk to me when they are helping me”. Heathfield Lodge DS0000005374.V290756.R01.S.doc Version 5.1 Page 14 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 & 15 The quality in this outcome area is adequate. The judgement has been made using available evidence including a site visit. Residents are not provided with sufficient opportunities to satisfy their social interests and needs. Residents are encouraged and supported to maintain relationships that are important to them. Residents do exercise choice and control over their lives. EVIDENCE: There was very little evidence available at the home to show that residents are offered or provided with a varied range of activities. The home did not have a structured activity programme available. Both one to one and group discussion took place with a number of residents regarding the range of activities at the home. Residents spoken with felt that there was little to do at the home other than to pursue personal hobbies and interests such as watching Television, knitting and reading. A number of residents and visitors felt that the home needed to provide a more varied and structured programme of activities. Heathfield Lodge DS0000005374.V290756.R01.S.doc Version 5.1 Page 15 Activities organised by the home include bingo, cards and the occasional film show. Surveys completed by residents and general discussion with them suggested that there are few activities available at the home that they can take part in. The manager said that she intends to introduce a wider range of activities to the home. Staff interviewed appeared to know the residents well. The home presented with a warm friendly and relaxed atmosphere. On the first day of the inspection the hairdresser was visiting the home and the residents said how much they enjoyed her company. The home does not have a separate facility for hairdressing the hairdresser was seen attending to residents in the main lounge. This was discussed with the manager who said that this arrangement is preferred by the residents who see it as an opportunity to socialise. Residents in the lounge confirmed that they have no objections to this arrangement. The manager was advised to include this information in the homes Service User Guide so that prospective residents are aware of the arrangement before making a decision about living at the home. The possibility of converting a large storeroom on the top floor of the home for this purpose was discussed with the manager who said that she would look into this idea. A number of residents received visitors on both days of the inspection. Discussion with residents showed that they receive visitors at any time of the day and night. Relatives that were spoken with during the inspection all said that they have always been made to feel welcome when visiting the home. They said that there were no restrictions regarding visiting the home. Visitors met with residents in their own rooms, outside in the garden and in the lounge. Comments made by relatives included: “I can visit any time and am made to feel welcome”. “I live close by so it is easy for me to get to and I can see her a couple of times a week”. “I can visit when I want”. “I have taken my aunt home for the day”. “We can visit at any time”. “Staff were seen to have good relationships with residents and their relatives and were cheerful and warm in their approach”. Residents are encouraged to manage their own finances. Management assist with financial arrangements when required. Financial records for three residents were examined these evidenced details of recent transactions. Records included receipts for purchases and a staff signature was entered when transactions were recorded. The manager was advised that two staff should sign the record were a resident does not have the capacity to sign for a transaction made. Heathfield Lodge DS0000005374.V290756.R01.S.doc Version 5.1 Page 16 The routine in the home was observed as being based around the needs and wishes of the residents. Throughout the inspection visit both one to one and group discussion took place with a number of residents regarding their routines. Residents were happy that they were able to exercise a level of independence in their lives, which they said is respected and encouraged by staff. Comments made by residents included: “I get up and go to bed when I choose”. “I make choices”. “It is in my hands what I do”. “I choose what I wear”. Care plans viewed provided details of resident’s daily routines, likes and dislikes. Lunch was served in the dining room by care staff. The dining room tables were attractively laid. The home offers three meals a day with snacks and drinks available at various other times. There was a choice at breakfast. The menu for each day is written on the menu board in the dining room however it is recommended that the weekly menu is displayed for residents to view. The main hot meal of the day is served at teatime. Soup and a snack or a choice of sandwiches is available at lunchtime. Residents made various comments about the quality and choice of food. Comments included: The food is good “I am happier with the food now that we have salads at lunchtime”. “I enjoy breakfast and supper but not the evening meal, the vegetables are not always cooked properly”.. “Meals are not so good the vegetables are not cooked enough”. “I have nothing to complain about except the main dinner”. The comments were discussed with the manager who said that she would address any issues with the cook. The manager confirmed that following the last inspection discussion took place with residents regarding their food likes and dislikes and the information was recorded in their care files. The manager said that none of the residents or staff on their behalf had raised any of the concerns with her. Surveys from the Commission for Social Care and Inspection and questionnaires in the home showed that residents were generally happy with the food served at the home. A tour of the kitchen took place it was clean, tidy and well organised. There was a good stock of fresh, frozen, tinned and dried foods. Heathfield Lodge DS0000005374.V290756.R01.S.doc Version 5.1 Page 17 Heathfield Lodge DS0000005374.V290756.R01.S.doc Version 5.1 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 & 18 The quality in this outcome area is adequate. The judgement has been made using available evidence including a site visit. Residents are at risk because staff have are not appropriately trained to ensure their full protection. EVIDENCE: A complaints procedure was viewed at the home. It described how the home responds to complaints and the timescales involved in the process. A copy of the homes complaints procedure was not on display in the home, a copy needs to be displayed near to the main entrance so that people can refer to it at any time. With the exception of one resident all others and relatives spoken with were confident about making a complaint or raising a concern if they ever needed to. Comments made by residents and relatives during the inspection included: “I have no concerns”. “I usually know who to speak to if I am not happy”. “Staff always listen and act on what I say”. “I have no concerns or complaints about the care and support that my relative receives at the home”. Heathfield Lodge DS0000005374.V290756.R01.S.doc Version 5.1 Page 19 A complaints book kept by the home was viewed. There were no recent complaints recorded in the book. During interview one resident who said that she was unhappy with the food was asked if she had made a complaint she said that she had not because she was not sure about how to go about it. This was discussed with the deputy manager who said that she would support the resident to make a complaint. A copy of Sefton Local Authorities Protection of Vulnerable Adults procedure was viewed at the home. Staff interviewed showed little awareness of the document and limited knowledge about what to do in the event of suspicion or following an allegation of abuse. The manager said that Protection of Vulnerable Adults training has been arranged for staff and will take place on 19th May 2006. The manager was advised that all staff must undertake Protection of Vulnerable Adults training. Heathfield Lodge DS0000005374.V290756.R01.S.doc Version 5.1 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 & 26 The quality in this outcome area is adequate. The judgement has been made using available evidence including a site visit. Areas of the home that are in need of repair and refurbishment compromise the comfort and dignity of the residents. EVIDENCE: A partial tour of the home was carried out. Improvements have been made to the environment following requirements raised as part of the last inspection report. Improvements include, the replacement of several bedroom carpets, the redecoration of several bedrooms and a replacement dishwasher. A maintenance plan for the renewal of fabric and furniture and the redecoration of the home was not available. This was raised as a requirement was raised as part of the last inspection report. The manager said that she and the handy man are in the process of developing one. Heathfield Lodge DS0000005374.V290756.R01.S.doc Version 5.1 Page 21 During this inspection visit a partial tour of the home took place. The following repairs and improvements that are required were identified: The skirting boards and architraves in the corridors on the ground floor that were badly damaged need repairing and painting. Furniture in the following bedrooms that were tatty and broken in parts needs repairing or replacing: Bedrooms 5, 6, 9, 10, & 26. Bathroom – room 12 The bath requires a side panel. Parts of the ceiling and the wall at the side of the toilet that was damaged needs repairing and painting. The lock on the door was broken, this needs repairing. Toilet – room 11 The window that is overlooked was not covered making it easy for people to see in. the window needs to be covered. Parts of the walls that were damaged need repairing and repainting. The lock on the door was broken, this needs repairing. The décor in both bathrooms on the first floor and the bathroom and shower room on the second floor was old and worn in places. Consideration should be given to redecorating all of these rooms. Two easy chairs in the lounge that were heavily stained need replacing. Exterior windows and ledges around the back and front of the home showed signs of deterioration; consideration should be given to repairing or replacing them to prevent them from deteriorating further. The Garden has a large lawn area and a patio, which is generally well maintained. One resident was seen gardening, he said he spends a lot of time outside in the gardens caring for the plants, shrubs and borders. Residents said they like to sit out in the warm weather. Residents and visitors were seen sitting outside on the second day of the visit. They requested the use of the parasol, a member of staff reported that it was broken. The parasol must be repaired or replaced so that residents are protected when sitting outside in the warm weather. All parts of the home were clean and tidy. Residents interviewed said that their rooms are cleaned each day and were complimentary of the domestic staff. A Housekeeper employed at the home is responsible for cleaning most parts of the home. The housekeeper said she is provided with sufficient equipment and materials, which she keeps, locked up in a cupboard on the top floor of the Heathfield Lodge DS0000005374.V290756.R01.S.doc Version 5.1 Page 22 home. During discussion the Housekeeper demonstrated high standards of cleanliness and hygiene. A number of resident’s bedrooms that were viewed were furnished to individual taste and residents had brought in personal items e.g. electrical equipment, ornaments and pictures. Surveys completed by residents showed that the home is always clean and tidy. Heathfield Lodge DS0000005374.V290756.R01.S.doc Version 5.1 Page 23 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 & 30 The quality in this outcome area is adequate. The judgement has been made using available evidence including a site visit. Staff have not received all the required training, which puts the residents at risk. EVIDENCE: Discussion took place with a total of six staff on a one to one basis. Group discussions also took place with staff. Staffing levels on the days of the site visit were sufficient in meeting the needs of the residents. Staff rotas showed that there is a minimum of three staff on duty throughout the day and two waking night staff. Staff spoken with said that they are happy with the current staffing arrangements. The manager said that Protection of Vulnerable Adults training has been arranged to take place on 19th May 2006. She expects the majority of the staff to attend but will arrange a further session for those staff who are do not attend for whatever reason. The manager said that she has registered with a training agency ‘Learn Direct’. Courses accessed via this agency up to date include Induction and Protection of Vulnerable Adults training. Information included in staff files showed that a number of staff need to attend refresher courses relating to core training. The manager said that she would arrange the required training for all staff to take place over a gradual period of time. Heathfield Lodge DS0000005374.V290756.R01.S.doc Version 5.1 Page 24 A total of four staff files were examined. Most of the required information required for staff was available in those files viewed. One file did not include two references. The manager explained that it was due to the length of time that the person had worked at the home. The manager was advised to provide her own reference for the member of staff. None of the files included a record of training or a training and development plan for the individuals. The manager was advised to provide these for all staff. Almost 50 of the staff group have obtained a National Vocational Qualification level 2 and/or 3 in care. The manager said that other staff are due to commence it in the near future. The deputy manager is an assessor for National Vocational Qualifications. Satisfactory Criminal Record Bureau checks for staff were available in the files that were viewed. Comments made by residents, relatives and visiting health professionals were all positive. The comments suggested that staff are polite, caring and good at their jobs. Staff that were interviewed on a one to one basis demonstrated that they have good knowledge and understanding of the needs of the residents. They all said that they enjoy their work and that they are generally well supported by the management of the home. Agency staff have been used in the past and are still used in an emergency, however the manager reported that the use of agency staff has been low over recent months. Staff sickness and holidays are usually covered as overtime by staff employed by the home. Staff interviewed said that they were aware of the homes policies and procedures and that they are able to access them easily. Comments made during the inspection by residents, relatives and visiting health care professional included: “The staff always help you, they are very good”. “The staff are very nice, yes they always knock before coming into my room”. “The staff are all very nice and helpful”. “The staff are always polite and respectful”. “The staff are all very good they seem to look after my aunt very well”. The staff seem to be caring. “Staff are always polite and welcoming”. “Staff always treat residents well”. “The staff are polite and caring”. Heathfield Lodge DS0000005374.V290756.R01.S.doc Version 5.1 Page 25 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 The quality in this outcome area is adequate. The judgement has been made using available evidence. Management and administration processes within the home have improved however, processes, which are not being carried out by the home, have the potential to put residents best interests at risk. EVIDENCE: The manager who is also the owner of the home has not yet made a decision about undertaking a National Vocational Qualification level 4 in care & management. The manager has managed the home for approximately fifteen years. Records show that there have been no concerns or complaints made about her or the general management of the home. The manager has very good support from her deputy manager. This was evident on observation and through discussion with the manager and staff who confirmed this. Staff and residents were complimentary of both the manager and her deputy. They said Heathfield Lodge DS0000005374.V290756.R01.S.doc Version 5.1 Page 26 that they are confident about approaching them which an issue if they needed to and know that they would be listened to. Since the last inspection quality assurance and quality monitoring questionnaires have been developed. There are four variations of questionnaires, for residents, resident’s family and friends, visiting service providers & Visiting GPs, district nurses, chiropodists, etc. Copies of completed questionnaires for all categories were viewed at the home. They show that people are mostly satisfied with all aspects of the home. Any areas that show dissatisfaction are highlighted with information to show the action taken by the home in response. Monthly visits to the home in accordance to Regulation 26 of the Care Homes Regulations are not yet being carried out. The manager said that a person has been identified to carry out the visits. It is not appropriate for Mrs Gidman as the owner/manager to undertake these visits because of her day-to-day involvement in the running of the home as the Registered manager. How to present the reports and suggestions of possible formats that could be used were discussed with the manager. A set of policies and procedures was viewed at the home. They are kept in a place that is easily accessed by staff and resident. Some of the policies and procedures showed that they have not been reviewed for some time. This was discussed with the manager who said that she would ensure that this is done over a gradual period of time. The management of the home handle personal monies for some residents. The records and money for three residents were examined and checked. All transactions made were well recorded for by the manager or the resident were they are able sign. A member of the management team signed for transactions made for residents who are unable to sign. The manager was advised that two signatures are required for all transactions made on behalf of residents. A large amount of money was held for one resident. The manager said that the resident has refused to open a bank account. The manager was advised to discuss this further with the resident with a view to encouraging her to open her own bank account. Staff spoken with said that they have not yet received formal supervision from management. The manager confirmed this and said that she has developed a new document for recording staff supervisions and now intends to formally supervise staff. The manager was advised that staff must receive formal supervision with their senior/manager at least six times a year. Records show that the required health and safety checks are being carried out at the home. Discussion with staff and the management evidenced that some staff need to undertake refresher courses in mandatory health and safety areas. Some records required by regulation are not complete, they are detailed within the relevant sections of this report. Heathfield Lodge DS0000005374.V290756.R01.S.doc Version 5.1 Page 27 Heathfield Lodge DS0000005374.V290756.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 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 X X 3 X 2 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Heathfield Lodge DS0000005374.V290756.R01.S.doc Version 5.1 Page 29 Are there any outstanding requirements from the last inspection? Yes 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. 2. 3. 4. Standard OP2 OP7 OP7OP37 OP7 Regulation 5 17 15(1) 13(4)(b) Requirement All residents must be provided with a completed contract/Terms and Conditions of the home. Daily records must be completed and kept up to date. All care plans must evidence the involvement of residents and/or their representatives. Risk assessments must be carried out for tasks and activities that pose a risk to residents. Residents must be provided with a wider range of activities. Arrangements must be made for all staff to undertake POVA training. A maintenance plan for repairs and refurbishment of the home must be provided. The homes complaints procedure must be displayed in the home. Arrangements must be made for the required repairs and refurbishment of the home to be carried out. Staff files must include all of the required information. Timescale for action 04/07/06 04/06/06 04/07/06 04/07/06 5. 6. 7. 8. 9. OP12 OP18 OP19 OP16 OP24 16(2)(m) (n) 13(6) 23(2)(b)( d) 22 23(2)(b) 04/08/06 04/07/06 04/08/06 04/06/06 04/09/06 10. OP28 19 Schedule 2 04/07/06 Heathfield Lodge DS0000005374.V290756.R01.S.doc Version 5.1 Page 30 11. OP33 26 12. OP15 16(2)(i) Monthly visits in accordance to 04/06/06 Regulation 26 must take place at home and a report of the findings must be sent to CSCI. Residents must be given a choice 04/06/06 of food that they are satisfied with. 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. Refer to Standard OP12 OP14 Good Practice Recommendations The home should provide a separate facility for hairdressing. Two signatures should be provided for all financial transactions made on behalf of residents. Heathfield Lodge DS0000005374.V290756.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Heathfield Lodge DS0000005374.V290756.R01.S.doc Version 5.1 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!